{"hospital_name": "Siouxland Surgery Center Limited Liability Partnership", "last_updated_on": "2026-04-07", "version": "3.0.0", "pid": "1549989107", "rid": "11224", "location_name": ["Dunes Surgical Hospital"], "hospital_address": ["600 N. Sioux Point Rd, Dakota Dunes, SD 57049"], "type_2_npi": ["1093714073"], "license_information": {"license_number": "10580", "state": "SD"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "1 EM CORE SESSION", "code_information": [{"code": "G9873", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1.0MM DRLL BIT*2312-", "code_information": [{"code": "3100210228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 386.16, "discounted_cash": 579.24, "setting": "both", "billing_class": "facility"}]}, {"description": "1.5M PR SUBDERMAL NE", "code_information": [{"code": "3480103016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.4, "discounted_cash": 9.6, "setting": "both", "billing_class": "facility"}]}, {"description": "1.5M SUBDERMAL NEEDL", "code_information": [{"code": "3480103017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.2, "discounted_cash": 4.8, "setting": "both", "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST/SBSQ PSYC COLLAB CARE", "code_information": [{"code": "99494", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 NO WL", "code_information": [{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 19-21 WL", "code_information": [{"code": "G9884", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 22-24 WL", "code_information": [{"code": "G9885", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2 STRIPER ACORN 2.8M", "code_information": [{"code": "3100204783", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.68, "discounted_cash": 62.52, "setting": "both", "billing_class": "facility"}]}, {"description": "2019 NON COV DIAGNOS", "code_information": [{"code": "U0001", "type": "HCPCS"}, {"code": "3440103092", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.03, "maximum": 137.74, "gross_charge": 142.0, "discounted_cash": 57.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 137.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 45.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 38.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D CEPHAL RADIO IMAGE", "code_information": [{"code": "D0702", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D CEPHALOMETRIC IMAGE", "code_information": [{"code": "D0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.78, "maximum": 179.78, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D ORAL/FACIAL PHOTO IMAGE", "code_information": [{"code": "D0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [{"code": "C8924", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90650", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "3-D RADIOTHERAPY PLAN", "code_information": [{"code": "77295", "type": "CPT"}], "standard_charges": [{"minimum": 2192.96, "maximum": 2192.96, "discounted_cash": 2120.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "3100205020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3100207029", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3100209022", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6603.87, "maximum": 9151.07, "gross_charge": 9434.1, "discounted_cash": 14151.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7547.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3D ECHO IMG CGEN CAR ANOMAL", "code_information": [{"code": "93319", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "3D GUIDE PIN*TG12-51", "code_information": [{"code": "3100210251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2601.43, "discounted_cash": 3902.15, "setting": "both", "billing_class": "facility"}]}, {"description": "4 EM CORE SESSIONS", "code_information": [{"code": "G9874", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "4.0X70MM CANN SCREW*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.06, "maximum": 873.08, "gross_charge": 900.09, "discounted_cash": 1350.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "4VHPV VACCINE 3 DOSE IM", "code_information": [{"code": "90649", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE IN LAC RINGERS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7121", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.54, "maximum": 4.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE/NORMAL SALINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7042", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.13, "maximum": 1.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "5% DEXTROSE/WATER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7060", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.8, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "9 EM CORE SESSIONS", "code_information": [{"code": "G9875", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "9VHPV VACCINE 2/3 DOSE IM", "code_information": [{"code": "90651", "type": "CPT"}], "standard_charges": [{"minimum": 229.62, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 229.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "A/D HALFWAY HOUSE, PER DIEM", "code_information": [{"code": "H2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER DIEM", "code_information": [{"code": "H2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "A/D TX PROGRAM, PER HOUR", "code_information": [{"code": "H2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.84, "maximum": 42.84, "discounted_cash": 69.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABCIXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 1407.86, "maximum": 1407.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1407.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABD BINDER LG62-74*9", "code_information": [{"code": "3100204874", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.36, "discounted_cash": 74.04, "setting": "both", "billing_class": "facility"}]}, {"description": "ABD HYSTERECTOMY", "code_information": [{"code": "58150", "type": "CPT"}, {"code": "3480102096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2127.3, "maximum": 8510.18, "gross_charge": 3039.0, "discounted_cash": 4558.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2947.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2431.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS", "code_information": [{"code": "49082", "type": "CPT"}], "standard_charges": [{"minimum": 1083.58, "maximum": 1083.58, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABD PARACENTESIS W I", "code_information": [{"code": "49083", "type": "CPT"}, {"code": "3480103322", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 925.01, "maximum": 2146.61, "gross_charge": 2213.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1881.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1659.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1549.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2146.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1549.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1659.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1881.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1770.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABDUCTION CENTRAL HI", "code_information": [{"code": "3100104127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2768.0, "discounted_cash": 4152.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABDUCTOR PILLOW", "code_information": [{"code": "3100100001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 255.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABG ARTERIAL PUNCTUR", "code_information": [{"code": "36600", "type": "CPT"}, {"code": "3310100265", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 130.2, "maximum": 300.38, "gross_charge": 186.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 180.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 148.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABL1 GENE", "code_information": [{"code": "81170", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 300.0, "discounted_cash": 481.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD", "code_information": [{"code": "33254", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA LMTD ENDO", "code_information": [{"code": "33265", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/BYPASS EXTEN", "code_information": [{"code": "33256", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA W/O BYPASS EXT", "code_information": [{"code": "33255", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE ATRIA X10SV ENDO", "code_information": [{"code": "33266", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20982", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE BONE TUMOR(S) PERQ", "code_information": [{"code": "20983", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33250", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", "code_information": [{"code": "32994", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ RF", "code_information": [{"code": "32998", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLATION MINERVA SYS", "code_information": [{"code": "3100202481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3016.0, "discounted_cash": 4524.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATION RF PROBE KI", "code_information": [{"code": "3100209886", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11852.7, "discounted_cash": 17779.05, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ARTHREX", "code_information": [{"code": "3100100002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ARTHREX", "code_information": [{"code": "3100102430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ASPIRATE 50*", "code_information": [{"code": "3100203857", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ASPIRATE SJ5", "code_information": [{"code": "3100206512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ASPIRATE XL*", "code_information": [{"code": "3100204748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR ASPIRATING X", "code_information": [{"code": "3100207643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLATOR COOLCUT", "code_information": [{"code": "3100100003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABLTJ B9 THYR NDUL PERQ LASR", "code_information": [{"code": "673T", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL BRST TUM PERQ CRTX", "code_information": [{"code": "581T", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ MAL PRST8 TISS HIFU", "code_information": [{"code": "55880", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 2242.36, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC PLEX/TRNCL NRV", "code_information": [{"code": "442T", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC UXTR/PERPH NRV", "code_information": [{"code": "440T", "type": "CPT"}], "standard_charges": [{"minimum": 2242.36, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP ABO 7 EXONS", "code_information": [{"code": "180U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABO GNOTYP NEXT GNRJ SEQ ABO", "code_information": [{"code": "221U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABOBOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0586", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.82, "maximum": 10.82, "discounted_cash": 14.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59840", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59841", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59850", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59852", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59855", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59856", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION (MPR)", "code_information": [{"code": "59866", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [{"code": "770", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3805.21, "maximum": 3805.21, "discounted_cash": 8917.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3805.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION WITHOUT D&C", "code_information": [{"code": "779", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3018.83, "maximum": 3018.83, "discounted_cash": 11043.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3018.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESION SINGLE", "code_information": [{"code": "15786", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABRASION LESIONS ADD-ON", "code_information": [{"code": "15787", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABUT CROWN PORC TO TITANIUM", "code_information": [{"code": "D6097", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUT RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6195", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT CROWN TITANIUM", "code_information": [{"code": "D6094", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUT SUPPORT RETAINER TITANI", "code_information": [{"code": "D6194", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT BA400 14MM*", "code_information": [{"code": "3100204517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5564.0, "discounted_cash": 8346.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED CROWN", "code_information": [{"code": "D6058", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6059", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6060", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6061", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6062", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6063", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED MTL CROWN", "code_information": [{"code": "D6064", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6068", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6069", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6070", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6071", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6072", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6073", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ABUTMENT SUPPORTED RETAINER", "code_information": [{"code": "D6074", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACAPELLA DH THERAPY", "code_information": [{"code": "3100100005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS NEEDLE NAV*PK", "code_information": [{"code": "3100209452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 879.0, "discounted_cash": 1318.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESS OF TRANSEP CYTOL SAMP", "code_information": [{"code": "D0486", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESS SHEATH PERC*B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 103.23, "maximum": 143.05, "gross_charge": 147.48, "discounted_cash": 221.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 125.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 103.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 143.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 103.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 125.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESS THORACIC LYMPH DUCT", "code_information": [{"code": "38794", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACCESSORY KIT", "code_information": [{"code": "3100104713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY KIT", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1366.47, "maximum": 1893.53, "gross_charge": 1952.1, "discounted_cash": 2928.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1659.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1464.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1366.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1893.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1366.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1464.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1659.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1561.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESSORY KIT*3550-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCESSORY KIT*3550-4", "code_information": [{"code": "3100204623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY KIT*355014", "code_information": [{"code": "3100202247", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY KIT*365538", "code_information": [{"code": "3100203222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY PKG W/O CA", "code_information": [{"code": "3100100006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1419.0, "discounted_cash": 2128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCESSORY PUMP KIT*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209647", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1516.78, "maximum": 2101.83, "gross_charge": 2166.84, "discounted_cash": 3250.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1841.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1625.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1516.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2101.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1516.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1625.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1841.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1733.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACCU-VU OMNI FLUSH*1", "code_information": [{"code": "3100205196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCUSTICK 21GX15*MAK", "code_information": [{"code": "3100206642", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.56, "discounted_cash": 318.84, "setting": "both", "billing_class": "facility"}]}, {"description": "ACCUSTICK II*M001207", "code_information": [{"code": "3100210044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ACESSO DL, PER SQ CM", "code_information": [{"code": "Q4293", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACESSO TL, PER SQ CM", "code_information": [{"code": "Q4300", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETAB LINER 28MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB LINER 32/54*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4924.5, "maximum": 6823.95, "gross_charge": 7035.0, "discounted_cash": 10552.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5979.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5276.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4924.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6823.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4924.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5276.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5979.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5628.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB LINER 32MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB LINER 32MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB LINER NEUT 36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB LOCK RING 54M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 190.4, "maximum": 263.84, "gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 263.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB LOCK RING 60M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 48MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4297.02, "maximum": 5954.44, "gross_charge": 6138.6, "discounted_cash": 9207.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5954.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4910.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 48MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5775.49, "maximum": 8003.18, "gross_charge": 8250.71, "discounted_cash": 12376.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8003.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6600.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 50MM*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 50MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3594.5, "maximum": 4980.95, "gross_charge": 5135.0, "discounted_cash": 7702.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4980.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 52MM*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 52MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4297.02, "maximum": 5954.44, "gross_charge": 6138.6, "discounted_cash": 9207.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5954.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4910.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 52MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5775.49, "maximum": 8003.18, "gross_charge": 8250.71, "discounted_cash": 12376.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8003.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6600.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 54MM*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202690", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 54MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4297.02, "maximum": 5954.44, "gross_charge": 6138.6, "discounted_cash": 9207.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5954.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4910.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 54MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5775.49, "maximum": 8003.18, "gross_charge": 8250.71, "discounted_cash": 12376.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8003.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6600.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 56MM*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 56MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5775.49, "maximum": 8003.18, "gross_charge": 8250.71, "discounted_cash": 12376.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8003.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5775.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6188.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7013.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6600.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 58MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4297.02, "maximum": 5954.44, "gross_charge": 6138.6, "discounted_cash": 9207.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5954.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4910.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 58MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3594.5, "maximum": 4980.95, "gross_charge": 5135.0, "discounted_cash": 7702.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4980.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 60MM*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 60MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4297.02, "maximum": 5954.44, "gross_charge": 6138.6, "discounted_cash": 9207.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5954.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4297.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4603.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5217.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4910.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 60MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207947", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5270.72, "maximum": 7303.71, "gross_charge": 7529.6, "discounted_cash": 11294.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6400.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5647.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5270.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7303.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5270.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5647.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6400.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6023.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 60MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3594.5, "maximum": 4980.95, "gross_charge": 5135.0, "discounted_cash": 7702.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4980.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 62MM*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB SHELL 64MM*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3594.5, "maximum": 4980.95, "gross_charge": 5135.0, "discounted_cash": 7702.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4980.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3594.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3851.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4364.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB WEDGE 15MM*50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3764.34, "maximum": 5216.3, "gross_charge": 5377.63, "discounted_cash": 8066.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4570.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4033.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3764.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5216.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3764.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4033.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4570.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4302.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB WEDGE 15MM*50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3764.34, "maximum": 5216.3, "gross_charge": 5377.63, "discounted_cash": 8066.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4570.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4033.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3764.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5216.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3764.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4033.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4570.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4302.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAB WEDGE 15MM*50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3762.24, "maximum": 5213.39, "gross_charge": 5374.63, "discounted_cash": 8061.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4568.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4030.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3762.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5213.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3762.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4030.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4568.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4299.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULA AUGMENT ME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4695.6, "maximum": 6506.76, "gross_charge": 6708.0, "discounted_cash": 10062.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5701.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5031.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4695.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6506.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4695.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5031.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5701.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5366.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULA SHELL CLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP 40*RH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP 42MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.92, "maximum": 2023.03, "gross_charge": 2085.6, "discounted_cash": 3128.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1564.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2023.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1564.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP 54*RH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR CUP DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2116.8, "maximum": 2933.28, "gross_charge": 3024.0, "discounted_cash": 4536.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2570.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2268.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2116.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2933.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2116.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2268.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2570.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2419.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR HIP SYS T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER 32*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1632.68, "maximum": 2262.42, "gross_charge": 2332.4, "discounted_cash": 3498.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1982.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1632.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2262.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1632.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1982.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER 32M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER 32M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER 36M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6777.68, "maximum": 9391.92, "gross_charge": 9682.4, "discounted_cash": 14523.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8230.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7261.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6777.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9391.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6777.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7261.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8230.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7745.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER 36M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER 36M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER BI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4065.6, "maximum": 5633.76, "gross_charge": 5808.0, "discounted_cash": 8712.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4936.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4356.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4065.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5633.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4065.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4356.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4936.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4646.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER DEP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5767.3, "maximum": 7991.83, "gross_charge": 8239.0, "discounted_cash": 12358.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7003.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6179.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5767.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7991.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5767.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6179.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7003.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6591.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER*122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER*122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207690", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER*122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LINER*122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR LOCK RING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 277.2, "maximum": 384.12, "gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 384.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 316.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4814.6, "maximum": 6671.66, "gross_charge": 6878.0, "discounted_cash": 10317.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5846.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5158.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4814.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6671.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4814.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5158.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5846.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5502.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL 50*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL 56*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL 58M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL 62M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL SEC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207689", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETABULAR SHELL SEC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN", "code_information": [{"code": "82003", "type": "CPT"}, {"code": "3440100840", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 127.4, "maximum": 176.54, "gross_charge": 182.0, "discounted_cash": 273.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 154.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 136.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 127.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 176.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 127.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 136.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 154.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAMINOPHEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0131", "type": "HCPCS"}, {"code": "3400300240", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.05, "maximum": 32.78, "gross_charge": 33.8, "discounted_cash": 50.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETAZOLAMID SODIUM INJECTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1120", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.23, "maximum": 26.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETBULAR SHELL 55M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLINESTERASE ASSAY", "code_information": [{"code": "82013", "type": "CPT"}], "standard_charges": [{"minimum": 12.29, "maximum": 40.05, "discounted_cash": 19.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BLCKG ANTB", "code_information": [{"code": "86042", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "discounted_cash": 29.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR BNDNG ANTB", "code_information": [{"code": "86041", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "discounted_cash": 29.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCHOLN RCPTR MODLG ANTB", "code_information": [{"code": "86043", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 12.05, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7604", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0132", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.77, "maximum": 0.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACETYLCYSTEINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7608", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.36, "maximum": 9.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACHILL SPDBRIDGE*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5341.59, "maximum": 7401.92, "gross_charge": 7630.85, "discounted_cash": 11446.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6486.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5723.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5341.59, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7401.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5341.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5723.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6486.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6104.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACID PERFUSION OF ESOPHAGUS", "code_information": [{"code": "91030", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACNE SURGERY", "code_information": [{"code": "10040", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC IMMITANCE TESTING", "code_information": [{"code": "92570", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACOUSTIC REFL THRESHOLD TST", "code_information": [{"code": "92568", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTH", "code_information": [{"code": "82024", "type": "CPT"}, {"code": "3440100843", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 38.62, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 62.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 49.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 41.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80400", "type": "CPT"}], "standard_charges": [{"minimum": 32.62, "maximum": 68.09, "discounted_cash": 52.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80402", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 86.96, "discounted_cash": 139.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 86.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTH STIMULATION PANEL", "code_information": [{"code": "80406", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 78.26, "discounted_cash": 125.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTIGRAPHY TESTING", "code_information": [{"code": "95803", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTIN ANTIBODY EACH", "code_information": [{"code": "86015", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACTIVATE MATRIX, PER SQ CM", "code_information": [{"code": "Q4301", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ACTIVE CORD*M0056127", "code_information": [{"code": "3100203685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 287.04, "discounted_cash": 430.56, "setting": "both", "billing_class": "facility"}]}, {"description": "ACTIVITY THERAPY, PER 15 MIN", "code_information": [{"code": "H2032", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL 15 MIN", "code_information": [{"code": "97810", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/O STIMUL ADDL 15M", "code_information": [{"code": "97811", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL 15 MIN", "code_information": [{"code": "97813", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUPUNCT W/STIMUL ADDL 15M", "code_information": [{"code": "97814", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [{"code": "880", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3339.16, "maximum": 3339.16, "discounted_cash": 10657.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3339.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [{"code": "289", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8843.77, "maximum": 8843.77, "discounted_cash": 16497.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8843.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [{"code": "288", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11660.94, "maximum": 11660.94, "discounted_cash": 28949.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11660.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [{"code": "290", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6295.29, "maximum": 6295.29, "discounted_cash": 11445.92, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6295.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE GI BLOOD LOSS IMAGING", "code_information": [{"code": "78278", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE HEPATITIS PANE", "code_information": [{"code": "80074", "type": "CPT"}, {"code": "3440100799", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 42.72, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 76.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 60.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 51.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "835", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16865.51, "maximum": 16865.51, "discounted_cash": 24958.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16865.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "834", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38298.62, "maximum": 38298.62, "discounted_cash": 62510.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38298.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "836", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7192.94, "maximum": 7192.94, "discounted_cash": 13367.34, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7192.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [{"code": "121", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5054.55, "maximum": 5054.55, "discounted_cash": 14304.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5054.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "122", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3265.38, "maximum": 3265.38, "discounted_cash": 8312.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3265.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [{"code": "281", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4721.31, "maximum": 4721.31, "discounted_cash": 10193.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4721.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [{"code": "280", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8184.06, "maximum": 8184.06, "discounted_cash": 17712.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8184.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [{"code": "282", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3896.2, "maximum": 3896.2, "discounted_cash": 8017.28, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3896.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [{"code": "284", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4514.11, "maximum": 4514.11, "discounted_cash": 8258.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4514.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [{"code": "283", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6804.37, "maximum": 6804.37, "discounted_cash": 22009.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6804.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [{"code": "285", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3052.04, "maximum": 3052.04, "discounted_cash": 5456.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3052.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACUTE VENOUS THROMBUS IMAGE", "code_information": [{"code": "78456", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACYCLOVIR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0133", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUAL", "code_information": [{"code": "82016", "type": "CPT"}], "standard_charges": [{"minimum": 16.49, "maximum": 40.05, "discounted_cash": 26.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ACYLCARNITINES QUANT", "code_information": [{"code": "82017", "type": "CPT"}], "standard_charges": [{"minimum": 16.87, "maximum": 40.05, "discounted_cash": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADALIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0135", "type": "HCPCS"}], "standard_charges": [{"minimum": 676.39, "maximum": 676.39, "discounted_cash": 2947.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 676.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPT BEHAVIOR TX PHYS/QHP", "code_information": [{"code": "97155", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADAPT BHV TX EA 15 MIN", "code_information": [{"code": "373T", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADAPTER CART THREAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 61.6, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER CATH URO BAL", "code_information": [{"code": "3100100012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER CAUTERY", "code_information": [{"code": "3100100013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 219.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER FEM BOLT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER FEMORAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3894.1, "maximum": 5396.11, "gross_charge": 5563.0, "discounted_cash": 8344.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4728.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4172.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3894.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5396.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3894.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4172.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4728.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4450.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER HIP NECK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 512.4, "maximum": 710.04, "gross_charge": 732.0, "discounted_cash": 1098.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 622.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 549.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 512.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 710.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 512.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 549.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 622.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 585.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER LPS FEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1073.1, "maximum": 1487.01, "gross_charge": 1533.0, "discounted_cash": 2299.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1303.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1149.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1073.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1487.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1073.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1149.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1303.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1226.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER M8*DB-9218-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER MDI INLINE", "code_information": [{"code": "3100100014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER NEUROSIM", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100102120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER REV HEMI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3271.1, "maximum": 4532.81, "gross_charge": 4673.0, "discounted_cash": 7009.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3972.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3504.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3271.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4532.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3271.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3504.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3972.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3738.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER STANDARD COM", "code_information": [{"code": "3100100015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER STRYKER OFFS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2094.4, "maximum": 2902.24, "gross_charge": 2992.0, "discounted_cash": 4488.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2543.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2244.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2902.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2244.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2543.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER TAPER 25M*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER TAPER*650-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER TAPER*650-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER TAPER*650-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTER TRIMANO", "code_information": [{"code": "3100100017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTER Y BOSTON SCI", "code_information": [{"code": "3100102121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 129.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTIS TALAR*336800", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9660.0, "maximum": 13386.0, "gross_charge": 13800.0, "discounted_cash": 20700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13386.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTIVE BEHAVIOR TX BY TECH", "code_information": [{"code": "97153", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADAPTOR HEMI-PROTH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5700.1, "maximum": 7898.71, "gross_charge": 8143.0, "discounted_cash": 12214.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6921.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6107.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5700.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7898.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5700.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6107.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6921.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6514.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTOR OFFSET W SCR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1979.25, "maximum": 2742.67, "gross_charge": 2827.5, "discounted_cash": 4241.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2403.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2120.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2742.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2120.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2403.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2262.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTOR POCKET MEDTR", "code_information": [{"code": "3100100019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2772.0, "discounted_cash": 4158.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADAPTOR TAPER 25MM*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 517.65, "maximum": 717.31, "gross_charge": 739.5, "discounted_cash": 1109.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 628.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 554.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 517.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 717.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 517.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 554.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 628.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 591.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADAPTOR Y SEAL*BPS-Y", "code_information": [{"code": "3100210213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.28, "discounted_cash": 112.92, "setting": "both", "billing_class": "facility"}]}, {"description": "ADATOR 8 CHANNEL*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2966.6, "maximum": 4110.86, "gross_charge": 4238.0, "discounted_cash": 6357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4110.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADD 30 MINS COUNSEL", "code_information": [{"code": "G2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADD CLASP TO PARTIAL DENTURE", "code_information": [{"code": "D5660", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADD METAL SUB TO ACRYLC DENT", "code_information": [{"code": "D5876", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADD PROC CONSTRUCT NEW CROWN", "code_information": [{"code": "D2971", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADD SPINAL FUSION AN", "code_information": [{"code": "22585", "type": "CPT"}, {"code": "3480101501", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 564.9, "maximum": 7959.27, "gross_charge": 807.0, "discounted_cash": 1210.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 685.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 605.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 564.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 782.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 564.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 605.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 685.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 645.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADD TOOTH TO PARTIAL DENTURE", "code_information": [{"code": "D5650", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITION OF WALKER TO CAST", "code_information": [{"code": "29440", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADDITIONAL LEVEL INS", "code_information": [{"code": "3100209156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADDITIVE FOR ENTERAL FORMULA", "code_information": [{"code": "B4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY, PRIMA", "code_information": [{"code": "42830", "type": "CPT"}, {"code": "3480101934", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY, PRIMA", "code_information": [{"code": "42831", "type": "CPT"}, {"code": "3480101935", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOIDECTOMY, SECON", "code_information": [{"code": "42835", "type": "CPT"}, {"code": "3480101936", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7332.23, "gross_charge": 7559.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7332.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6047.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOSINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0153", "type": "HCPCS"}, {"code": "3400300148", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.56, "maximum": 0.56, "gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IA", "code_information": [{"code": "87301", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS AG IF", "code_information": [{"code": "87260", "type": "CPT"}], "standard_charges": [{"minimum": 14.43, "maximum": 24.03, "discounted_cash": 23.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ANTIBODY", "code_information": [{"code": "86603", "type": "CPT"}], "standard_charges": [{"minimum": 12.87, "maximum": 30.26, "discounted_cash": 20.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS ASSAY W/OPTIC", "code_information": [{"code": "87809", "type": "CPT"}], "standard_charges": [{"minimum": 21.76, "maximum": 24.03, "discounted_cash": 34.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 4", "code_information": [{"code": "90476", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "discounted_cash": 73.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADENOVIRUS VACCINE TYPE 7", "code_information": [{"code": "90477", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJ TISS TRF OTHER 1", "code_information": [{"code": "14041", "type": "CPT"}, {"code": "3480101365", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJ TISS TRF OTHER <", "code_information": [{"code": "14060", "type": "CPT"}, {"code": "3480101366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4528.93, "gross_charge": 4669.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3968.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3501.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3268.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4528.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3268.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3501.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3968.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3735.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJ TISS TRF OTHR 10", "code_information": [{"code": "14040", "type": "CPT"}, {"code": "3480101364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJ TISSUE TRF, HEAD", "code_information": [{"code": "14020", "type": "CPT"}, {"code": "3480101363", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJACENT TISSUE TRAN", "code_information": [{"code": "14001", "type": "CPT"}, {"code": "3480103095", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4655.03, "gross_charge": 4799.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4079.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3599.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3359.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4655.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3359.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3599.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4079.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3839.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJMT/REVJ EXT FIXJ SYS ANES", "code_information": [{"code": "20693", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2895.17, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJUNCTIVE PROCEDURE", "code_information": [{"code": "D9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADJUST MAX PROST APPLIANCE", "code_information": [{"code": "D5992", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM IV CHEMO 1ST HOME VISIT", "code_information": [{"code": "G0090", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM IV DRUG 1ST HOME VISIT", "code_information": [{"code": "G0088", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM IV INFUSION DRUG IN HOME", "code_information": [{"code": "G0068", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM OF CHEMO DRUG IN HOME", "code_information": [{"code": "G0070", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM SQ INFUSION DRUG IN HOME", "code_information": [{"code": "G0069", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM SUBQ DRUG 1ST HOME VISIT", "code_information": [{"code": "G0089", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 1ST", "code_information": [{"code": "M0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 450.0, "discounted_cash": 723.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADM TOCILIZU COVID-19 2ND", "code_information": [{"code": "M0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 450.0, "discounted_cash": 723.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADMIN ECG CONTRAST AGENT", "code_information": [{"code": "93352", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADMIN HEPATITIS B VACCINE", "code_information": [{"code": "G0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADMIN INFLUENZA VACC", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "3340100593", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 119.31, "gross_charge": 123.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 119.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADMIN PNEUMONIA VACC", "code_information": [{"code": "G0009", "type": "HCPCS"}, {"code": "3340100594", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 119.31, "gross_charge": 123.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 119.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADOPTIVE IMMUNOTHERAPY", "code_information": [{"code": "S2107", "type": "HCPCS"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADPTER CHANNEL CLEAN", "code_information": [{"code": "3100104718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [{"code": "614", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15792.63, "maximum": 15792.63, "discounted_cash": 25147.07, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15792.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "615", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9485.66, "maximum": 9485.66, "discounted_cash": 16424.19, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9485.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADRENAL CORTEX & MEDULLA IMG", "code_information": [{"code": "78075", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRENAL TISSUE TRANSPLANT", "code_information": [{"code": "S2103", "type": "HCPCS"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADRNL CORTCL TUM BCHM ASY 25", "code_information": [{"code": "15M", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2097.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADTL NECK SPINE FUSI", "code_information": [{"code": "22552", "type": "CPT"}, {"code": "3480101497", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 667.8, "maximum": 7959.27, "gross_charge": 954.0, "discounted_cash": 1431.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 810.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 925.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 810.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 763.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADULT SPEECH AID", "code_information": [{"code": "D5953", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADVANTAGE FIT*M00685", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2118.51, "maximum": 2935.65, "gross_charge": 3026.45, "discounted_cash": 4539.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2572.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2269.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2118.51, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2935.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2118.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2269.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2572.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2421.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN 30 MIN", "code_information": [{"code": "99497", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ADVNCD CARE PLAN ADDL 30 MIN", "code_information": [{"code": "99498", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AEP HEARING STATUS DETER I&R", "code_information": [{"code": "92651", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AEP NEURODIAGNOSTIC I&R", "code_information": [{"code": "92653", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AEP SCR AUDITORY POTENTIAL", "code_information": [{"code": "92650", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AEROSOL INHALATION TREATMENT", "code_information": [{"code": "94642", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 326.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFAMELANOTIDE IMPLANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7352", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 4616.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81171", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFF2 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81172", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFFINITY1 SQUARE CM", "code_information": [{"code": "Q4159", "type": "HCPCS"}], "standard_charges": [{"minimum": 309.58, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 309.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFLIBERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0178", "type": "HCPCS"}], "standard_charges": [{"minimum": 841.13, "maximum": 841.13, "discounted_cash": 1385.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 841.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFLURIA VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2035", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFO PLASTIC", "code_information": [{"code": "L1930", "type": "HCPCS"}, {"code": "3100100020", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 419.3, "maximum": 581.03, "gross_charge": 599.0, "discounted_cash": 898.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 509.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 449.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 419.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 581.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 419.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 449.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 509.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 479.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFP AMNIOTIC FLUID", "code_information": [{"code": "82106", "type": "CPT"}, {"code": "3440100853", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.0, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 27.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFP L3 FRACTN ISOFOR", "code_information": [{"code": "82107", "type": "CPT"}, {"code": "3440100854", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 53.85, "maximum": 545.14, "gross_charge": 562.0, "discounted_cash": 103.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 477.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 70.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 82.09, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 477.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 449.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 68.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 70.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFP SERUM", "code_information": [{"code": "82105", "type": "CPT"}, {"code": "3440100852", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.77, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 26.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITH CC/MCC", "code_information": [{"code": "949", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13567.54, "maximum": 13567.54, "discounted_cash": 11567.61, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13567.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE WITHOUT CC/MCC", "code_information": [{"code": "950", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3910.34, "maximum": 3910.34, "discounted_cash": 7013.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3910.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "560", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9235.42, "maximum": 9235.42, "discounted_cash": 12639.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9235.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "559", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9235.42, "maximum": 9235.42, "discounted_cash": 20660.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9235.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "561", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4017.94, "maximum": 4017.94, "discounted_cash": 8710.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4017.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AG DETECTION POLYVAL", "code_information": [{"code": "87300", "type": "CPT"}, {"code": "3480103082", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 55.29, "gross_charge": 57.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 48.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 42.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 39.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 55.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 39.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 42.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 48.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 45.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AGALSIDASE BETA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 218.28, "maximum": 218.28, "discounted_cash": 350.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 218.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGEE DIGIT WIDGET", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3100102122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AGGLUTININS FEBRILE", "code_information": [{"code": "86000", "type": "CPT"}, {"code": "3440101057", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.98, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 11.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.48, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.48, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AGRIFLU VACCINE", "code_information": [{"code": "Q2034", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AI IBD MRNA XPRSN PRFL 17", "code_information": [{"code": "203U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AI PSOR MRNA 50-100 GEN ALG", "code_information": [{"code": "258U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 5903.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AI SLE IGG&IGM ALYS 80 BMRK", "code_information": [{"code": "62U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 611.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AICD GENERATOR PROCEDURES", "code_information": [{"code": "245", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27643.55, "maximum": 27643.55, "discounted_cash": 50591.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27643.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AICD LEAD PROCEDURES", "code_information": [{"code": "265", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18598.11, "maximum": 18598.11, "discounted_cash": 39456.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18598.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AIMING GUIDE LT*AR-8", "code_information": [{"code": "3100204346", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIMING GUIDE LT*AR-8", "code_information": [{"code": "3100204544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIR INJECTION INTO ABDOMEN", "code_information": [{"code": "49400", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AIRWAY E/T", "code_information": [{"code": "3100100021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.6, "discounted_cash": 9.9, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T ENDOTROL", "code_information": [{"code": "3100100022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T ENDOTROL", "code_information": [{"code": "3100104446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL", "code_information": [{"code": "3100100023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL", "code_information": [{"code": "3100102433", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL RAE", "code_information": [{"code": "3100100024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL RAE", "code_information": [{"code": "3100100025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 16.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL UNC", "code_information": [{"code": "3100100026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 16.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL/ORA", "code_information": [{"code": "3100100027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL/ORA", "code_information": [{"code": "3100104434", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NASAL/ORA", "code_information": [{"code": "3100104438", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T NIM/EMG", "code_information": [{"code": "3100100028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 942.0, "discounted_cash": 1413.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T ORAL", "code_information": [{"code": "3100100029", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T ORAL UNCU", "code_information": [{"code": "3100100030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.0, "discounted_cash": 16.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY E/T REINFORCE", "code_information": [{"code": "3100100031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY EAR REUTER BO", "code_information": [{"code": "3100100032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ENDO NIM 7MM*", "code_information": [{"code": "3100206876", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 966.6, "discounted_cash": 1449.9, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ENDO TRACH", "code_information": [{"code": "3100104343", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 939.0, "discounted_cash": 1408.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ENDO TRACH", "code_information": [{"code": "3100104394", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 358.0, "discounted_cash": 537.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY ENDO TRACHEAL", "code_information": [{"code": "3100100033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.6, "discounted_cash": 9.9, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MLT ENDO 5.0*", "code_information": [{"code": "3100203510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.16, "discounted_cash": 31.74, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY MLT ENDO 6.0*", "code_information": [{"code": "3100203511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.16, "discounted_cash": 31.74, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY NASOPHARN", "code_information": [{"code": "3100100034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.6, "discounted_cash": 11.4, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PAPARELLA", "code_information": [{"code": "3100100035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 112.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY PRESSURE EZPA", "code_information": [{"code": "3100100036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 154.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SUPRA SZ2*KLT", "code_information": [{"code": "3100207741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 171.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SUPRA SZ3*KLT", "code_information": [{"code": "3100203945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.04, "discounted_cash": 193.56, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SUPRA SZ4*KLT", "code_information": [{"code": "3100205170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.52, "discounted_cash": 156.78, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SUPRAGLOT KIN", "code_information": [{"code": "3100100037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 346.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY SUPRAGLOT KIN", "code_information": [{"code": "3100104406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY T-TUBE RICHAR", "code_information": [{"code": "3100100040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 124.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY T-TUBE ULTRAS", "code_information": [{"code": "3100100041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 129.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACH", "code_information": [{"code": "3100104722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 211.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACH PED", "code_information": [{"code": "3100102296", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 814.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACH TUBE", "code_information": [{"code": "3100103944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACHEOSTOMY", "code_information": [{"code": "3100100038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 340.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACHEOSTOMY", "code_information": [{"code": "3100100039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 159.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACHEOSTOMY", "code_information": [{"code": "3100102434", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWAY TRACHEOSTOMY", "code_information": [{"code": "3100104403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 376.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AIRWY RESIST BY OSCILLOMETRY", "code_information": [{"code": "94728", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALANINE AMINO ALT SG", "code_information": [{"code": "84460", "type": "CPT"}, {"code": "3440101004", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.3, "maximum": 44.62, "gross_charge": 46.0, "discounted_cash": 8.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALATROFLOXACIN MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0200", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.51, "maximum": 17.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 20 ML", "code_information": [{"code": "P9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 34.11, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 25%, 50ML", "code_information": [{"code": "P9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 85.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN), 5%, 250 ML", "code_information": [{"code": "P9045", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 85.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN (HUMAN),5%, 50ML", "code_information": [{"code": "P9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 17.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN ISCHEMIA MODIFIED", "code_information": [{"code": "82045", "type": "CPT"}], "standard_charges": [{"minimum": 33.94, "maximum": 53.85, "discounted_cash": 54.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN SER PLASMA/W", "code_information": [{"code": "82040", "type": "CPT"}, {"code": "3440100844", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.95, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 7.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN URINE MICRO", "code_information": [{"code": "82043", "type": "CPT"}, {"code": "3440100846", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.78, "maximum": 47.53, "gross_charge": 49.0, "discounted_cash": 9.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUMIN URINE/OTHER", "code_information": [{"code": "82042", "type": "CPT"}, {"code": "3440100845", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.78, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 12.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.33, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7610", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL IPRATROP NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7620", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.2, "maximum": 0.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7611", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.16, "maximum": 0.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7613", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL SULFATE", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300065", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"minimum": 4.27, "maximum": 5.91, "gross_charge": 6.1, "discounted_cash": 9.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}, {"code": "3400300245", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.1, "maximum": 17.84, "gross_charge": 18.4, "discounted_cash": 27.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALBUTEROL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7609", "type": "HCPCS"}, {"code": "3400300246", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.1, "maximum": 17.84, "gross_charge": 18.4, "discounted_cash": 27.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG ASSESS", "code_information": [{"code": "H0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG INTERVEN", "code_information": [{"code": "H0022", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SCREENIN", "code_information": [{"code": "H0003", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0004", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0005", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.55, "maximum": 84.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0006", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0007", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0008", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0009", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0010", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0011", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0012", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0014", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0015", "type": "HCPCS"}], "standard_charges": [{"minimum": 524.66, "maximum": 524.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 524.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0017", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0018", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0019", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL AND/OR DRUG SERVICES", "code_information": [{"code": "H0020", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [{"code": "895", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6209.82, "maximum": 6209.82, "discounted_cash": 17961.56, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6209.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [{"code": "896", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7507.74, "maximum": 7507.74, "discounted_cash": 19851.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7507.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [{"code": "897", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4296.46, "maximum": 4296.46, "discounted_cash": 9552.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4296.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [{"code": "894", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2811.02, "maximum": 2811.02, "discounted_cash": 6414.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2811.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG ABUSE SVC NOS", "code_information": [{"code": "H0047", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SCREENING", "code_information": [{"code": "H0049", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/DRUG SERVICE 15 MIN", "code_information": [{"code": "H0050", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUB MISUSE ASSESS", "code_information": [{"code": "G2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV 15-30MN", "code_information": [{"code": "G0396", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBS INTERV >30 MIN", "code_information": [{"code": "G0397", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOL/SUBSTANCE ABUSE SKIL", "code_information": [{"code": "T1012", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 1OR 2", "code_information": [{"code": "80321", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BIOMARKERS 3/MORE", "code_information": [{"code": "80322", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALCOHOLS BLOOD/SERUM", "code_information": [{"code": "80320", "type": "CPT"}, {"code": "3440103061", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALDESLEUKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9015", "type": "HCPCS"}], "standard_charges": [{"minimum": 3681.13, "maximum": 3681.13, "discounted_cash": 6334.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3681.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALDOLASE", "code_information": [{"code": "82085", "type": "CPT"}, {"code": "3440100848", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.71, "maximum": 82.45, "gross_charge": 85.0, "discounted_cash": 15.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 72.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 72.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE", "code_information": [{"code": "82088", "type": "CPT"}, {"code": "3440100849", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 40.75, "maximum": 355.02, "gross_charge": 366.0, "discounted_cash": 65.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 311.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 274.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 256.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 355.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 256.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 274.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 51.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 311.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 292.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 43.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALDOSTERONE SUPPRESSION EVAL", "code_information": [{"code": "80408", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 125.5, "discounted_cash": 201.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 125.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALEFACEPT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0215", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0205", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALGLUCOSIDASE ALFA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0220", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 239.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALIF 10MM 28X28X7*80", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIF 14MM 12 DEG *AL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIF 14X30X14*AX1430", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIF 14X30X20*AX1430", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIF 14X36X20*AX1436", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIF 16X36X20*AX1636", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIF 24X30X13*2013-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8246.7, "maximum": 11427.57, "gross_charge": 11781.0, "discounted_cash": 17671.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10013.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8835.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8246.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11427.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8246.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8835.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10013.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9424.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIGN RAD HEAD 22M*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4277.0, "maximum": 5926.7, "gross_charge": 6110.0, "discounted_cash": 9165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5926.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIGN RAD HEAD/SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4277.0, "maximum": 5926.7, "gross_charge": 6110.0, "discounted_cash": 9165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5926.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIGN RAD STEM 7MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIGN RAD STEM 8X10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIGN RADIAL STEM*AL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALIGNMENT GUIDE*PROP", "code_information": [{"code": "3100208159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3517.8, "discounted_cash": 5276.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ALKALOIDS NOS", "code_information": [{"code": "80323", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT 29*4254", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT 32*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALL POLY PAT 35*4254", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IG", "code_information": [{"code": "86003", "type": "CPT"}, {"code": "3440101058", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 5.22, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 8.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGEN SPECIFIC IGG", "code_information": [{"code": "86001", "type": "CPT"}], "standard_charges": [{"minimum": 7.82, "maximum": 30.26, "discounted_cash": 12.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITH MCC", "code_information": [{"code": "915", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6947.01, "maximum": 6947.01, "discounted_cash": 19805.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6947.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [{"code": "916", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3302.89, "maximum": 3302.89, "discounted_cash": 7355.22, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3302.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLERGY PATCH TESTS", "code_information": [{"code": "95044", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLEVYN NON-ADH", "code_information": [{"code": "3100104140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLEVYN NON-ADH 2X2I", "code_information": [{"code": "3100210130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLEVYN NON-ADHESIVE", "code_information": [{"code": "3100100042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE MULTIALLG SCR", "code_information": [{"code": "86005", "type": "CPT"}], "standard_charges": [{"minimum": 7.97, "maximum": 30.26, "discounted_cash": 12.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLG SPEC IGE RECOMB EA", "code_information": [{"code": "86008", "type": "CPT"}], "standard_charges": [{"minimum": 17.93, "maximum": 30.26, "discounted_cash": 28.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29867", "type": "CPT"}], "standard_charges": [{"minimum": 7500.92, "maximum": 7500.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLO PLUG SLEEVE*AR-", "code_information": [{"code": "3100203425", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLO PLUG SLEEVE*AR-", "code_information": [{"code": "3100203426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLO PLUG SLEEVE*AR-", "code_information": [{"code": "3100203427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLODERM 16X20*15183", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12062.4, "maximum": 16715.04, "gross_charge": 17232.0, "discounted_cash": 25848.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14647.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12924.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12062.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16715.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12062.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12924.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13785.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM 4 X 16 THIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2968.42, "maximum": 4113.38, "gross_charge": 4240.6, "discounted_cash": 6360.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3604.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3180.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2968.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4113.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2968.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3180.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3604.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3392.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM CONTOUR MD", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100104100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 11443.0, "discounted_cash": 17164.5, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM MATRIX 16X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12062.4, "maximum": 16715.04, "gross_charge": 17232.0, "discounted_cash": 25848.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14647.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12924.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12062.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16715.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12062.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12924.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13785.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM MATRIX 16X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12427.07, "maximum": 17220.37, "gross_charge": 17752.96, "discounted_cash": 26629.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15090.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13314.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12427.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17220.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12427.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13314.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15090.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14202.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM MATRIX 2 X", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100202337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 1329.0, "discounted_cash": 1993.5, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM MATRIX 4X7C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2338.7, "maximum": 3240.77, "gross_charge": 3341.0, "discounted_cash": 5011.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2839.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2505.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2338.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3240.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2338.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2505.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2839.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2672.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100100043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 10792.0, "discounted_cash": 16188.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100102435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 4514.0, "discounted_cash": 6771.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100102436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100102437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 5785.0, "discounted_cash": 8677.5, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100102438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLODERM PER SQ CM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100102439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOGEN LIQUID 2ML*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5092.36, "maximum": 7056.55, "gross_charge": 7274.8, "discounted_cash": 10912.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6183.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5456.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5092.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7056.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5092.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5456.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6183.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5819.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGEN, PER CC", "code_information": [{"code": "Q4212", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [{"code": "14", "type": "MS-DRG"}], "standard_charges": [{"minimum": 86116.72, "maximum": 86116.72, "discounted_cash": 127955.96, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 86116.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT CANC BONE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 1725.27, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT CANC BONE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 821.1, "maximum": 1725.27, "gross_charge": 1173.0, "discounted_cash": 1759.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 997.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1137.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 997.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT DERMIS 16X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10124.08, "maximum": 14029.09, "gross_charge": 14462.98, "discounted_cash": 21694.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12293.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10847.23, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10124.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14029.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10124.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10847.23, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12293.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11570.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOGRAFT OAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10045.0, "maximum": 13919.5, "gross_charge": 14350.0, "discounted_cash": 21525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12197.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10762.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10045.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13919.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10045.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10762.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12197.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4115", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.13, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN", "code_information": [{"code": "Q4123", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.6, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOSKIN AC, 1 CM", "code_information": [{"code": "Q4141", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.35, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC DBM 10CC*AB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC DBM 5CC*ABS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 1901.2, "gross_charge": 1960.0, "discounted_cash": 2940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1901.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC EXP 1CC*ABS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC EXP 2.5CC*A", "code_information": [{"code": "3100205811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ALLOSYNC EXP*ABS-201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC EXP*ABS-201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1783.6, "maximum": 2471.56, "gross_charge": 2548.0, "discounted_cash": 3822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1783.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2471.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1783.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2038.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC PURE 1CC*AB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC PURE 5CC*AB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1820.0, "maximum": 2522.0, "gross_charge": 2600.0, "discounted_cash": 3900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2210.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2522.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2210.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC PURE 5CC*AB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3185.0, "maximum": 4413.5, "gross_charge": 4550.0, "discounted_cash": 6825.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4413.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC WEDGE*ABS-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOSYNC WEDGE*ABS-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALLOWRAP DS OR DRY 1 SQ CM", "code_information": [{"code": "Q4150", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 ANTITRYPSIN", "code_information": [{"code": "82103", "type": "CPT"}, {"code": "3440100850", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.44, "maximum": 140.65, "gross_charge": 145.0, "discounted_cash": 21.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 123.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 140.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 123.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALPHA 1 PROTEINASE INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0256", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.91, "maximum": 4.91, "discounted_cash": 7.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPHA-1-ANTITRYPSIN", "code_information": [{"code": "82104", "type": "CPT"}, {"code": "3440100851", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.46, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 23.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL FOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.8, "maximum": 6.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALPROSTADIL URETHRAL SUPPOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0275", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ALTEPLASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2997", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.82, "maximum": 88.82, "discounted_cash": 142.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 88.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTRX LINER 43*12212", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTRX LINER*1221-28-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALTUVIIIO PER FACTOR VIII IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7214", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.63, "maximum": 4.63, "discounted_cash": 7.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ALUMINUM", "code_information": [{"code": "82108", "type": "CPT"}, {"code": "3440100855", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.03, "maximum": 222.13, "gross_charge": 229.0, "discounted_cash": 40.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 194.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 171.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 222.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 160.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 171.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 194.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 183.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY NOT W/EXTRACTS", "code_information": [{"code": "D7321", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY W/EXTRACT 1-3", "code_information": [{"code": "D7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOLOPLASTY, EACH", "code_information": [{"code": "41874", "type": "CPT"}, {"code": "3480101913", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOLUS CLSD REDUC STBLZ TE", "code_information": [{"code": "D7771", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOLUS OPEN REDUCTION", "code_information": [{"code": "D7671", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/ EXTRACTION", "code_information": [{"code": "D7310", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALVEOPLASTY W/O EXTRACTION", "code_information": [{"code": "D7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG 15 MIN", "code_information": [{"code": "95983", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALYS BRN NPGT PRGRMG ADDL 15", "code_information": [{"code": "95984", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX CN NPGT PRGRMG", "code_information": [{"code": "95977", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALYS CPLX SP/PN NPGT W/PRGRM", "code_information": [{"code": "95972", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ALYS SMPL CN NPGT PRGRMG", "code_information": [{"code": "95976", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMALGAM 4 OR > SURFACES PERM", "code_information": [{"code": "D2161", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMALGAM ONE SURFACE PERMANEN", "code_information": [{"code": "D2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMALGAM THREE SURFACES PERMA", "code_information": [{"code": "D2160", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMALGAM TWO SURFACES PERMANE", "code_information": [{"code": "D2150", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SOFTWARE", "code_information": [{"code": "93784", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW A/R", "code_information": [{"code": "93788", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW I&R", "code_information": [{"code": "93790", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMBL BP MNTR W/SW REC ONLY", "code_information": [{"code": "93786", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMBU BAG ADULT", "code_information": [{"code": "3100100046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "AMBU BAG PED", "code_information": [{"code": "3100100047", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 124.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMBULATORY SETTING SUBSTANCE", "code_information": [{"code": "S9475", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMENDIA INST", "code_information": [{"code": "3100104154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1403.0, "discounted_cash": 2104.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMIFOSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0207", "type": "HCPCS"}], "standard_charges": [{"minimum": 1125.19, "maximum": 1125.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1125.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMIKACIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0278", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.86, "maximum": 0.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINES VAGINAL FLUID QUAL", "code_information": [{"code": "82120", "type": "CPT"}], "standard_charges": [{"minimum": 5.99, "maximum": 20.92, "discounted_cash": 9.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINO ACID SINGLE QUAL", "code_information": [{"code": "82127", "type": "CPT"}], "standard_charges": [{"minimum": 14.18, "maximum": 40.05, "discounted_cash": 22.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS MULT QUAL", "code_information": [{"code": "82128", "type": "CPT"}], "standard_charges": [{"minimum": 13.87, "maximum": 40.05, "discounted_cash": 22.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUAN 6 OR MORE", "code_information": [{"code": "82139", "type": "CPT"}], "standard_charges": [{"minimum": 16.87, "maximum": 40.05, "discounted_cash": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS QUANT 2-5", "code_information": [{"code": "82136", "type": "CPT"}], "standard_charges": [{"minimum": 19.61, "maximum": 40.05, "discounted_cash": 31.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 22.98, "maximum": 40.05, "discounted_cash": 36.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID HCL TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7308", "type": "HCPCS"}], "standard_charges": [{"minimum": 396.53, "maximum": 396.53, "discounted_cash": 630.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 396.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINOLEVULINIC ACID, 10% GEL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7345", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.7, "maximum": 1.7, "discounted_cash": 2.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMINOPHYLLIN 250 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0280", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.84, "maximum": 8.84, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMIODARONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0282", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMITRIPTYLINE", "code_information": [{"code": "80152", "type": "CPT"}, {"code": "3440100804", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMITRIPTYLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMMONIA", "code_information": [{"code": "82140", "type": "CPT"}, {"code": "3440100856", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.57, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 23.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO+, PER SQ CM", "code_information": [{"code": "Q4299", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNICORE PRO, PER SQ CM", "code_information": [{"code": "Q4298", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO OR BIODMATRIX, INJ 1CC", "code_information": [{"code": "Q4139", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIO OR DERMA TL, PER SQ CM", "code_information": [{"code": "Q4225", "type": "HCPCS"}], "standard_charges": [{"minimum": 7685.0, "maximum": 7685.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7685.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIO QUAD-CORE, PER SQ CM", "code_information": [{"code": "Q4294", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO TRI-CORE, PER SQ CM", "code_information": [{"code": "Q4295", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMNIO WOUND, PER SQUARE CM", "code_information": [{"code": "Q4181", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIO-MAXX OR LITE PER SQ CM", "code_information": [{"code": "Q4239", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.68, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOAMP-MP PER SQ CM", "code_information": [{"code": "Q4250", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOARMOR 1 SQ CM", "code_information": [{"code": "Q4188", "type": "HCPCS"}], "standard_charges": [{"minimum": 637.63, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 637.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, 1 MG", "code_information": [{"code": "Q4168", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.05, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOBAND, GUARDIAN 1 SQ CM", "code_information": [{"code": "Q4151", "type": "HCPCS"}], "standard_charges": [{"minimum": 132.88, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 132.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS DIAGNOSTIC", "code_information": [{"code": "59000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2169.82, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCENTESIS THERAPEUTIC", "code_information": [{"code": "59001", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2169.82, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCORE PER SQ CM", "code_information": [{"code": "Q4227", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.19, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 96.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOCYTE PLUS, PER 0.5 CC", "code_information": [{"code": "Q4242", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOEXCEL BIODEXCEL 1SQ CM", "code_information": [{"code": "Q4137", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.91, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 104.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNION BIO OR AXOBIO SQ CM", "code_information": [{"code": "Q4211", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNION THICK 3X3*ABS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4681.95, "maximum": 6487.84, "gross_charge": 6688.5, "discounted_cash": 10032.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5685.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5016.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4681.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6487.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4681.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5016.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5685.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNION THIN 2X2*ABS-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNION THIN 3X3*ABS-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMNIOREPAIR OR ALTIPLY SQ CM", "code_information": [{"code": "Q4235", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.77, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 149.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT PATCH, PER SQ CM", "code_information": [{"code": "Q4247", "type": "HCPCS"}], "standard_charges": [{"minimum": 530.0, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 530.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOTEXT, PER CC", "code_information": [{"code": "Q4245", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC FLUID SCAN", "code_information": [{"code": "82143", "type": "CPT"}], "standard_charges": [{"minimum": 9.35, "maximum": 20.92, "discounted_cash": 15.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOTIC MEMBRANE", "code_information": [{"code": "V2790", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIOWRAP2 PER SQ CM", "code_information": [{"code": "Q4221", "type": "HCPCS"}], "standard_charges": [{"minimum": 1696.0, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1696.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMNIPLY, PER SQ CM", "code_information": [{"code": "Q4249", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMOBARBITAL 125 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0300", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.37, "maximum": 98.37, "discounted_cash": 183.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 98.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMP F/TH PHAL LOC FL", "code_information": [{"code": "26952", "type": "CPT"}, {"code": "3340102335", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4245.69, "gross_charge": 4377.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4245.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3501.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMP LEG THRU TIB/FIB", "code_information": [{"code": "27886", "type": "CPT"}, {"code": "3340102321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1565.2, "maximum": 4111.8, "gross_charge": 2236.0, "discounted_cash": 3354.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1900.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1677.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1565.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2168.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1565.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1677.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1900.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 3OR 4", "code_information": [{"code": "80325", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPHETAMINES 5 OR MORE", "code_information": [{"code": "80326", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPHO B CHOLESTERYL SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0288", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0285", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.57, "maximum": 38.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPID COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0287", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.13, "maximum": 11.13, "discounted_cash": 17.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPHOTERICIN B LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.68, "maximum": 27.68, "discounted_cash": 42.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN 500 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0290", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPICILLIN/SULBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0295", "type": "HCPCS"}, {"code": "3400300018", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.12, "maximum": 8.43, "gross_charge": 8.7, "discounted_cash": 13.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPLATZ EXTRA STIFF*", "code_information": [{"code": "3100203042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 202.5, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPLATZ STIFF 035*M0", "code_information": [{"code": "3100205116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.92, "discounted_cash": 221.88, "setting": "both", "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25920", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE HAND AT WRIST", "code_information": [{"code": "25922", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27590", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27591", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LEG AT THIGH", "code_information": [{"code": "27592", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE LOWER LEG AT KNEE", "code_information": [{"code": "27598", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATE UPPER ARM & IMPLANT", "code_information": [{"code": "24931", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24925", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "24930", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25907", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25909", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25924", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25929", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "25931", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27594", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOLLOW-UP SURGERY", "code_information": [{"code": "27596", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "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": 16163.37, "maximum": 16163.37, "discounted_cash": 31363.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16163.37, "methodology": "fee schedule"}], "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": 27642.94, "maximum": 27642.94, "discounted_cash": 53665.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27642.94, "methodology": "fee schedule"}], "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": 9786.93, "maximum": 9786.93, "discounted_cash": 15516.51, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9786.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "475", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12960.7, "maximum": 12960.7, "discounted_cash": 23944.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12960.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "474", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15169.8, "maximum": 15169.8, "discounted_cash": 48038.9, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15169.8, "methodology": "fee schedule"}], "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": 5815.71, "maximum": 5815.71, "discounted_cash": 13139.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5815.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27888", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOOT AT ANKLE", "code_information": [{"code": "27889", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25900", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25905", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27290", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27880", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27881", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LOWER LEG", "code_information": [{"code": "27882", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "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": 9692.24, "maximum": 9692.24, "discounted_cash": 22156.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9692.24, "methodology": "fee schedule"}], "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": 12779.94, "maximum": 12779.94, "discounted_cash": 44186.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12779.94, "methodology": "fee schedule"}], "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": 4647.53, "maximum": 4647.53, "discounted_cash": 12967.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4647.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF MIDFOOT", "code_information": [{"code": "28800", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF TOE", "code_information": [{"code": "28820", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3930.57, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24900", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF UPPER ARM", "code_information": [{"code": "24920", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION THRU METATARSAL", "code_information": [{"code": "28805", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION TOE & METATARSAL", "code_information": [{"code": "28810", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION, FINGER O", "code_information": [{"code": "26951", "type": "CPT"}, {"code": "3480101658", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4829.63, "gross_charge": 4979.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4829.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3983.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMPUTATION, METACARP", "code_information": [{"code": "26910", "type": "CPT"}, {"code": "3480101657", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7014.07, "gross_charge": 7231.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMYLASE", "code_information": [{"code": "82150", "type": "CPT"}, {"code": "3440100857", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.48, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 1 OR 2", "code_information": [{"code": "80327", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANABOLIC STEROID 3 OR MORE", "code_information": [{"code": "80328", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANACAULASE-BCDB 8.8% GEL 1 G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7353", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [{"code": "348", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6907.66, "maximum": 6907.66, "discounted_cash": 14529.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6907.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [{"code": "347", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15138.44, "maximum": 15138.44, "discounted_cash": 28459.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15138.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "349", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5967.58, "maximum": 5967.58, "discounted_cash": 10894.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5967.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANAL PRESSURE RECORD", "code_information": [{"code": "91122", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL SP INF PMP W/REPRG&FILL", "code_information": [{"code": "62369", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE", "code_information": [{"code": "51785", "type": "CPT"}, {"code": "3480103315", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 252.2, "maximum": 987.46, "gross_charge": 1018.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 865.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 763.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 987.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 763.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 865.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 814.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAL/URINARY MUSCLE STUDY", "code_information": [{"code": "51784", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESIA", "code_information": [{"code": "D9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 1 OR 2", "code_information": [{"code": "80329", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 3-5", "code_information": [{"code": "80330", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [{"code": "80331", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYSIS NERVE", "code_information": [{"code": "88356", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 218.46, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 218.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYSIS OF SALIVA SAMPLE", "code_information": [{"code": "D0418", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYSIS TUMOR", "code_information": [{"code": "88358", "type": "CPT"}], "standard_charges": [{"minimum": 125.99, "maximum": 182.01, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 125.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYZE NEUROSTIM SI", "code_information": [{"code": "95971", "type": "CPT"}, {"code": "3480103292", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 98.78, "maximum": 466.57, "gross_charge": 481.0, "discounted_cash": 148.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 102.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 466.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 100.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 101.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 117.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 100.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYZE PACEMAKER SYSTEM", "code_information": [{"code": "93724", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYZE SP INF PUMP W/REPROG", "code_information": [{"code": "62368", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 303.49, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANALYZE SPINE INFUS PUMP", "code_information": [{"code": "62367", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 303.49, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANAPLSMA PHGCYTOPHLM AMP PRB", "code_information": [{"code": "87468", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANASTOMOSIS/ARTERY-AORTA", "code_information": [{"code": "33606", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANCA SCREEN EACH ANTIBODY", "code_information": [{"code": "86036", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANCA TITER EACH ANTIBODY", "code_information": [{"code": "86037", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1056.3, "maximum": 1463.73, "gross_charge": 1509.0, "discounted_cash": 2263.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1282.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1131.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1056.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1463.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1056.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1131.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1282.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1207.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR BI-WING", "code_information": [{"code": "3100104728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR BUMPY INJEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR DART CHONDRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.8, "maximum": 469.48, "gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 469.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 387.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR DRILL CONN*AR", "code_information": [{"code": "3100207424", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 356.52, "discounted_cash": 534.78, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.3, "maximum": 7235.23, "gross_charge": 7459.0, "discounted_cash": 11188.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR JUGGERKNOT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SPEEDBRIDGE A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.44, "maximum": 5282.95, "gross_charge": 5446.35, "discounted_cash": 8169.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4084.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5282.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4084.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE CORKSC", "code_information": [{"code": "3100104267", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE CORKSC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 546.0, "maximum": 756.6, "gross_charge": 780.0, "discounted_cash": 1170.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 585.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 756.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 585.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 624.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE PUSHLO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 882.0, "maximum": 1222.2, "gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1222.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE PUSHLO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 714.0, "maximum": 989.4, "gross_charge": 1020.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE PUSHLO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURE PUSHLO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1186.5, "maximum": 1644.15, "gross_charge": 1695.0, "discounted_cash": 2542.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1440.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1271.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1186.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1644.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1186.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1271.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1440.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1356.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SUTURETAK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 640.5, "maximum": 887.55, "gross_charge": 915.0, "discounted_cash": 1372.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 777.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 686.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 640.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 887.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 640.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 686.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 777.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 732.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANCHOR SWIVEL LOCK T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 850.5, "maximum": 1178.55, "gross_charge": 1215.0, "discounted_cash": 1822.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 972.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANDROLOGY INFERTILITY ASSMT", "code_information": [{"code": "255U", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 50.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANDROSTANEDIOL GLUCURONIDE", "code_information": [{"code": "82154", "type": "CPT"}], "standard_charges": [{"minimum": 28.83, "maximum": 34.27, "discounted_cash": 46.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES C HYST FLWG NEURAXIAL", "code_information": [{"code": "1969", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN DELIVERY ONLY", "code_information": [{"code": "1961", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES CESAREAN HYSTERECTOMY", "code_information": [{"code": "1963", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES COMP CTRLD HYPOTENSION", "code_information": [{"code": "99135", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES COMP TOT BDY HYPTHRM", "code_information": [{"code": "99116", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR CRV/THRC", "code_information": [{"code": "1937", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES DRG/ASPIR LMBR/SAC", "code_information": [{"code": "1938", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES DX SHOULDER ARTHROSCOPY", "code_information": [{"code": "1622", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR DIPHRG HRNA", "code_information": [{"code": "756", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR LMBR&VNT&/DEHS", "code_information": [{"code": "752", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR OMPHALOCELE", "code_information": [{"code": "754", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES HRNA RPR UPR ABD NOS", "code_information": [{"code": "750", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD LVR TRNSPL", "code_information": [{"code": "796", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD NOS", "code_information": [{"code": "790", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PNCRTECT", "code_information": [{"code": "794", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD PRTL HPTC", "code_information": [{"code": "792", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES LMA CLASSIC", "code_information": [{"code": "3100100057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 627.0, "discounted_cash": 940.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES LMA FLEXIBLE", "code_information": [{"code": "3100100058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 785.0, "discounted_cash": 1177.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES LMA SUPREME", "code_information": [{"code": "3100100059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES LMA SUPREME", "code_information": [{"code": "3100104474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES LMA SUPREME", "code_information": [{"code": "3100104641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES LMA UNIQUE STD", "code_information": [{"code": "3100100060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANES LWR INTST NDSC NOS", "code_information": [{"code": "811", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES LWR INTST SCR COLSC", "code_information": [{"code": "812", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES MEDIASCPY & DX THORSCPY", "code_information": [{"code": "528", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES MEDSCPY&THORSCPY 1 LUNG", "code_information": [{"code": "529", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT CRV/THRC", "code_information": [{"code": "1941", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES NEUROMD/NTRVRT LMBR/SAC", "code_information": [{"code": "1942", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT CRV/THRC", "code_information": [{"code": "1939", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES NULYT AGT LMBR/SAC", "code_information": [{"code": "1940", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES PT EXTEME AGE<1 YR&>70", "code_information": [{"code": "99100", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES PX MAJ ABD BLOOD VESSEL", "code_information": [{"code": "770", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANSTHOR W/VENT", "code_information": [{"code": "626", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX ERCP", "code_information": [{"code": "732", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES UPR GI NDSC PX NOS", "code_information": [{"code": "731", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES UPR LWR GI NDSC PX", "code_information": [{"code": "813", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES URGENT HYSTERECTOMY", "code_information": [{"code": "1962", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES VAGINAL DELIVERY ONLY", "code_information": [{"code": "1960", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES XTRNL CEPHALIC VERSION", "code_information": [{"code": "1958", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES. COMPLICATED BY", "code_information": [{"code": "99140", "type": "CPT"}, {"code": "3300100261", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"minimum": 33.38, "maximum": 118.34, "gross_charge": 122.0, "discounted_cash": 183.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 118.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 97.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANEST BLOCK AXILLARY", "code_information": [{"code": "3300100263", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST BLOCK POPLITEA", "code_information": [{"code": "3300100264", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST BLOCK SCALENE", "code_information": [{"code": "3300100265", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST BLOCK SUPRACLA", "code_information": [{"code": "3300100266", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST BLOCK TEMORAL", "code_information": [{"code": "3300100267", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST CATHETER INSER", "code_information": [{"code": "3300100268", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST EPI TO GEN EA", "code_information": [{"code": "3300100280", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST EPI TO GEN INI", "code_information": [{"code": "3300100279", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST EPIDURAL", "code_information": [{"code": "3300100251", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 592.0, "discounted_cash": 888.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST EPIDURAL W MAC", "code_information": [{"code": "3300100269", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST FIBEROP INTUB", "code_information": [{"code": "3300100283", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST FIBEROP INTUB", "code_information": [{"code": "3300100284", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST GEN W MAC EA A", "code_information": [{"code": "3300100243", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 265.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST GEN W MAC INIT", "code_information": [{"code": "3300100262", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 874.0, "discounted_cash": 1311.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST LOCAL TO GEN E", "code_information": [{"code": "3300100276", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST LOCAL TO GEN I", "code_information": [{"code": "3300100275", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST LOCAL TO MAC E", "code_information": [{"code": "3300100282", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST LOCAL TO MAC I", "code_information": [{"code": "3300100281", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 772.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST MAC EA ADD 15", "code_information": [{"code": "3300100248", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST MAC INITIAL 30", "code_information": [{"code": "3300100247", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 772.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST MAC RCC EA ADD", "code_information": [{"code": "3300100289", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST MAC RCC INITIA", "code_information": [{"code": "3300100288", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 772.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST MAC TO GEN EA", "code_information": [{"code": "3300100274", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST MAC TO GEN INI", "code_information": [{"code": "3300100273", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST PERIPHERAL/MAC", "code_information": [{"code": "3300100285", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST PERIPHERAL/MAC", "code_information": [{"code": "3300100286", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST REGIONAL BLOCK", "code_information": [{"code": "3300100249", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST REGIONAL W MAC", "code_information": [{"code": "3300100270", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST REGIONAL W MAC", "code_information": [{"code": "3300100271", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 646.0, "discounted_cash": 969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST SPIN TO GEN EA", "code_information": [{"code": "3300100278", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST SPIN TO GEN IN", "code_information": [{"code": "3300100277", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST SPINAL", "code_information": [{"code": "3300100250", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 724.0, "discounted_cash": 1086.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST SPINAL W MAC E", "code_information": [{"code": "3300100272", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST- GEN EACH ADD", "code_information": [{"code": "3300100245", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST- GEN INITIAL 3", "code_information": [{"code": "3300100244", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 848.0, "discounted_cash": 1272.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANEST.ARTERIAL LINE", "code_information": [{"code": "36620", "type": "CPT"}, {"code": "3300100255", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 104.3, "maximum": 1029.73, "gross_charge": 149.0, "discounted_cash": 223.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 144.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 111.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "820", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ACHILLES TENDON SURG", "code_information": [{"code": "1472", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH AMNIOCENTESIS", "code_information": [{"code": "842", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT KNEE", "code_information": [{"code": "1404", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION AT PELVIS", "code_information": [{"code": "1140", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF FEMUR", "code_information": [{"code": "1232", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH AMPUTATION OF PENIS", "code_information": [{"code": "932", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE REPLACEMENT", "code_information": [{"code": "1486", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ANKLE/FT ARTHROSCOPY", "code_information": [{"code": "1464", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ANORECTAL SURGERY", "code_information": [{"code": "902", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ARM-LEG VESSEL SURG", "code_information": [{"code": "1656", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ARTHROSCOPY OF HIP", "code_information": [{"code": "1202", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BICEPS TENDON REPAIR", "code_information": [{"code": "1716", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF NOSE", "code_information": [{"code": "164", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BIOPSY OF THYROID", "code_information": [{"code": "322", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER STONE SURG", "code_information": [{"code": "870", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER SURGERY", "code_information": [{"code": "910", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BLADDER TUMOR SURG", "code_information": [{"code": "912", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEEDING CONTROL", "code_information": [{"code": "916", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BLEPHAROPLASTY", "code_information": [{"code": "103", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BODY CAST PROCEDURE", "code_information": [{"code": "1130", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BONE ASPIRATE/BX", "code_information": [{"code": "1112", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN 4-9 PERCENT", "code_information": [{"code": "1952", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN EACH 9 PERCENT", "code_information": [{"code": "1953", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH BURN LESS 4 PERCENT", "code_information": [{"code": "1951", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/O PUMP", "code_information": [{"code": "566", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CABG W/PUMP", "code_information": [{"code": "567", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIAC ELECTROPHYS", "code_information": [{"code": "537", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CARDIOVERTER/DEFIB", "code_information": [{"code": "534", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CAT OR MRI SCAN", "code_information": [{"code": "1922", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CATHETERIZE HEART", "code_information": [{"code": "1920", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST DRAINAGE", "code_information": [{"code": "524", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST LINING BIOPSY", "code_information": [{"code": "522", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST PROCEDURE", "code_information": [{"code": "520", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST SURGERY", "code_information": [{"code": "540", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CHEST WALL REPAIR", "code_information": [{"code": "472", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CLEFT PALATE REPAIR", "code_information": [{"code": "172", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH COLLAR BONE BIOPSY", "code_information": [{"code": "454", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CORNEAL TRANSPLANT", "code_information": [{"code": "144", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CORRECT HEART RHYTHM", "code_information": [{"code": "410", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CRAN SURG HEMOTOMA", "code_information": [{"code": "211", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH CRANIAL SURG NOS", "code_information": [{"code": "210", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ARTERIOGRAPHY", "code_information": [{"code": "1916", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH DX ELBOW ARTHROSCOPY", "code_information": [{"code": "1732", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH DX KNEE ARTHROSCOPY", "code_information": [{"code": "1382", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH DX WRIST ARTHROSCOPY", "code_information": [{"code": "1829", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR EXAM", "code_information": [{"code": "124", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH EAR SURGERY", "code_information": [{"code": "120", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW AREA SURGERY", "code_information": [{"code": "1710", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ELBOW REPLACEMENT", "code_information": [{"code": "1760", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ELECTROSHOCK", "code_information": [{"code": "104", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ESOPHAGEAL SURGERY", "code_information": [{"code": "500", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH EYE EXAM", "code_information": [{"code": "148", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FACE/SKULL BONE SURG", "code_information": [{"code": "190", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FACIAL BONE SURGERY", "code_information": [{"code": "192", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FAT LAYER REMOVAL", "code_information": [{"code": "802", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL ARTERY SURG", "code_information": [{"code": "1272", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FEMORAL EMBOLECTOMY", "code_information": [{"code": "1274", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FOR LIVER BIOPSY", "code_information": [{"code": "702", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FOREQUARTER AMPUT", "code_information": [{"code": "1636", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH FX REPAIR PELVIS", "code_information": [{"code": "1173", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH GENITALIA SURGERY", "code_information": [{"code": "920", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD NERVE SURGERY", "code_information": [{"code": "222", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD VESSEL SURGERY", "code_information": [{"code": "216", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEAD/NECK/PTRUNK", "code_information": [{"code": "300", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG <1 YR", "code_information": [{"code": "561", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/ARREST", "code_information": [{"code": "563", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART SURG W/O PUMP", "code_information": [{"code": "560", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HEART/LUNG TRANSPLNT", "code_information": [{"code": "580", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR < 1 YR", "code_information": [{"code": "834", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HERNIA REPAIR PREEMIE", "code_information": [{"code": "836", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP ARTHROPLASTY", "code_information": [{"code": "1214", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP DISARTICULATION", "code_information": [{"code": "1212", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT PROCEDURE", "code_information": [{"code": "1200", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HIP JOINT SURGERY", "code_information": [{"code": "1210", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HRT SURG W/PMP AGE 1+", "code_information": [{"code": "562", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERAL LESION SURG", "code_information": [{"code": "1758", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS REPAIR", "code_information": [{"code": "1744", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HUMERUS SURGERY", "code_information": [{"code": "1742", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTERECTOMY", "code_information": [{"code": "846", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH HYSTEROSCOPE/GRAPH", "code_information": [{"code": "952", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH INSERT PENIS DEVICE", "code_information": [{"code": "938", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH INTRCRN NERVE", "code_information": [{"code": "220", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH IRIDECTOMY", "code_information": [{"code": "147", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "872", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY STONE DESTRUCT", "code_information": [{"code": "873", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY TRANSPLANT", "code_information": [{"code": "868", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KIDNEY/URETER SURG", "code_information": [{"code": "862", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1340", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA PROCEDURE", "code_information": [{"code": "1390", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1320", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1360", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE AREA SURGERY", "code_information": [{"code": "1392", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERIES SURG", "code_information": [{"code": "1440", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY REPAIR", "code_information": [{"code": "1444", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTERY SURG", "code_information": [{"code": "1442", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE ARTHROPLASTY", "code_information": [{"code": "1402", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT CASTING", "code_information": [{"code": "1420", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT PROCEDURE", "code_information": [{"code": "1380", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE JOINT SURGERY", "code_information": [{"code": "1400", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VEINS SURGERY", "code_information": [{"code": "1430", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH KNEE VESSEL SURG", "code_information": [{"code": "1432", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LARYNX/TRACH < 1 YR", "code_information": [{"code": "326", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LEG ARTERIES SURG", "code_information": [{"code": "1500", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LENS SURGERY", "code_information": [{"code": "142", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM CASTING", "code_information": [{"code": "1860", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM PROCEDURE", "code_information": [{"code": "1820", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1810", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM SURGERY", "code_information": [{"code": "1830", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER ARM VEIN SURG", "code_information": [{"code": "1850", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG BONE SURG", "code_information": [{"code": "1480", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG CASTING", "code_information": [{"code": "1490", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG PROCEDURE", "code_information": [{"code": "1462", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG REVISION", "code_information": [{"code": "1484", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1470", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG SURGERY", "code_information": [{"code": "1474", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1520", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LOWER LEG VEIN SURG", "code_information": [{"code": "1522", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LUMBAR PUNCTURE", "code_information": [{"code": "635", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LUNG CHEST WALL SURG", "code_information": [{"code": "546", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM ARTERY SURG", "code_information": [{"code": "1840", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM EMBOLECTOMY", "code_information": [{"code": "1842", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR ARM VEIN REPAIR", "code_information": [{"code": "1852", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH LWR LEG EMBOLECTOMY", "code_information": [{"code": "1502", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH MAJOR VEIN LIGATION", "code_information": [{"code": "882", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH N BLOCK/INJ PRONE", "code_information": [{"code": "1992", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK ORGAN 1YR/>", "code_information": [{"code": "320", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "350", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH NECK VESSEL SURGERY", "code_information": [{"code": "352", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH NERVE BLOCK/INJ", "code_information": [{"code": "1991", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "160", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH NOSE/SINUS SURGERY", "code_information": [{"code": "162", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH ONE LUNG VENTILATION", "code_information": [{"code": "541", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PACEMAKER INSERTION", "code_information": [{"code": "530", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC ORGAN SURG", "code_information": [{"code": "848", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIC TUMOR SURGERY", "code_information": [{"code": "1150", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS PROCEDURE", "code_information": [{"code": "1160", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1120", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "1170", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PELVIS SURGERY", "code_information": [{"code": "844", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "934", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PENIS NODES REMOVAL", "code_information": [{"code": "936", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PERINEAL SURGERY", "code_information": [{"code": "904", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "174", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PHARYNGEAL SURGERY", "code_information": [{"code": "176", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON FEMUR", "code_information": [{"code": "1220", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURE ON MOUTH", "code_information": [{"code": "170", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH PROCEDURES ON EYE", "code_information": [{"code": "140", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL FEMUR SURG", "code_information": [{"code": "1234", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL HUMERUS SURG", "code_information": [{"code": "1756", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH RADICAL LEG SURGERY", "code_information": [{"code": "1482", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF ADRENAL", "code_information": [{"code": "866", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF BLADDER", "code_information": [{"code": "864", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF NERVES", "code_information": [{"code": "632", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "865", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "908", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF PROSTATE", "code_information": [{"code": "914", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF RIB", "code_information": [{"code": "470", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "926", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF TESTIS", "code_information": [{"code": "928", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REMOVAL OF VULVA", "code_information": [{"code": "906", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CERVIX", "code_information": [{"code": "948", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF CLEFT LIP", "code_information": [{"code": "102", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "830", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REPAIR OF HERNIA", "code_information": [{"code": "832", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH REVISE HIP REPAIR", "code_information": [{"code": "1215", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SALIVARY GLAND", "code_information": [{"code": "100", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER ARTERY SURG", "code_information": [{"code": "1650", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER CASTING", "code_information": [{"code": "1680", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER JOINT AMPUT", "code_information": [{"code": "1634", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER PROCEDURE", "code_information": [{"code": "1620", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER REPLACEMENT", "code_information": [{"code": "1638", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VEIN SURG", "code_information": [{"code": "1670", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1652", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SHOULDER VESSEL SURG", "code_information": [{"code": "1654", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SITTING PROCEDURE", "code_information": [{"code": "604", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SKIN EXT/PER/ATRUNK", "code_information": [{"code": "400", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "212", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL DRAINAGE", "code_information": [{"code": "214", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SKULL REPAIR/FRACT", "code_information": [{"code": "215", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPECIAL HEAD SURGERY", "code_information": [{"code": "218", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPERM DUCT SURGERY", "code_information": [{"code": "922", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "600", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "620", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "630", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE CORD SURGERY", "code_information": [{"code": "670", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SPINE MANIPULATION", "code_information": [{"code": "640", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH STERNAL DEBRIDEMENT", "code_information": [{"code": "550", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH STONE REMOVAL", "code_information": [{"code": "918", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG LOWER ABDOMEN", "code_information": [{"code": "840", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURG ON VAG/URETHRAL", "code_information": [{"code": "942", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY 1ST 3", "code_information": [{"code": "3480103105", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 23056.0, "discounted_cash": 34584.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF ABDOMEN", "code_information": [{"code": "860", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "402", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "404", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF BREAST", "code_information": [{"code": "406", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF FEMUR", "code_information": [{"code": "1230", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF RIB", "code_information": [{"code": "474", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1610", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "1630", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH SURGERY OF SHOULDER", "code_information": [{"code": "450", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS EXPLORATION", "code_information": [{"code": "924", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH TESTIS SUSPENSION", "code_information": [{"code": "930", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH THIGH ARTERIES SURG", "code_information": [{"code": "1270", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACH-BRONCH RECONST", "code_information": [{"code": "539", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH TRACHEA BRONCHI SURG", "code_information": [{"code": "548", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH TUBAL LIGATION", "code_information": [{"code": "851", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH TYMPANOTOMY", "code_information": [{"code": "126", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM SURGERY", "code_information": [{"code": "1740", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER ARM VEIN SURG", "code_information": [{"code": "1780", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG SURGERY", "code_information": [{"code": "1250", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPER LEG VEINS SURG", "code_information": [{"code": "1260", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM ARTERY SURG", "code_information": [{"code": "1770", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM EMBOLECTOMY", "code_information": [{"code": "1772", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM PROCEDURE", "code_information": [{"code": "1730", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1712", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM TENDON SURG", "code_information": [{"code": "1714", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH UPPR ARM VEIN REPAIR", "code_information": [{"code": "1782", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL ENDOSCOPY", "code_information": [{"code": "950", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL HYSTERECTOMY", "code_information": [{"code": "944", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VAGINAL PROCEDURES", "code_information": [{"code": "940", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR ACCESS", "code_information": [{"code": "532", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VASCULAR SHUNT SURG", "code_information": [{"code": "1844", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VASECTOMY", "code_information": [{"code": "921", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH VITREORETINAL SURG", "code_information": [{"code": "145", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH WRIST REPLACEMENT", "code_information": [{"code": "1832", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANESTH-GENERAL", "code_information": [{"code": "3300100287", "type": "CDM"}, {"code": "370", "type": "RC"}], "standard_charges": [{"gross_charge": 739.0, "discounted_cash": 1108.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANESTHESIA REMOVAL PLEURA", "code_information": [{"code": "542", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGINA PECTORIS", "code_information": [{"code": "311", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2683.75, "maximum": 2683.75, "discounted_cash": 7793.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2683.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANGIO CATH FLUSH*M00", "code_information": [{"code": "3100205117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ANGIOSCOPY", "code_information": [{"code": "35400", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANGIOTENSIN I CONVER", "code_information": [{"code": "82164", "type": "CPT"}, {"code": "3440100858", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.6, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 23.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANIDULAFUNGIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0348", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.46, "maximum": 0.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANKLE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29892", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANNUAL ALCOHOL SCREEN 15 MIN", "code_information": [{"code": "G0442", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46611", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY", "code_information": [{"code": "46615", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2076.37, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND BIOPSY", "code_information": [{"code": "46606", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY AND DILATION", "code_information": [{"code": "46604", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY CONTROL BLEEDING", "code_information": [{"code": "46614", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE FOR BODY", "code_information": [{"code": "46608", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESION", "code_information": [{"code": "46610", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3409.56, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANOSCOPY REMOVE LESIONS", "code_information": [{"code": "46612", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2076.37, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANRCT XM SURG REQ AN", "code_information": [{"code": "45990", "type": "CPT"}, {"code": "3480102230", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4341.72, "gross_charge": 4476.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4341.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3580.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANT RESIN-BASED CMPST CROWN", "code_information": [{"code": "D2390", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG I&R SPECLR MIC", "code_information": [{"code": "92286", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANT SGM IMG IR FLRSCN ANGRPH", "code_information": [{"code": "92287", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANT TIBIAL GRAFT*SAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTB TP TOTAL&RPR IA QUAL", "code_information": [{"code": "64U", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 50.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTENNA PT PROGRAMME", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "3100100061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59425", "type": "CPT"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 176.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM CARE ONLY", "code_information": [{"code": "59426", "type": "CPT"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 176.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTEPARTUM MANIPULATION", "code_information": [{"code": "59412", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2169.82, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTERIOR COLPORRHAPH", "code_information": [{"code": "57240", "type": "CPT"}, {"code": "3480102089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8960.86, "gross_charge": 9238.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8960.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7390.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTEROLATERAL LIG RE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTHRAX VACCINE SC OR IM", "code_information": [{"code": "90581", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTI-INHIBITOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7198", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.29, "maximum": 2.29, "discounted_cash": 3.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTI-PHOSPHOLIPID ANTIBODY", "code_information": [{"code": "86148", "type": "CPT"}], "standard_charges": [{"minimum": 16.07, "maximum": 30.26, "discounted_cash": 25.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY DETECTION NOS IF", "code_information": [{"code": "87299", "type": "CPT"}], "standard_charges": [{"minimum": 16.1, "maximum": 24.03, "discounted_cash": 25.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ELUTION RBC", "code_information": [{"code": "86860", "type": "CPT"}, {"code": "3440101137", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.41, "gross_charge": 165.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY HELMINTH NE", "code_information": [{"code": "86682", "type": "CPT"}, {"code": "3440103051", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.01, "maximum": 82.45, "gross_charge": 85.0, "discounted_cash": 20.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 72.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 72.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ID LEUKOCYT", "code_information": [{"code": "86021", "type": "CPT"}, {"code": "3440101059", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.05, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 24.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ID PLATELET", "code_information": [{"code": "86022", "type": "CPT"}, {"code": "3440101060", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.37, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 29.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY ID RBC EA P", "code_information": [{"code": "86870", "type": "CPT"}, {"code": "3440101138", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 52.43, "maximum": 436.49, "gross_charge": 227.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 52.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SARS-COV-2 TITER(S)", "code_information": [{"code": "224U", "type": "CPT"}], "standard_charges": [{"minimum": 51.43, "maximum": 82.77, "discounted_cash": 82.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY SCREEN RBC", "code_information": [{"code": "86850", "type": "CPT"}, {"code": "3440101136", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 9.77, "maximum": 113.49, "gross_charge": 117.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY TEST PUB HLTH PATH", "code_information": [{"code": "D0605", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIBODY VIRUS NES", "code_information": [{"code": "86790", "type": "CPT"}, {"code": "3440101130", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.88, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 20.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTICOAG MGMT PT WARFARIN", "code_information": [{"code": "93793", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT NOT SPECIFIED", "code_information": [{"code": "80338", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT TRICYCLIC 1/2", "code_information": [{"code": "80335", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANT TRICYCLIC 3-5", "code_information": [{"code": "80336", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 1 OR 2", "code_information": [{"code": "80332", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 3-5", "code_information": [{"code": "80333", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIDEPRESSANTS CLASS 6/MORE", "code_information": [{"code": "80334", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC DRUG ORAL NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8597", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEMETIC RECTAL/SUPP NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8498", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 1-3", "code_information": [{"code": "80339", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 4-6", "code_information": [{"code": "80340", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIEPILEPTICS NOS 7/MORE", "code_information": [{"code": "80341", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN TEST PUB HLTH PATHOG", "code_information": [{"code": "D0604", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95144", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95145", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95146", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95147", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95148", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95149", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95165", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIGEN THERAPY SERVICES", "code_information": [{"code": "95170", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIHEMOPHILIC VIII/VWF COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.19, "maximum": 1.19, "discounted_cash": 1.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTIHUM GLOB IND QUA", "code_information": [{"code": "86885", "type": "CPT"}, {"code": "3440101140", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.72, "maximum": 207.41, "gross_charge": 66.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIHUMAN GLOBULN DI", "code_information": [{"code": "86880", "type": "CPT"}, {"code": "3440101139", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.39, "maximum": 74.28, "gross_charge": 66.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIHUMAN GLOBULN IN", "code_information": [{"code": "86886", "type": "CPT"}, {"code": "3440103043", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 207.41, "gross_charge": 202.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 151.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 195.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 141.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 151.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 171.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 161.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTINOMYCES ANTIBODY", "code_information": [{"code": "86602", "type": "CPT"}], "standard_charges": [{"minimum": 10.18, "maximum": 30.26, "discounted_cash": 16.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTINUCLEAR AB ANA", "code_information": [{"code": "86038", "type": "CPT"}, {"code": "3440101061", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.09, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 19.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTINUCLEAR AB ANA T", "code_information": [{"code": "86039", "type": "CPT"}, {"code": "3440101062", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.16, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 17.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 1-3", "code_information": [{"code": "80342", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 4-6", "code_information": [{"code": "80343", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIPSYCHOTICS NOS 7/MORE", "code_information": [{"code": "80344", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTIROTAT NOTCH 5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 333.9, "maximum": 462.69, "gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 405.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 333.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 462.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 333.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 405.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 381.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTISPERM ANTIBODIES TEST", "code_information": [{"code": "S3655", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTISTREPTOLYSIN O SCREEN", "code_information": [{"code": "86063", "type": "CPT"}], "standard_charges": [{"minimum": 5.77, "maximum": 30.26, "discounted_cash": 9.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTISTREPTOLYSIN O T", "code_information": [{"code": "86060", "type": "CPT"}, {"code": "3440101063", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.3, "maximum": 65.96, "gross_charge": 68.0, "discounted_cash": 11.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III ANTIGEN", "code_information": [{"code": "85301", "type": "CPT"}], "standard_charges": [{"minimum": 10.81, "maximum": 20.47, "discounted_cash": 17.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN III INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7197", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.74, "maximum": 3.74, "discounted_cash": 6.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHROMBIN RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7196", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.46, "maximum": 97.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 97.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTITHYMOCYTE GLOBULN RABBIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 927.94, "maximum": 927.94, "discounted_cash": 1492.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 927.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AO TO MQC ADAPTER*23", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 714.42, "maximum": 989.98, "gross_charge": 1020.6, "discounted_cash": 1530.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 867.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 765.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 714.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 714.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 765.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 867.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 816.48, "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": 32090.65, "maximum": 32090.65, "discounted_cash": 76529.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32090.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [{"code": "269", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18257.5, "maximum": 18257.5, "discounted_cash": 46428.96, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18257.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33970", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC CIRCULATION ASSIST", "code_information": [{"code": "33971", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81410", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 504.0, "discounted_cash": 809.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC DYSFUNCTION/DILATION", "code_information": [{"code": "81411", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1350.19, "discounted_cash": 2169.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1350.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC HEMIARCH GRAFT", "code_information": [{"code": "33866", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AP IHC", "code_information": [{"code": "G0461", "type": "HCPCS"}, {"code": "3440103009", "type": "CDM"}, {"code": "312", "type": "RC"}], "standard_charges": [{"minimum": 212.8, "maximum": 294.88, "gross_charge": 304.0, "discounted_cash": 456.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 294.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 200.0, "discounted_cash": 321.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 780.0, "discounted_cash": 1253.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 280.0, "discounted_cash": 449.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APC MRNA SEQ ALYS", "code_information": [{"code": "157U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC FINAL", "code_information": [{"code": "D3353", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INITIAL", "code_information": [{"code": "D3351", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APEXIFICATION/RECALC INTERIM", "code_information": [{"code": "D3352", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHAKIA PROSTH SERVICE TEMP", "code_information": [{"code": "92358", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS IMMUNOADS SLCTV", "code_information": [{"code": "36516", "type": "CPT"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "discounted_cash": 7083.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS RBC", "code_information": [{"code": "36512", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APHERESIS WBC", "code_information": [{"code": "36511", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APICAL HOLE PLUG*010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APICOECTOMY - ANTERIOR", "code_information": [{"code": "D3410", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APLIGRAF", "code_information": [{"code": "Q4101", "type": "HCPCS"}, {"code": "3100100062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30.62, "maximum": 1725.27, "gross_charge": 4430.0, "discounted_cash": 6645.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APOC PT CART", "code_information": [{"code": "3100104673", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APOLLO RF MP90*AR-98", "code_information": [{"code": "3100202240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APOMORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.7, "maximum": 34.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+CNTRST BTH EA 15", "code_information": [{"code": "97034", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+HUBBRD TNK EA 15", "code_information": [{"code": "97036", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+IONTPHRSIS EA 15", "code_information": [{"code": "97033", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MDLTY 1+ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 2895.17, "maximum": 2895.17, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX XCH", "code_information": [{"code": "20697", "type": "CPT"}], "standard_charges": [{"minimum": 2895.17, "maximum": 2895.17, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44950", "type": "CPT"}, {"code": "3480101966", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5446.7, "maximum": 9187.05, "gross_charge": 7781.0, "discounted_cash": 11580.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6613.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7982.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5835.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5446.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7547.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7874.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5446.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7951.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5835.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7720.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9187.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6613.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7720.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6224.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7720.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7874.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY", "code_information": [{"code": "44960", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDECTOMY ADD-ON", "code_information": [{"code": "44955", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPENDICO-VESICOSTOMY", "code_information": [{"code": "50845", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL DESENSITIZING RESIN", "code_information": [{"code": "D9911", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL HALO CRANIAL 6+PINS", "code_information": [{"code": "20664", "type": "CPT"}], "standard_charges": [{"minimum": 2895.17, "maximum": 2895.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL MODALITY 1+ESTIM EA 15", "code_information": [{"code": "97032", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL MULTLAY COMPRS ARM/HAND", "code_information": [{"code": "29584", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPL OF HEAD BRACE-H", "code_information": [{"code": "20661", "type": "CPT"}, {"code": "3480101439", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 2895.17, "gross_charge": 1252.0, "discounted_cash": 1878.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 939.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 876.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1214.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 876.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 939.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1064.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1001.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLIANCE REMOVAL", "code_information": [{"code": "D7997", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO FEMORAL", "code_information": [{"code": "20663", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2895.17, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION HALO PELVIC", "code_information": [{"code": "20662", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2895.17, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION LONG LEG SPLINT", "code_information": [{"code": "29505", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION LOWER LEG SPLINT", "code_information": [{"code": "29515", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF A UNI", "code_information": [{"code": "20690", "type": "CPT"}, {"code": "3480101442", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8687.35, "gross_charge": 8074.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29000", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29010", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29015", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29040", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29044", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29046", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FIGURE EIGHT", "code_information": [{"code": "29049", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29130", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FOREARM CAST", "code_information": [{"code": "29075", "type": "CPT"}], "standard_charges": [{"minimum": 274.05, "maximum": 326.12, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 282.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 326.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CAST", "code_information": [{"code": "29305", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP S", "code_information": [{"code": "29325", "type": "CPT"}, {"code": "3480101784", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 274.05, "maximum": 770.18, "gross_charge": 794.0, "discounted_cash": 411.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 674.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 595.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 555.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 770.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 555.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 282.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 595.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 326.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 674.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 635.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LEG CAST", "code_information": [{"code": "29450", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG ARM CAST", "code_information": [{"code": "29065", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29345", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29355", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF LONG LEG CAST", "code_information": [{"code": "29365", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF MULTI", "code_information": [{"code": "20692", "type": "CPT"}, {"code": "3480101443", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 15981.88, "gross_charge": 9688.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF PASTE BOOT", "code_information": [{"code": "29580", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29055", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF SHOULDER CAST", "code_information": [{"code": "29058", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATON ON-BODY INJECTOR", "code_information": [{"code": "96377", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLICATOR ASSEM 10C", "code_information": [{"code": "3100204679", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SPRAY TIP", "code_information": [{"code": "3100100063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR VISCOUS A", "code_information": [{"code": "3100100064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY FINGER CAST", "code_information": [{"code": "29086", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29125", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY INTERSTIT RAD", "code_information": [{"code": "77778", "type": "CPT"}, {"code": "3270102304", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 731.63, "maximum": 3084.6, "gross_charge": 3180.0, "discounted_cash": 1097.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2703.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 756.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3084.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 746.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 753.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 731.63, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2703.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 731.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2544.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 731.63, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 746.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 1097.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY LONG ARM SPLINT", "code_information": [{"code": "29105", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2895.17, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29425", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SPINE PROSTH D", "code_information": [{"code": "22851", "type": "CPT"}, {"code": "3480101525", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 12111.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APPLY SURF LDR RADIONUCLIDE", "code_information": [{"code": "77789", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 183.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "APROTONIN, 10,000 KIU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.7, "maximum": 2.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 37.73, "discounted_cash": 60.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQMBF PET REST & RX STRESS", "code_information": [{"code": "78434", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB CBA EACH", "code_information": [{"code": "86052", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUAPORIN-4 ANTB ELISA", "code_information": [{"code": "86051", "type": "CPT"}], "standard_charges": [{"minimum": 11.53, "maximum": 30.26, "discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUATIC THERAPY/EXERCISES", "code_information": [{"code": "97113", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/GRAFT", "code_information": [{"code": "66180", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AQUEOUS SHUNT EYE W/O GRAFT", "code_information": [{"code": "66179", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR FULL SEQUENCE ANALYSIS", "code_information": [{"code": "230U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 484.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR GENE CHARAC ALLELES", "code_information": [{"code": "81204", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR GENE FULL GENE SEQUENCE", "code_information": [{"code": "81173", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 301.35, "discounted_cash": 484.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81174", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AR-8970AR-06", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5369.0, "maximum": 7439.9, "gross_charge": 7670.0, "discounted_cash": 11505.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7439.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARBUTAMINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0395", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARCADUS AESCULAP", "code_information": [{"code": "3100103867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARCH BAR STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.1, "maximum": 158.11, "gross_charge": 163.0, "discounted_cash": 244.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 138.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 138.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARCH BAR STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 21.0, "maximum": 29.1, "gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARCHITECT ECM PX FX 1 SQ CM", "code_information": [{"code": "Q4147", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.22, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 147.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARFORMOTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7605", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.85, "maximum": 1.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0892", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.82, "maximum": 1.82, "discounted_cash": 2.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN DIALYSIS, AUROMED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0899", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.64, "maximum": 1.64, "discounted_cash": 6.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN ESRD DIALYSIS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0884", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.28, "maximum": 4.28, "discounted_cash": 1.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0891", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.82, "maximum": 1.82, "discounted_cash": 2.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD (AUROMED)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0898", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.64, "maximum": 1.64, "discounted_cash": 6.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARGATROBAN NONESRD USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0883", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.92, "maximum": 3.92, "discounted_cash": 1.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0400", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ARIPIPRAZOLE LAUROXIL 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1944", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.12, "maximum": 3.12, "discounted_cash": 5.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARISTA 3G", "code_information": [{"code": "3100100066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 762.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARM TENDON LENGTHENI", "code_information": [{"code": "24305", "type": "CPT"}, {"code": "3480101561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AROTHROFLE 20X25X1MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1732.5, "maximum": 2400.75, "gross_charge": 2475.0, "discounted_cash": 3712.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2103.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1856.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2400.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1856.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2103.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1980.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARSENIC", "code_information": [{"code": "82175", "type": "CPT"}, {"code": "3440100859", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.97, "maximum": 164.9, "gross_charge": 170.0, "discounted_cash": 30.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARSENIC TRIOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9017", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.9, "maximum": 11.9, "discounted_cash": 25.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP AOR-CELIAC-MSN-RENAL", "code_information": [{"code": "35631", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORSUBCL/CAROT/INNOM", "code_information": [{"code": "35626", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBI-ILIAC", "code_information": [{"code": "35638", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOBIFEMORAL", "code_information": [{"code": "35646", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOFEMORAL", "code_information": [{"code": "35647", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AORTOILIAC", "code_information": [{"code": "35637", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILL-FEM-FEMORAL", "code_information": [{"code": "35654", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-AXILLARY", "code_information": [{"code": "35650", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-FEMORAL", "code_information": [{"code": "35621", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP AXILLARY-POP-TIBIAL", "code_information": [{"code": "35623", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-SUBCLAVIAN", "code_information": [{"code": "35606", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35666", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-POPLITEAL", "code_information": [{"code": "35656", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": "35540", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOFEMORAL", "code_information": [{"code": "35539", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRCHL-ULNR-RDL", "code_information": [{"code": "35523", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CONTRAL CAROTID", "code_information": [{"code": "35509", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT HEPATORENAL", "code_information": [{"code": "35535", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOFEMORAL", "code_information": [{"code": "35565", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT ILIOILIAC", "code_information": [{"code": "35563", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-AXILARY", "code_information": [{"code": "35516", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-VERTBRL", "code_information": [{"code": "35515", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-CELIAC", "code_information": [{"code": "35632", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOFEMORAL", "code_information": [{"code": "35665", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35571", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART BYP TIBIAL-TIB/PERONEAL", "code_information": [{"code": "35570", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART SURF INS TIP*425", "code_information": [{"code": "3100204384", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ART SURFACE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART SURFACE RT *4252", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART SURFACE RT *4252", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART SURFACE RT MRD*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART SURFACE RT MRD*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART SURFACE RT MRD*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART SURFACE SZ10MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ CAROTID SUBCLAV", "code_information": [{"code": "35695", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAV CAROTID", "code_information": [{"code": "35694", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ SUBCLAVIAN", "code_information": [{"code": "35693", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC 1 SQ CM", "code_information": [{"code": "Q4190", "type": "HCPCS"}], "standard_charges": [{"minimum": 320.38, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 320.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTACENT AC, 1 MG", "code_information": [{"code": "Q4189", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTACENT CORD PER SQ CM", "code_information": [{"code": "Q4216", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTACENT WOUND, PER SQ CM", "code_information": [{"code": "Q4169", "type": "HCPCS"}], "standard_charges": [{"minimum": 176.06, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 176.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTCULAR SURFACE*596", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY EXPOS/GRAFT ARTERY", "code_information": [{"code": "33987", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY TO VEIN SHUNT", "code_information": [{"code": "36835", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5104.6, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY TRANSPOSE/ENDOVAS TAA", "code_information": [{"code": "33889", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAY EACH VESSEL", "code_information": [{"code": "75774", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ABDOMEN", "code_information": [{"code": "75726", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARM/LEG", "code_information": [{"code": "75710", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARMS/LEGS", "code_information": [{"code": "75716", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75741", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75746", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNGS", "code_information": [{"code": "75743", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS PELVIS", "code_information": [{"code": "75736", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS SPINE", "code_information": [{"code": "75705", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTH BIO SWIV W/LOOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTH BIO SWIVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTH BIO TAK MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTH ELBOW SYNOVEC C", "code_information": [{"code": "29836", "type": "CPT"}, {"code": "3340102322", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 14459.79, "gross_charge": 14907.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14459.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11925.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTH SHAFT CURVED", "code_information": [{"code": "3100100071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTH SWIVEL TENODIS*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHDSIS POST/POSTE", "code_information": [{"code": "22633", "type": "CPT"}, {"code": "3480101507", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3160.5, "maximum": 22630.21, "gross_charge": 4515.0, "discounted_cash": 28525.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3837.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19663.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3386.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3160.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4379.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3160.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19587.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3386.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22630.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3837.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3612.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHDSIS POST/POSTER", "code_information": [{"code": "22634", "type": "CPT"}, {"code": "3480101508", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1009.4, "maximum": 7959.27, "gross_charge": 1442.0, "discounted_cash": 2163.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1225.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1081.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1009.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1398.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1009.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1081.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1225.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1153.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHR SI JT OPN B1GRF INSTRM", "code_information": [{"code": "27280", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT DFRM 4-7 VRT SGM", "code_information": [{"code": "22810", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD ANT TORAL/XORAL C1-C2", "code_information": [{"code": "22548", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD GLENOHUMERAL JT W/GRF", "code_information": [{"code": "23802", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 12563.69, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD HIP JT SBTRCHC OSTEOT", "code_information": [{"code": "27286", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD LAT XTRCVTRY TQ LMBR", "code_information": [{"code": "22533", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PRE-SAC NTRBDY L5-S1", "code_information": [{"code": "22586", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ 1NTRSPC LM EA", "code_information": [{"code": "22632", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD PST TQ CRANIOCERVICAL", "code_information": [{"code": "22590", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRD SI JT PERQ/MIN NVAS", "code_information": [{"code": "27279", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHREX KIT", "code_information": [{"code": "3100103957", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTHRO, LOOSE BODY + CHONDRO", "code_information": [{"code": "G0289", "type": "HCPCS"}], "standard_charges": [{"minimum": 7500.92, "maximum": 7500.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROCELL 2.5CC*ABS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1712.2, "maximum": 2372.62, "gross_charge": 2446.0, "discounted_cash": 3669.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2079.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1834.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1712.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2372.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1712.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1834.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2079.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1956.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROCELL PLUS1CC*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS ANTERIOR", "code_information": [{"code": "22511", "type": "CPT"}, {"code": "3480103143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3303.0, "maximum": 8833.79, "gross_charge": 9107.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7740.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6830.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6374.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8833.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6374.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6830.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7740.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7285.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS GLENOHUMERAL JT", "code_information": [{"code": "23800", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS HIP JOINT", "code_information": [{"code": "27284", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS LATERAL", "code_information": [{"code": "22534", "type": "CPT"}, {"code": "3480103092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 836.5, "maximum": 14462.5, "gross_charge": 1195.0, "discounted_cash": 1792.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1015.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 896.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 836.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1159.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 836.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 896.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1015.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 956.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS POST C1-", "code_information": [{"code": "22595", "type": "CPT"}, {"code": "3340102320", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3449.6, "maximum": 14462.5, "gross_charge": 4928.0, "discounted_cash": 7392.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4188.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3696.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3449.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4780.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3449.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3696.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4188.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3942.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS SYMPHYSIS PUBIS", "code_information": [{"code": "27282", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS, GREAT T", "code_information": [{"code": "28750", "type": "CPT"}, {"code": "3480101779", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14692.59, "gross_charge": 15147.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12874.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11360.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10602.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14692.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10602.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11360.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12874.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS, GREAT T", "code_information": [{"code": "28755", "type": "CPT"}, {"code": "3480101780", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8687.35, "gross_charge": 5544.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS, INTERPH", "code_information": [{"code": "26860", "type": "CPT"}, {"code": "3480101656", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7014.07, "gross_charge": 7231.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS, MIDTARS", "code_information": [{"code": "28735", "type": "CPT"}, {"code": "3480101777", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17631.69, "gross_charge": 18177.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15450.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13632.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12723.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17631.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12723.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13632.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15450.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14541.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRODESIS, MIDTARS", "code_information": [{"code": "28740", "type": "CPT"}, {"code": "3480101778", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14692.59, "gross_charge": 15147.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12874.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11360.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10602.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14692.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10602.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11360.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12874.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROEREISIS, SUBTALAR", "code_information": [{"code": "S2117", "type": "HCPCS"}], "standard_charges": [{"minimum": 3498.15, "maximum": 3498.15, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROFLE 10X14X2MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "3100104028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 4004.0, "gross_charge": 10010.0, "discounted_cash": 15015.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX 20X30X4MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2620.8, "maximum": 3631.68, "gross_charge": 3744.0, "discounted_cash": 5616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3631.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2995.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROFLEX 40X50X3MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY TM JNT", "code_information": [{"code": "21240", "type": "CPT"}, {"code": "3340102347", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY, KNEE,", "code_information": [{"code": "27446", "type": "CPT"}, {"code": "3480101703", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 13430.15, "maximum": 32598.79, "gross_charge": 33607.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28565.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25205.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23524.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32598.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23524.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25205.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28565.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26885.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROPLASTY, TOTAL", "code_information": [{"code": "27130", "type": "CPT"}, {"code": "3480101668", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 10062.5, "maximum": 15981.88, "gross_charge": 14375.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12218.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10781.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10062.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13943.75, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10062.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10781.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12218.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11500.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPIC ROTATOR", "code_information": [{"code": "29827", "type": "CPT"}, {"code": "3480101794", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AID", "code_information": [{"code": "29850", "type": "CPT"}, {"code": "3480101804", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AID", "code_information": [{"code": "29855", "type": "CPT"}, {"code": "3480101805", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AID", "code_information": [{"code": "29888", "type": "CPT"}, {"code": "3480101818", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPICALLY AID", "code_information": [{"code": "29889", "type": "CPT"}, {"code": "3480101819", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 23883.34, "gross_charge": 24622.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23883.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19697.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY", "code_information": [{"code": "509", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10293.55, "maximum": 10293.55, "discounted_cash": 14806.44, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10293.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE", "code_information": [{"code": "29899", "type": "CPT"}, {"code": "3480101824", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY ANKLE SU", "code_information": [{"code": "29897", "type": "CPT"}, {"code": "3480103041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY CLAVICUL", "code_information": [{"code": "29824", "type": "CPT"}, {"code": "3480101791", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY HIP SURG", "code_information": [{"code": "29914", "type": "CPT"}, {"code": "3480103039", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7300.29, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY HIP SURG", "code_information": [{"code": "29916", "type": "CPT"}, {"code": "3480103038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7300.29, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY KNEE,SUR", "code_information": [{"code": "29886", "type": "CPT"}, {"code": "3480103032", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY LATERAL", "code_information": [{"code": "29873", "type": "CPT"}, {"code": "3480101807", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ANKLE (", "code_information": [{"code": "29894", "type": "CPT"}, {"code": "3480101821", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ANKLE (", "code_information": [{"code": "29895", "type": "CPT"}, {"code": "3480101822", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5885.96, "gross_charge": 6068.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5157.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4551.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4247.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5885.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4247.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4551.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5157.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4854.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ANKLE (", "code_information": [{"code": "29898", "type": "CPT"}, {"code": "3480101823", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5885.96, "gross_charge": 6068.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5157.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4551.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4247.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5885.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4247.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4551.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5157.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4854.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ANKLE,", "code_information": [{"code": "29891", "type": "CPT"}, {"code": "3480101820", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ELBOW,", "code_information": [{"code": "29834", "type": "CPT"}, {"code": "3480101796", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ELBOW,", "code_information": [{"code": "29835", "type": "CPT"}, {"code": "3480101797", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ELBOW,", "code_information": [{"code": "29837", "type": "CPT"}, {"code": "3480101798", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, ELBOW,", "code_information": [{"code": "29838", "type": "CPT"}, {"code": "3480101799", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, D", "code_information": [{"code": "29870", "type": "CPT"}, {"code": "3480101806", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29874", "type": "CPT"}, {"code": "3480101808", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29875", "type": "CPT"}, {"code": "3480101809", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29876", "type": "CPT"}, {"code": "3480101810", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29879", "type": "CPT"}, {"code": "3480101812", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29880", "type": "CPT"}, {"code": "3480101813", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5120.63, "gross_charge": 5279.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4487.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3959.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3695.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5120.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3695.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3959.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4487.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4223.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29881", "type": "CPT"}, {"code": "3480101814", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29882", "type": "CPT"}, {"code": "3480101815", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29883", "type": "CPT"}, {"code": "3480101816", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, KNEE, S", "code_information": [{"code": "29884", "type": "CPT"}, {"code": "3480101817", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDE", "code_information": [{"code": "29819", "type": "CPT"}, {"code": "3480101788", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15808.09, "gross_charge": 16297.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15808.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDE", "code_information": [{"code": "29822", "type": "CPT"}, {"code": "3480101789", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDE", "code_information": [{"code": "29823", "type": "CPT"}, {"code": "3480101790", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDE", "code_information": [{"code": "29825", "type": "CPT"}, {"code": "3480101792", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15808.09, "gross_charge": 16297.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15808.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDE", "code_information": [{"code": "29826", "type": "CPT"}, {"code": "3480101793", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8602.93, "gross_charge": 8869.0, "discounted_cash": 13303.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8602.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6208.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6651.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7538.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7095.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDE", "code_information": [{"code": "29828", "type": "CPT"}, {"code": "3480101795", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7300.29, "maximum": 15808.09, "gross_charge": 16297.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15808.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, SHOULDER, SURGI", "code_information": [{"code": "S2300", "type": "HCPCS"}], "standard_charges": [{"minimum": 3461.21, "maximum": 3461.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, WRIST,", "code_information": [{"code": "29844", "type": "CPT"}, {"code": "3480101800", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, WRIST,", "code_information": [{"code": "29845", "type": "CPT"}, {"code": "3480101801", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROSCOPY, WRIST,", "code_information": [{"code": "29846", "type": "CPT"}, {"code": "3480101802", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY ELBOW W J", "code_information": [{"code": "24101", "type": "CPT"}, {"code": "3340102315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY WITH MENI", "code_information": [{"code": "27403", "type": "CPT"}, {"code": "3480101697", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8687.35, "gross_charge": 8074.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY, INCLUDIN", "code_information": [{"code": "28020", "type": "CPT"}, {"code": "3480101741", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY, INCLUDIN", "code_information": [{"code": "28022", "type": "CPT"}, {"code": "3480101742", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY, INCLUDIN", "code_information": [{"code": "28024", "type": "CPT"}, {"code": "3480101743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY, KNEE, WI", "code_information": [{"code": "27310", "type": "CPT"}, {"code": "3480101682", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTOMY, WITH EXC", "code_information": [{"code": "27332", "type": "CPT"}, {"code": "3480101686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHROTUNNEL SUT LOA", "code_information": [{"code": "3100100072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTHROTUNNELER", "code_information": [{"code": "3100100073", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1677.0, "discounted_cash": 2515.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ARTHRT ELBOW W/SYNOVECTOMY", "code_information": [{"code": "24102", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW EXPL DRG/RMVL FB", "code_information": [{"code": "24000", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTHRT ELBW SYNOVIAL BX ONLY", "code_information": [{"code": "24100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTIC BEAR SZ12*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIC SURF KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIC SURF KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR BEAR*42-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR BEAR*42-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR BEAR*42-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR BEAR*42-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR BEAR*42-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR BEAR*42-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR INSERT *71", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10626.0, "maximum": 14724.6, "gross_charge": 15180.0, "discounted_cash": 22770.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12903.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11385.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10626.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14724.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10626.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11385.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12903.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR LARGE*8WC0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5916.82, "maximum": 8199.02, "gross_charge": 8452.6, "discounted_cash": 12678.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7184.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6339.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5916.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8199.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5916.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6339.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7184.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6762.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 8MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 8MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 8MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 9MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 9MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 9MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF 9MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF SZ12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF10MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURF12MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURFACE*59", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTICULAR SURFACE*59", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58321", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL INSEMINATION", "code_information": [{"code": "58322", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ARTIFICIAL TEARS", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300044", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.6, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "AS-AORT GRF F/AORTIC DSJ", "code_information": [{"code": "33858", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AS-AORT GRF F/DS OTH/THN DSJ", "code_information": [{"code": "33859", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASAY OF INTERLEUKIN-6 (IL-6)", "code_information": [{"code": "83529", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 40.05, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33863", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASCENDING AORTIC GRAFT", "code_information": [{"code": "33864", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASCENT, 0.5 MG", "code_information": [{"code": "Q4213", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASCOPE 4 BRONCH REG*", "code_information": [{"code": "3100206258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 753.0, "discounted_cash": 1129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASCOPE 4 RHINOLAYNGO", "code_information": [{"code": "3100206250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASHKENAZI JEWISH ASSOC DIS", "code_information": [{"code": "81412", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2448.56, "discounted_cash": 3933.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASP/RELS VITREO SUBR", "code_information": [{"code": "67015", "type": "CPT"}, {"code": "3410100704", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPA GENE", "code_information": [{"code": "81200", "type": "CPT"}], "standard_charges": [{"minimum": 47.25, "maximum": 79.66, "discounted_cash": 75.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPARAGINASE, NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9020", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS AG IA", "code_information": [{"code": "87305", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPERGILLUS ANTIBODY", "code_information": [{"code": "86606", "type": "CPT"}], "standard_charges": [{"minimum": 15.05, "maximum": 30.26, "discounted_cash": 24.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIR/INJ THYROID CYST", "code_information": [{"code": "60300", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASPIR/INJECT TX BONE", "code_information": [{"code": "20615", "type": "CPT"}, {"code": "3480101438", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1207.65, "gross_charge": 1245.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 933.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 871.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1207.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 871.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 933.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 996.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATE PLEURA W IM", "code_information": [{"code": "32555", "type": "CPT"}, {"code": "3340102490", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 641.05, "maximum": 2009.84, "gross_charge": 2072.0, "discounted_cash": 961.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1761.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1450.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2009.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1450.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1761.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1657.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATION OF BLADDE", "code_information": [{"code": "51102", "type": "CPT"}, {"code": "3480102017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4785.01, "gross_charge": 4933.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4193.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3699.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3453.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4785.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3453.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3699.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4193.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3946.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATION ORBITAL CONTENTS", "code_information": [{"code": "67415", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATION TUBING SE", "code_information": [{"code": "3100202592", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.72, "discounted_cash": 332.58, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIRATION&/INJ GANG", "code_information": [{"code": "20612", "type": "CPT"}, {"code": "3480101437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 766.3, "gross_charge": 790.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 671.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 592.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 553.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 766.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 553.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 592.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 671.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 632.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASPIRATOR ENT", "code_information": [{"code": "3100100076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIRATOR ENT", "code_information": [{"code": "3100102124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ASPIRATOR SET ENDO C", "code_information": [{"code": "3100100077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ASSAY ACID PHOSPHATASE", "code_information": [{"code": "84060", "type": "CPT"}], "standard_charges": [{"minimum": 7.64, "maximum": 20.92, "discounted_cash": 12.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY ACTIVATED PROT", "code_information": [{"code": "85307", "type": "CPT"}, {"code": "3440103039", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.32, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 24.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY ALKALINE PHOSPHATASE", "code_information": [{"code": "84078", "type": "CPT"}], "standard_charges": [{"minimum": 8.26, "maximum": 20.92, "discounted_cash": 13.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY AMINOLEVULINIC ACID", "code_information": [{"code": "82135", "type": "CPT"}], "standard_charges": [{"minimum": 16.45, "maximum": 40.05, "discounted_cash": 26.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY ANTI-MULLERIAN HORM", "code_information": [{"code": "82166", "type": "CPT"}], "standard_charges": [{"minimum": 38.62, "maximum": 38.62, "discounted_cash": 62.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY BLOOD CATECHOLAMINES", "code_information": [{"code": "82383", "type": "CPT"}], "standard_charges": [{"minimum": 29.08, "maximum": 34.27, "discounted_cash": 46.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY C-D TRANSFER MEASURE", "code_information": [{"code": "82373", "type": "CPT"}], "standard_charges": [{"minimum": 18.06, "maximum": 40.05, "discounted_cash": 29.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY CARBOXYHB QUAL", "code_information": [{"code": "82376", "type": "CPT"}], "standard_charges": [{"minimum": 14.07, "maximum": 40.05, "discounted_cash": 22.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY CHONDROITIN SULFATE", "code_information": [{"code": "82485", "type": "CPT"}], "standard_charges": [{"minimum": 20.65, "maximum": 34.27, "discounted_cash": 33.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY DIR MEAS FR ESTRADIOL", "code_information": [{"code": "82681", "type": "CPT"}], "standard_charges": [{"minimum": 27.94, "maximum": 34.27, "discounted_cash": 44.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY DUODENAL FLUID TRYPSIN", "code_information": [{"code": "84485", "type": "CPT"}], "standard_charges": [{"minimum": 7.2, "maximum": 20.92, "discounted_cash": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY FOR CALPROTECTIN FECAL", "code_information": [{"code": "83993", "type": "CPT"}], "standard_charges": [{"minimum": 19.63, "maximum": 40.05, "discounted_cash": 31.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY FOR PHENCYCLIDINE", "code_information": [{"code": "83992", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 25.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY FREE HYDROXYPROLINE", "code_information": [{"code": "83500", "type": "CPT"}], "standard_charges": [{"minimum": 22.65, "maximum": 34.27, "discounted_cash": 36.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY GALACTOSE TRANSFERASE", "code_information": [{"code": "82775", "type": "CPT"}], "standard_charges": [{"minimum": 21.07, "maximum": 40.05, "discounted_cash": 33.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY LIPOPROTEIN PLA2", "code_information": [{"code": "83698", "type": "CPT"}], "standard_charges": [{"minimum": 46.31, "maximum": 53.85, "discounted_cash": 74.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY MALATE DEHYDROGENASE", "code_information": [{"code": "83775", "type": "CPT"}], "standard_charges": [{"minimum": 7.37, "maximum": 20.92, "discounted_cash": 11.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY NONENDOCRINE RECEPTOR", "code_information": [{"code": "84238", "type": "CPT"}], "standard_charges": [{"minimum": 36.57, "maximum": 53.85, "discounted_cash": 58.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF 17-HYDROXYPREGNENO", "code_information": [{"code": "84143", "type": "CPT"}], "standard_charges": [{"minimum": 22.81, "maximum": 34.27, "discounted_cash": 36.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ADP & AMP", "code_information": [{"code": "82030", "type": "CPT"}], "standard_charges": [{"minimum": 25.8, "maximum": 34.27, "discounted_cash": 41.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF AMIKACIN", "code_information": [{"code": "80150", "type": "CPT"}], "standard_charges": [{"minimum": 15.08, "maximum": 41.39, "discounted_cash": 24.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANDROSTENEDIONE", "code_information": [{"code": "82157", "type": "CPT"}], "standard_charges": [{"minimum": 29.28, "maximum": 34.27, "discounted_cash": 47.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANDROSTERONE", "code_information": [{"code": "82160", "type": "CPT"}], "standard_charges": [{"minimum": 25.55, "maximum": 34.27, "discounted_cash": 41.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ANGIOTENSIN II", "code_information": [{"code": "82163", "type": "CPT"}], "standard_charges": [{"minimum": 20.52, "maximum": 34.27, "discounted_cash": 32.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF APOLIPOPROTEIN", "code_information": [{"code": "82172", "type": "CPT"}], "standard_charges": [{"minimum": 21.09, "maximum": 40.05, "discounted_cash": 33.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ASCORBIC ACID", "code_information": [{"code": "82180", "type": "CPT"}], "standard_charges": [{"minimum": 9.89, "maximum": 20.92, "discounted_cash": 15.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF B HEXOSAMINIDASE EA", "code_information": [{"code": "83080", "type": "CPT"}], "standard_charges": [{"minimum": 16.87, "maximum": 40.05, "discounted_cash": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BETA-2 PROTEIN", "code_information": [{"code": "82232", "type": "CPT"}], "standard_charges": [{"minimum": 16.18, "maximum": 34.27, "discounted_cash": 26.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BIOTINIDASE", "code_information": [{"code": "82261", "type": "CPT"}], "standard_charges": [{"minimum": 16.87, "maximum": 40.05, "discounted_cash": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD FATTY ACIDS", "code_information": [{"code": "82725", "type": "CPT"}], "standard_charges": [{"minimum": 18.77, "maximum": 40.05, "discounted_cash": 30.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD LIPOPROTEIN", "code_information": [{"code": "83719", "type": "CPT"}], "standard_charges": [{"minimum": 12.75, "maximum": 40.05, "discounted_cash": 20.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD PKU", "code_information": [{"code": "84030", "type": "CPT"}], "standard_charges": [{"minimum": 5.5, "maximum": 20.92, "discounted_cash": 8.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BRADYKININ", "code_information": [{"code": "82286", "type": "CPT"}], "standard_charges": [{"minimum": 5.16, "maximum": 20.92, "discounted_cash": 8.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BREATH ETHANOL", "code_information": [{"code": "82075", "type": "CPT"}], "standard_charges": [{"minimum": 30.0, "maximum": 44.95, "discounted_cash": 48.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CALCITONIN", "code_information": [{"code": "82308", "type": "CPT"}], "standard_charges": [{"minimum": 26.79, "maximum": 34.27, "discounted_cash": 43.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CARNITINE", "code_information": [{"code": "82379", "type": "CPT"}], "standard_charges": [{"minimum": 16.87, "maximum": 40.05, "discounted_cash": 27.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CAROTENE", "code_information": [{"code": "82380", "type": "CPT"}], "standard_charges": [{"minimum": 9.22, "maximum": 20.92, "discounted_cash": 14.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CATHEPSIN-D", "code_information": [{"code": "82387", "type": "CPT"}], "standard_charges": [{"minimum": 18.06, "maximum": 40.05, "discounted_cash": 29.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CHLORAMPHENICOL", "code_information": [{"code": "82415", "type": "CPT"}], "standard_charges": [{"minimum": 12.67, "maximum": 41.39, "discounted_cash": 20.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CHROMIUM", "code_information": [{"code": "82495", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 20.28, "discounted_cash": 32.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CORTICOSTERONE", "code_information": [{"code": "82528", "type": "CPT"}], "standard_charges": [{"minimum": 22.52, "maximum": 34.27, "discounted_cash": 36.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CRYOFIBRINOGEN", "code_information": [{"code": "82585", "type": "CPT"}], "standard_charges": [{"minimum": 14.14, "maximum": 40.05, "discounted_cash": 22.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF CYANIDE", "code_information": [{"code": "82600", "type": "CPT"}], "standard_charges": [{"minimum": 19.4, "maximum": 20.03, "discounted_cash": 31.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF DIBUCAINE NUMBER", "code_information": [{"code": "82638", "type": "CPT"}], "standard_charges": [{"minimum": 12.25, "maximum": 40.05, "discounted_cash": 19.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF DIGOXIN FREE", "code_information": [{"code": "80163", "type": "CPT"}], "standard_charges": [{"minimum": 13.28, "maximum": 41.39, "discounted_cash": 21.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ENDOCRINE HORMONE", "code_information": [{"code": "84235", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 71.23, "discounted_cash": 114.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 71.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTRIOL", "code_information": [{"code": "82677", "type": "CPT"}], "standard_charges": [{"minimum": 24.18, "maximum": 34.27, "discounted_cash": 38.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGEN", "code_information": [{"code": "82672", "type": "CPT"}], "standard_charges": [{"minimum": 21.7, "maximum": 34.27, "discounted_cash": 34.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGEN", "code_information": [{"code": "84233", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 87.88, "discounted_cash": 141.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 87.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTROGENS", "code_information": [{"code": "82671", "type": "CPT"}], "standard_charges": [{"minimum": 32.3, "maximum": 68.09, "discounted_cash": 51.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ESTRONE", "code_information": [{"code": "82679", "type": "CPT"}], "standard_charges": [{"minimum": 24.95, "maximum": 34.27, "discounted_cash": 40.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETHOSUXIMIDE", "code_information": [{"code": "80168", "type": "CPT"}], "standard_charges": [{"minimum": 16.34, "maximum": 41.39, "discounted_cash": 26.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETHYLENE GLYCOL", "code_information": [{"code": "82693", "type": "CPT"}], "standard_charges": [{"minimum": 14.9, "maximum": 20.03, "discounted_cash": 23.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF ETIOCHOLANOLONE", "code_information": [{"code": "82696", "type": "CPT"}], "standard_charges": [{"minimum": 26.24, "maximum": 34.27, "discounted_cash": 42.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECAL FAT", "code_information": [{"code": "82715", "type": "CPT"}], "standard_charges": [{"minimum": 22.97, "maximum": 40.05, "discounted_cash": 36.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES FOR TRYPSIN", "code_information": [{"code": "84490", "type": "CPT"}], "standard_charges": [{"minimum": 9.93, "maximum": 20.92, "discounted_cash": 15.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES PORPHYRINS", "code_information": [{"code": "84126", "type": "CPT"}], "standard_charges": [{"minimum": 39.11, "maximum": 53.85, "discounted_cash": 62.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FECES/UROBILINOGEN", "code_information": [{"code": "84577", "type": "CPT"}], "standard_charges": [{"minimum": 16.8, "maximum": 40.05, "discounted_cash": 26.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FETAL FIBRONECTIN", "code_information": [{"code": "82731", "type": "CPT"}], "standard_charges": [{"minimum": 64.41, "maximum": 181.56, "discounted_cash": 103.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF FLUORIDE", "code_information": [{"code": "82735", "type": "CPT"}], "standard_charges": [{"minimum": 18.54, "maximum": 20.03, "discounted_cash": 29.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GALACTOSE", "code_information": [{"code": "82760", "type": "CPT"}], "standard_charges": [{"minimum": 11.2, "maximum": 40.05, "discounted_cash": 18.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GDH ENZYME", "code_information": [{"code": "82965", "type": "CPT"}], "standard_charges": [{"minimum": 13.15, "maximum": 40.05, "discounted_cash": 21.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUCAGON", "code_information": [{"code": "82943", "type": "CPT"}], "standard_charges": [{"minimum": 14.29, "maximum": 34.27, "discounted_cash": 22.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUCOSIDASE", "code_information": [{"code": "82963", "type": "CPT"}], "standard_charges": [{"minimum": 21.48, "maximum": 40.05, "discounted_cash": 34.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF GLUTATHIONE", "code_information": [{"code": "82978", "type": "CPT"}], "standard_charges": [{"minimum": 15.45, "maximum": 40.05, "discounted_cash": 24.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HAPTOGLOBINS", "code_information": [{"code": "83012", "type": "CPT"}], "standard_charges": [{"minimum": 26.89, "maximum": 53.85, "discounted_cash": 43.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HISTAMINE", "code_information": [{"code": "83088", "type": "CPT"}], "standard_charges": [{"minimum": 29.53, "maximum": 53.85, "discounted_cash": 47.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF HOMOVANILLIC ACID", "code_information": [{"code": "83150", "type": "CPT"}], "standard_charges": [{"minimum": 22.41, "maximum": 34.27, "discounted_cash": 36.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF IDH ENZYME", "code_information": [{"code": "83570", "type": "CPT"}], "standard_charges": [{"minimum": 8.85, "maximum": 20.92, "discounted_cash": 14.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INTRINSIC FACTOR", "code_information": [{"code": "83528", "type": "CPT"}], "standard_charges": [{"minimum": 19.82, "maximum": 40.05, "discounted_cash": 31.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF KETOGENIC STEROIDS", "code_information": [{"code": "83582", "type": "CPT"}], "standard_charges": [{"minimum": 15.47, "maximum": 34.27, "discounted_cash": 24.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LAP ENZYME", "code_information": [{"code": "83670", "type": "CPT"}], "standard_charges": [{"minimum": 9.81, "maximum": 20.92, "discounted_cash": 15.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LDH ENZYMES", "code_information": [{"code": "83625", "type": "CPT"}], "standard_charges": [{"minimum": 12.79, "maximum": 40.05, "discounted_cash": 20.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LIDOCAINE", "code_information": [{"code": "80176", "type": "CPT"}], "standard_charges": [{"minimum": 14.69, "maximum": 41.39, "discounted_cash": 23.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LIPOPROTEIN(A)", "code_information": [{"code": "83695", "type": "CPT"}], "standard_charges": [{"minimum": 14.32, "maximum": 40.05, "discounted_cash": 23.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF LRH HORMONE", "code_information": [{"code": "83727", "type": "CPT"}], "standard_charges": [{"minimum": 17.19, "maximum": 34.27, "discounted_cash": 27.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF MERCURY", "code_information": [{"code": "83825", "type": "CPT"}], "standard_charges": [{"minimum": 16.26, "maximum": 20.03, "discounted_cash": 26.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF METHEMALBUMIN", "code_information": [{"code": "83857", "type": "CPT"}], "standard_charges": [{"minimum": 10.74, "maximum": 20.92, "discounted_cash": 17.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NEONATAL THYROXINE", "code_information": [{"code": "84437", "type": "CPT"}], "standard_charges": [{"minimum": 6.47, "maximum": 34.27, "discounted_cash": 10.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NICKEL", "code_information": [{"code": "83885", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 24.51, "discounted_cash": 39.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF NUCLEOTIDASE", "code_information": [{"code": "83915", "type": "CPT"}], "standard_charges": [{"minimum": 11.15, "maximum": 40.05, "discounted_cash": 17.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF OSTEOCALCIN", "code_information": [{"code": "83937", "type": "CPT"}], "standard_charges": [{"minimum": 29.85, "maximum": 68.09, "discounted_cash": 47.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PHENYLKETONES", "code_information": [{"code": "84035", "type": "CPT"}], "standard_charges": [{"minimum": 3.98, "maximum": 20.92, "discounted_cash": 6.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNANEDIOL", "code_information": [{"code": "84135", "type": "CPT"}], "standard_charges": [{"minimum": 21.27, "maximum": 34.27, "discounted_cash": 34.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNANETRIOL", "code_information": [{"code": "84138", "type": "CPT"}], "standard_charges": [{"minimum": 21.05, "maximum": 34.27, "discounted_cash": 33.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNENOLONE", "code_information": [{"code": "84140", "type": "CPT"}], "standard_charges": [{"minimum": 20.67, "maximum": 34.27, "discounted_cash": 33.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROCAINAMIDE", "code_information": [{"code": "80190", "type": "CPT"}], "standard_charges": [{"minimum": 41.39, "maximum": 60.0, "discounted_cash": 96.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROCAINAMIDE", "code_information": [{"code": "80192", "type": "CPT"}], "standard_charges": [{"minimum": 16.75, "maximum": 41.39, "discounted_cash": 26.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROGESTERONE", "code_information": [{"code": "84234", "type": "CPT"}], "standard_charges": [{"minimum": 64.88, "maximum": 68.09, "discounted_cash": 104.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROSTAGLANDIN", "code_information": [{"code": "84150", "type": "CPT"}], "standard_charges": [{"minimum": 41.77, "maximum": 68.09, "discounted_cash": 67.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN ANY SOURCE", "code_information": [{"code": "84160", "type": "CPT"}], "standard_charges": [{"minimum": 5.61, "maximum": 20.92, "discounted_cash": 9.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PSA COMPLEXED", "code_information": [{"code": "84152", "type": "CPT"}], "standard_charges": [{"minimum": 18.39, "maximum": 40.05, "discounted_cash": 29.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PYRUVATE", "code_information": [{"code": "84210", "type": "CPT"}], "standard_charges": [{"minimum": 14.48, "maximum": 40.05, "discounted_cash": 23.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PYRUVATE KINASE", "code_information": [{"code": "84220", "type": "CPT"}], "standard_charges": [{"minimum": 9.44, "maximum": 20.92, "discounted_cash": 15.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF QUINIDINE", "code_information": [{"code": "80194", "type": "CPT"}], "standard_charges": [{"minimum": 14.6, "maximum": 41.39, "discounted_cash": 23.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF QUININE", "code_information": [{"code": "84228", "type": "CPT"}], "standard_charges": [{"minimum": 11.63, "maximum": 41.39, "discounted_cash": 18.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RBC GALACTOKINASE", "code_information": [{"code": "82759", "type": "CPT"}], "standard_charges": [{"minimum": 21.48, "maximum": 40.05, "discounted_cash": 34.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF RBC PG6D ENZYME", "code_information": [{"code": "84085", "type": "CPT"}], "standard_charges": [{"minimum": 9.44, "maximum": 20.92, "discounted_cash": 15.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SELENIUM", "code_information": [{"code": "84255", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 25.53, "discounted_cash": 41.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SEMEN FRUCTOSE", "code_information": [{"code": "82757", "type": "CPT"}], "standard_charges": [{"minimum": 17.34, "maximum": 40.05, "discounted_cash": 27.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SIALIC ACID", "code_information": [{"code": "84275", "type": "CPT"}], "standard_charges": [{"minimum": 13.44, "maximum": 40.05, "discounted_cash": 21.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SILICA", "code_information": [{"code": "84285", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 25.21, "discounted_cash": 40.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SIROLIMUS", "code_information": [{"code": "80195", "type": "CPT"}], "standard_charges": [{"minimum": 13.73, "maximum": 41.39, "discounted_cash": 22.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SOMATOSTATIN", "code_information": [{"code": "84307", "type": "CPT"}], "standard_charges": [{"minimum": 18.28, "maximum": 34.27, "discounted_cash": 29.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SWEAT SODIUM", "code_information": [{"code": "84302", "type": "CPT"}], "standard_charges": [{"minimum": 4.86, "maximum": 20.92, "discounted_cash": 7.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THIOCYANATE", "code_information": [{"code": "84430", "type": "CPT"}], "standard_charges": [{"minimum": 11.63, "maximum": 20.03, "discounted_cash": 18.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROGLOBULIN", "code_information": [{"code": "84432", "type": "CPT"}], "standard_charges": [{"minimum": 16.06, "maximum": 34.27, "discounted_cash": 25.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROID ACTIVITY", "code_information": [{"code": "84442", "type": "CPT"}], "standard_charges": [{"minimum": 14.78, "maximum": 34.27, "discounted_cash": 23.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TOPIRAMATE", "code_information": [{"code": "80201", "type": "CPT"}, {"code": "3440103078", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.92, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 19.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TRANSCORTIN", "code_information": [{"code": "84449", "type": "CPT"}], "standard_charges": [{"minimum": 18.0, "maximum": 34.27, "discounted_cash": 28.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TROPONIN QUAL", "code_information": [{"code": "84512", "type": "CPT"}], "standard_charges": [{"minimum": 10.09, "maximum": 20.92, "discounted_cash": 16.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TSI GLOBULIN", "code_information": [{"code": "84445", "type": "CPT"}], "standard_charges": [{"minimum": 50.86, "maximum": 68.09, "discounted_cash": 81.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF TYROSINE", "code_information": [{"code": "84510", "type": "CPT"}], "standard_charges": [{"minimum": 10.63, "maximum": 20.92, "discounted_cash": 17.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE PHOSPHORUS", "code_information": [{"code": "84105", "type": "CPT"}], "standard_charges": [{"minimum": 5.78, "maximum": 20.92, "discounted_cash": 9.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE SULFATE", "code_information": [{"code": "84392", "type": "CPT"}], "standard_charges": [{"minimum": 5.49, "maximum": 16.02, "discounted_cash": 8.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE UROBILINOGEN", "code_information": [{"code": "84580", "type": "CPT"}], "standard_charges": [{"minimum": 9.55, "maximum": 20.92, "discounted_cash": 15.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE UROBILINOGEN", "code_information": [{"code": "84583", "type": "CPT"}], "standard_charges": [{"minimum": 6.05, "maximum": 20.92, "discounted_cash": 9.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE VMA", "code_information": [{"code": "84585", "type": "CPT"}], "standard_charges": [{"minimum": 15.5, "maximum": 34.27, "discounted_cash": 24.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF URINE/URIC ACID", "code_information": [{"code": "84560", "type": "CPT"}], "standard_charges": [{"minimum": 5.08, "maximum": 20.92, "discounted_cash": 8.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VIP", "code_information": [{"code": "84586", "type": "CPT"}], "standard_charges": [{"minimum": 35.33, "maximum": 68.09, "discounted_cash": 56.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN A", "code_information": [{"code": "84590", "type": "CPT"}], "standard_charges": [{"minimum": 11.61, "maximum": 40.05, "discounted_cash": 18.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN B-2", "code_information": [{"code": "84252", "type": "CPT"}], "standard_charges": [{"minimum": 20.24, "maximum": 40.05, "discounted_cash": 32.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN B6", "code_information": [{"code": "84207", "type": "CPT"}, {"code": "3440103086", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 28.1, "maximum": 170.72, "gross_charge": 176.0, "discounted_cash": 45.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 170.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 35.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VITAMIN K", "code_information": [{"code": "84597", "type": "CPT"}], "standard_charges": [{"minimum": 13.72, "maximum": 40.05, "discounted_cash": 22.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF VOLATILES", "code_information": [{"code": "84600", "type": "CPT"}], "standard_charges": [{"minimum": 17.11, "maximum": 40.05, "discounted_cash": 27.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OTHER FLUID CHLORIDES", "code_information": [{"code": "82438", "type": "CPT"}], "standard_charges": [{"minimum": 5.0, "maximum": 20.92, "discounted_cash": 8.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY PHOSPHATIDYLGLYCEROL", "code_information": [{"code": "84081", "type": "CPT"}], "standard_charges": [{"minimum": 16.52, "maximum": 40.05, "discounted_cash": 26.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY PHOSPHOHEXOSE ENZYMES", "code_information": [{"code": "84087", "type": "CPT"}], "standard_charges": [{"minimum": 10.73, "maximum": 20.92, "discounted_cash": 17.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY PROSTATE PHOSPHATASE", "code_information": [{"code": "84066", "type": "CPT"}], "standard_charges": [{"minimum": 9.66, "maximum": 20.92, "discounted_cash": 15.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC CHOLINESTERASE", "code_information": [{"code": "82482", "type": "CPT"}], "standard_charges": [{"minimum": 9.81, "maximum": 20.92, "discounted_cash": 15.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC GLUTATHIONE", "code_information": [{"code": "82979", "type": "CPT"}], "standard_charges": [{"minimum": 9.44, "maximum": 20.92, "discounted_cash": 15.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY RBC PROTOPORPHYRIN", "code_information": [{"code": "84202", "type": "CPT"}], "standard_charges": [{"minimum": 14.35, "maximum": 40.05, "discounted_cash": 23.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY SERUM CHOLINESTERASE", "code_information": [{"code": "82480", "type": "CPT"}], "standard_charges": [{"minimum": 7.87, "maximum": 20.92, "discounted_cash": 12.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY SPEC XCP UR&BREATH IA", "code_information": [{"code": "82077", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 44.95, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY SYNOVIAL FLUID MUCIN", "code_information": [{"code": "83872", "type": "CPT"}], "standard_charges": [{"minimum": 5.86, "maximum": 20.92, "discounted_cash": 9.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY TEST FOR BLOOD FECAL", "code_information": [{"code": "82274", "type": "CPT"}], "standard_charges": [{"minimum": 15.92, "maximum": 40.05, "discounted_cash": 25.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY TOTAL HYDROXYPROLINE", "code_information": [{"code": "83505", "type": "CPT"}], "standard_charges": [{"minimum": 24.3, "maximum": 34.27, "discounted_cash": 39.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY URINE CATECHOLAMINES", "code_information": [{"code": "82382", "type": "CPT"}], "standard_charges": [{"minimum": 27.3, "maximum": 34.27, "discounted_cash": 43.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSESS CYST CONTRAST INJECT", "code_information": [{"code": "49424", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSESS OF SALIVARY FLOW", "code_information": [{"code": "D0419", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT FOR HEARING AID", "code_information": [{"code": "V5010", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT OF A PATIENT", "code_information": [{"code": "D0191", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSESSMENT OF APHASIA", "code_information": [{"code": "96105", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89280", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 1316.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSIST OOCYTE FERTILIZATION", "code_information": [{"code": "89281", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSISTIVE TECHNOLOGY ASSESS", "code_information": [{"code": "97755", "type": "CPT"}], "standard_charges": [{"minimum": 145.07, "maximum": 145.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSMT & CARE PLN PT COG IMP", "code_information": [{"code": "99483", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASST OOCYTE FERT CASE RATE", "code_information": [{"code": "S4022", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASTHMA EDUCATION", "code_information": [{"code": "S9441", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASTRAZENECA VACC ADM 1ST DOS", "code_information": [{"code": "D1705", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASTRAZENECA VACC ADM 2ND DOS", "code_information": [{"code": "D1706", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASXL1 FULL GENE SEQUENCE", "code_information": [{"code": "81175", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 676.5, "discounted_cash": 1086.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASXL1 GENE TARGET SEQ ALYS", "code_information": [{"code": "81176", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 241.9, "discounted_cash": 388.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 241.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASY CARBAMAZEPIN 10,11-EPXID", "code_information": [{"code": "80161", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYCORTICOSTEROIDS17", "code_information": [{"code": "83491", "type": "CPT"}], "standard_charges": [{"minimum": 17.9, "maximum": 34.27, "discounted_cash": 28.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASY HYDROXYPROGESTERONE 17-D", "code_information": [{"code": "83498", "type": "CPT"}], "standard_charges": [{"minimum": 27.17, "maximum": 34.27, "discounted_cash": 43.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASY THIOPURIN S-MTHYLTRNSFRS", "code_information": [{"code": "84433", "type": "CPT"}], "standard_charges": [{"minimum": 22.17, "maximum": 22.17, "discounted_cash": 35.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASYM PATELLA 40X11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITH MCC", "code_information": [{"code": "302", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4373.93, "maximum": 4373.93, "discounted_cash": 12516.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4373.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [{"code": "303", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3784.3, "maximum": 3784.3, "discounted_cash": 7347.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3784.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATLANTIS TRAN LEV1*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2471.56, "maximum": 3424.87, "gross_charge": 3530.8, "discounted_cash": 5296.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3001.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2471.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3424.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2471.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3001.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2824.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATLANTIS TRAN LEV2*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3177.51, "maximum": 4403.12, "gross_charge": 4539.3, "discounted_cash": 6808.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3858.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3404.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3177.51, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4403.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3177.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3404.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3858.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3631.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATLANTIS TRAN LEV3*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3880.24, "maximum": 5376.9, "gross_charge": 5543.2, "discounted_cash": 8314.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4711.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4157.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5376.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4157.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4711.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4434.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATLANTIS TRAN LEV4*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATLAS CABLE 12 PACK*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3625.44, "maximum": 5023.82, "gross_charge": 5179.2, "discounted_cash": 7768.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4402.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3884.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3625.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5023.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3625.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3884.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4402.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4143.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATM MRNA SEQ ALYS", "code_information": [{"code": "136U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 654.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATN1 GENE DETC ABNOR ALLELES", "code_information": [{"code": "81177", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATOMIC ABSORPTION", "code_information": [{"code": "82190", "type": "CPT"}], "standard_charges": [{"minimum": 15.9, "maximum": 40.05, "discounted_cash": 25.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATOMIZER MUCOSAL", "code_information": [{"code": "3100100078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ATRACURIUM BESYLATE", "code_information": [{"code": "3400300259", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.4, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "ATROPINE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7635", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATROPINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7636", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ATROPINE SULFATE", "code_information": [{"code": "3400300222", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 85.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ATROPINE SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "3400300123", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 10.57, "gross_charge": 10.9, "discounted_cash": 16.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATROPINE SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0461", "type": "HCPCS"}, {"code": "3400300170", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 42.19, "gross_charge": 43.5, "discounted_cash": 65.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51840", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTACH BLADDER/URETHRA", "code_information": [{"code": "51841", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTACH OCULAR IMPLANT", "code_information": [{"code": "65140", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC AFTER CARE", "code_information": [{"code": "59622", "type": "CPT"}], "standard_charges": [{"minimum": 3961.84, "maximum": 3961.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3961.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY", "code_information": [{"code": "59618", "type": "CPT"}], "standard_charges": [{"minimum": 3961.84, "maximum": 3961.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3961.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTEMPTED VBAC DELIVERY ONLY", "code_information": [{"code": "59620", "type": "CPT"}], "standard_charges": [{"minimum": 3961.84, "maximum": 3961.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3961.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATTRACT MAGNET BAHA", "code_information": [{"code": "3100102394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ATXN1 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81178", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATXN10 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81183", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATXN2 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81179", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATXN3 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81180", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATXN7 GENE DETC ABNOR ALLELE", "code_information": [{"code": "81181", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ATXN8OS GEN DETC ABNOR ALLEL", "code_information": [{"code": "81182", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUD BRAINSTEM IMPLT PROGRAMG", "code_information": [{"code": "92640", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUD EVOKE POTEN MLT", "code_information": [{"code": "92652", "type": "CPT"}, {"code": "3500102301", "type": "CDM"}, {"code": "471", "type": "RC"}], "standard_charges": [{"minimum": 147.3, "maximum": 694.52, "gross_charge": 716.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 608.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 608.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 572.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUD REHAB POSTLING HEAR LOSS", "code_information": [{"code": "92633", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUD REHAB PRE-LING HEAR LOSS", "code_information": [{"code": "92630", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "209T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR & BONE", "code_information": [{"code": "92553", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY AIR ONLY", "code_information": [{"code": "208T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDIOMETRY FOR HEARING AID", "code_information": [{"code": "S0618", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST 15-30 MIN", "code_information": [{"code": "99408", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDIT/DAST OVER 30 MIN", "code_information": [{"code": "99409", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDITOR EVOKE POTENT", "code_information": [{"code": "92585", "type": "CPT"}, {"code": "3340102488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 147.3, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION + 15 MIN", "code_information": [{"code": "92621", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUDITORY FUNCTION 60 MIN", "code_information": [{"code": "92620", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION CHEEK BONE", "code_information": [{"code": "21270", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21125", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION LOWER JAW BONE", "code_information": [{"code": "21127", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUGMENTATION OF FACIAL BONES", "code_information": [{"code": "21208", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AURICULAR ELECTROSTIMULATION", "code_information": [{"code": "S8930", "type": "HCPCS"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AURICULAR PROSTHESIS", "code_information": [{"code": "D5914", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AURICULAR REPLACEMENT", "code_information": [{"code": "D5927", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUROTHIOGLUCOSE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2910", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AUTGRFT IMPLNT KNEE W/SCOPE", "code_information": [{"code": "29866", "type": "CPT"}], "standard_charges": [{"minimum": 7500.92, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTO ALYS XST CT STD VRT FX", "code_information": [{"code": "691T", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTO QUANTIFICATION C PLAQUE", "code_information": [{"code": "623T", "type": "CPT"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOCHONDROCYTE IMPLANT KNEE", "code_information": [{"code": "27412", "type": "CPT"}], "standard_charges": [{"minimum": 7500.92, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOIMMUNE RA ALYS 12 BMRK", "code_information": [{"code": "81490", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 840.65, "discounted_cash": 1350.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 840.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL BLD/CMP CLT P&", "code_information": [{"code": "86890", "type": "CPT"}, {"code": "3440101141", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 102.8, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 136.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL BLD/CMP CLT P&", "code_information": [{"code": "86891", "type": "CPT"}, {"code": "3440101142", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 81.9, "maximum": 1044.18, "gross_charge": 117.0, "discounted_cash": 1316.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 907.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 903.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1044.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 255.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL BLOOD CELL SAV", "code_information": [{"code": "86891", "type": "CPT"}, {"code": "3480102240", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 79.8, "maximum": 1044.18, "gross_charge": 114.0, "discounted_cash": 1316.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 96.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 907.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 110.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 903.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1044.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 96.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 91.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 255.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS HRVG", "code_information": [{"code": "565T", "type": "CPT"}], "standard_charges": [{"minimum": 453.46, "maximum": 453.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 453.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOL CELL IMPLT ADPS NJX", "code_information": [{"code": "566T", "type": "CPT"}], "standard_charges": [{"minimum": 456.57, "maximum": 456.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOLOG PRP NOT DIAB ULCER", "code_information": [{"code": "G0460", "type": "HCPCS"}], "standard_charges": [{"minimum": 208.81, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 208.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC", "code_information": [{"code": "16", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39772.38, "maximum": 39772.38, "discounted_cash": 68963.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39772.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC", "code_information": [{"code": "17", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24260.12, "maximum": 24260.12, "discounted_cash": 68963.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24260.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOMATED RBC COUNT", "code_information": [{"code": "85041", "type": "CPT"}, {"code": "3440103022", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.02, "maximum": 28.13, "gross_charge": 29.0, "discounted_cash": 4.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV ADRENRG INERVJ", "code_information": [{"code": "95922", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AUTOTOME 44*M0054517", "code_information": [{"code": "3100203682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.46, "discounted_cash": 921.69, "setting": "both", "billing_class": "facility"}]}, {"description": "AUTOTRANSPLANT PARATHYROID", "code_information": [{"code": "60512", "type": "CPT"}], "standard_charges": [{"minimum": 5635.04, "maximum": 5635.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION OPEN", "code_information": [{"code": "36832", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM BASILIC", "code_information": [{"code": "36819", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSE UPPR ARM CEPHALIC", "code_information": [{"code": "36818", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSION DIRECT ANY SITE", "code_information": [{"code": "36821", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5104.6, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AV FUSION/FOREARM VEIN", "code_information": [{"code": "36820", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AVANCE NERVE GRAFT*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4666.48, "maximum": 6466.4, "gross_charge": 6666.4, "discounted_cash": 9999.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5666.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4999.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4666.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6466.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4666.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4999.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5666.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5333.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVANCE NERVE GRAFT*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11571.0, "maximum": 16034.1, "gross_charge": 16530.0, "discounted_cash": 24795.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14050.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12397.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11571.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16034.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11571.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12397.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14050.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVANCE NERVE GRAFT*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4398.94, "maximum": 6095.67, "gross_charge": 6284.2, "discounted_cash": 9426.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5341.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4713.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4398.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6095.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4398.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4713.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5341.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5027.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVANCE NERVE GRAFT*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7860.58, "maximum": 10892.51, "gross_charge": 11229.4, "discounted_cash": 16844.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9544.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8422.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7860.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10892.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7860.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8422.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9544.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8983.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AVANCE NERVE GRAFT*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11072.6, "maximum": 15343.46, "gross_charge": 15818.0, "discounted_cash": 23727.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13445.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11863.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11072.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15343.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11072.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11863.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13445.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12654.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AXICABTAGENE CILOLEUCEL CAR+", "code_information": [{"code": "Q2041", "type": "HCPCS"}], "standard_charges": [{"minimum": 459381.45, "maximum": 459381.45, "discounted_cash": 722025.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 459381.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AXIOS STENT 15MM*M00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 8972.6, "maximum": 12433.46, "gross_charge": 12818.0, "discounted_cash": 19227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10895.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8972.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12433.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8972.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10895.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10254.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AXOLOTL AMBIENT, CRYO 0.1 MG", "code_information": [{"code": "Q4215", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AXOLOTL GRAF DUALGRAF SQ CM", "code_information": [{"code": "Q4210", "type": "HCPCS"}], "standard_charges": [{"minimum": 848.0, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 848.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AZACITIDINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9025", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE ORAL 50MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7500", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.56, "maximum": 2.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZATHIOPRINE PARENTERAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 234.35, "maximum": 234.35, "discounted_cash": 385.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 234.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0456", "type": "HCPCS"}, {"code": "3400300284", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.41, "maximum": 21.53, "gross_charge": 22.2, "discounted_cash": 33.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 21.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AZITHROMYCIN DIHYDRATE, ORAL", "code_information": [{"code": "Q0144", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "AZTREONAM", "code_information": [{"code": "3400300285", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 231.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Abd us w/contrast", "code_information": [{"code": "C9744", "type": "HCPCS"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abdominal Pain, Major", "code_information": [{"code": "251.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12083.26, "maximum": 12083.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12083.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abdominal Pain, Minor", "code_information": [{"code": "251.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6812.45, "maximum": 6812.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6812.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abdominal Pain, Moderate", "code_information": [{"code": "251.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8433.55, "maximum": 8433.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8433.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abdominal Pain, Severe", "code_information": [{"code": "251.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18661.2, "maximum": 18661.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18661.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ablation, hifu, prostate", "code_information": [{"code": "C9747", "type": "HCPCS"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion With D&C, Aspiration Curettage Or Hysterotomy, Major", "code_information": [{"code": "543.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14111.88, "maximum": 14111.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14111.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion With D&C, Aspiration Curettage Or Hysterotomy, Minor", "code_information": [{"code": "543.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7316.08, "maximum": 7316.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7316.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion With D&C, Aspiration Curettage Or Hysterotomy, Moderate", "code_information": [{"code": "543.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8236.2, "maximum": 8236.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8236.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion With D&C, Aspiration Curettage Or Hysterotomy, Severe", "code_information": [{"code": "543.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34931.13, "maximum": 34931.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34931.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion Without D&C, Aspiration Curettage Or Hysterotomy, Major", "code_information": [{"code": "564.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8568.11, "maximum": 8568.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8568.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion Without D&C, Aspiration Curettage Or Hysterotomy, Minor", "code_information": [{"code": "564.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5587.34, "maximum": 5587.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5587.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion Without D&C, Aspiration Curettage Or Hysterotomy, Moderate", "code_information": [{"code": "564.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6617.67, "maximum": 6617.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6617.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Abortion Without D&C, Aspiration Curettage Or Hysterotomy, Severe", "code_information": [{"code": "564.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21352.35, "maximum": 21352.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21352.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute And Subacute Endocarditis, Major", "code_information": [{"code": "193.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26723.12, "maximum": 26723.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26723.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute And Subacute Endocarditis, Minor", "code_information": [{"code": "193.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10835.08, "maximum": 10835.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10835.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute And Subacute Endocarditis, Moderate", "code_information": [{"code": "193.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16430.11, "maximum": 16430.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16430.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute And Subacute Endocarditis, Severe", "code_information": [{"code": "193.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29925.59, "maximum": 29925.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29925.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Anxiety And Delirium States, Major", "code_information": [{"code": "756.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12548.45, "maximum": 12548.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12548.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Anxiety And Delirium States, Minor", "code_information": [{"code": "756.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5537.36, "maximum": 5537.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5537.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Anxiety And Delirium States, Moderate", "code_information": [{"code": "756.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6447.23, "maximum": 6447.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Anxiety And Delirium States, Severe", "code_information": [{"code": "756.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16254.55, "maximum": 16254.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16254.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Bronchitis And Related Symptoms, Major", "code_information": [{"code": "145.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7595.45, "maximum": 7595.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7595.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Bronchitis And Related Symptoms, Minor", "code_information": [{"code": "145.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5338.73, "maximum": 5338.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5338.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Bronchitis And Related Symptoms, Moderate", "code_information": [{"code": "145.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7487.8, "maximum": 7487.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7487.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Bronchitis And Related Symptoms, Severe", "code_information": [{"code": "145.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19067.44, "maximum": 19067.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19067.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Kidney Injury, Major", "code_information": [{"code": "469.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15695.81, "maximum": 15695.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15695.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Kidney Injury, Minor", "code_information": [{"code": "469.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6090.97, "maximum": 6090.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6090.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Kidney Injury, Moderate", "code_information": [{"code": "469.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8943.59, "maximum": 8943.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8943.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Kidney Injury, Severe", "code_information": [{"code": "469.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34359.58, "maximum": 34359.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34359.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Leukemia, Major", "code_information": [{"code": "690.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 61013.5, "maximum": 61013.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61013.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Leukemia, Minor", "code_information": [{"code": "690.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12534.35, "maximum": 12534.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12534.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Leukemia, Moderate", "code_information": [{"code": "690.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55018.64, "maximum": 55018.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55018.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Leukemia, Severe", "code_information": [{"code": "690.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 111977.47, "maximum": 111977.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 111977.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Myocardial Infarction, Major", "code_information": [{"code": "190.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15898.29, "maximum": 15898.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15898.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Myocardial Infarction, Minor", "code_information": [{"code": "190.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9365.2, "maximum": 9365.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9365.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Myocardial Infarction, Moderate", "code_information": [{"code": "190.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10073.87, "maximum": 10073.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10073.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Acute Myocardial Infarction, Severe", "code_information": [{"code": "190.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31518.49, "maximum": 31518.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31518.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adjustment Disorders And Neuroses Except Depressive Diagnoses, Major", "code_information": [{"code": "755.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15996.96, "maximum": 15996.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15996.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adjustment Disorders And Neuroses Except Depressive Diagnoses, Minor", "code_information": [{"code": "755.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4171.28, "maximum": 4171.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4171.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adjustment Disorders And Neuroses Except Depressive Diagnoses, Moderate", "code_information": [{"code": "755.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6552.31, "maximum": 6552.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6552.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adjustment Disorders And Neuroses Except Depressive Diagnoses, Severe", "code_information": [{"code": "755.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17670.6, "maximum": 17670.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17670.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Administration, Processing And Storage For Blood And Blood Components Administration (E.G., Transfusions)", "code_information": [{"code": "391", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Administration, Processing And Storage For Blood And Blood Components General", "code_information": [{"code": "390", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Adrenal Procedures, Major", "code_information": [{"code": "401.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 41524.44, "maximum": 41524.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41524.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adrenal Procedures, Minor", "code_information": [{"code": "401.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15945.7, "maximum": 15945.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15945.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adrenal Procedures, Moderate", "code_information": [{"code": "401.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33755.99, "maximum": 33755.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33755.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Adrenal Procedures, Severe", "code_information": [{"code": "401.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 73756.73, "maximum": 73756.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 73756.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol Abuse And Dependence, Major", "code_information": [{"code": "775.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12302.4, "maximum": 12302.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12302.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol Abuse And Dependence, Minor", "code_information": [{"code": "775.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7071.32, "maximum": 7071.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7071.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol Abuse And Dependence, Moderate", "code_information": [{"code": "775.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8051.66, "maximum": 8051.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8051.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol Abuse And Dependence, Severe", "code_information": [{"code": "775.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38400.15, "maximum": 38400.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38400.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy, Major", "code_information": [{"code": "772.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15340.84, "maximum": 15340.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15340.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy, Minor", "code_information": [{"code": "772.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11879.51, "maximum": 11879.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11879.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy, Moderate", "code_information": [{"code": "772.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12527.94, "maximum": 12527.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12527.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcohol And Drug Dependence With Rehabilitation And/Or Detoxification Therapy, Severe", "code_information": [{"code": "772.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27712.44, "maximum": 27712.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27712.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcoholic Liver Disease, Major", "code_information": [{"code": "280.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15010.21, "maximum": 15010.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15010.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcoholic Liver Disease, Minor", "code_information": [{"code": "280.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6676.62, "maximum": 6676.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6676.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcoholic Liver Disease, Moderate", "code_information": [{"code": "280.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9402.37, "maximum": 9402.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9402.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alcoholic Liver Disease, Severe", "code_information": [{"code": "280.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40487.71, "maximum": 40487.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40487.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allergic Reactions, Major", "code_information": [{"code": "811.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7408.35, "maximum": 7408.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7408.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allergic Reactions, Minor", "code_information": [{"code": "811.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5488.66, "maximum": 5488.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5488.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allergic Reactions, Moderate", "code_information": [{"code": "811.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6733.0, "maximum": 6733.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6733.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allergic Reactions, Severe", "code_information": [{"code": "811.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22423.69, "maximum": 22423.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22423.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allogeneic Bone Marrow Transplant, Major", "code_information": [{"code": "7.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 111710.92, "maximum": 111710.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 111710.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allogeneic Bone Marrow Transplant, Minor", "code_information": [{"code": "7.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 93999.31, "maximum": 93999.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93999.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allogeneic Bone Marrow Transplant, Moderate", "code_information": [{"code": "7.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 103900.18, "maximum": 103900.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 103900.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Allogeneic Bone Marrow Transplant, Severe", "code_information": [{"code": "7.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 242248.35, "maximum": 242248.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 242248.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alteration In Consciousness, Major", "code_information": [{"code": "52.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17507.85, "maximum": 17507.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17507.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alteration In Consciousness, Minor", "code_information": [{"code": "52.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5698.83, "maximum": 5698.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5698.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alteration In Consciousness, Moderate", "code_information": [{"code": "52.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7380.16, "maximum": 7380.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7380.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Alteration In Consciousness, Severe", "code_information": [{"code": "52.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37087.89, "maximum": 37087.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37087.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Amer am ac tri-lay per sq cm", "code_information": [{"code": "Q4305", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Americ amnion ac per sq cm", "code_information": [{"code": "Q4306", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "American amnion, per sq cm", "code_information": [{"code": "Q4307", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Amputation Of Lower Limb Except Toes, Major", "code_information": [{"code": "305.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29791.03, "maximum": 29791.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29791.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Amputation Of Lower Limb Except Toes, Minor", "code_information": [{"code": "305.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13410.9, "maximum": 13410.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13410.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Amputation Of Lower Limb Except Toes, Moderate", "code_information": [{"code": "305.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20638.56, "maximum": 20638.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20638.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Amputation Of Lower Limb Except Toes, Severe", "code_information": [{"code": "305.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 63935.32, "maximum": 63935.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63935.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anal And Perineal Procedures, Major", "code_information": [{"code": "226.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18847.02, "maximum": 18847.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18847.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anal And Perineal Procedures, Minor", "code_information": [{"code": "226.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10067.46, "maximum": 10067.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10067.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anal And Perineal Procedures, Moderate", "code_information": [{"code": "226.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14980.74, "maximum": 14980.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14980.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anal And Perineal Procedures, Severe", "code_information": [{"code": "226.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38592.37, "maximum": 38592.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38592.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Analysis Of Data From CT Study Of Heart Blood Vessels To Assess Severity Of Heart Artery Disease, Analysis Of Fluid Dynamics", "code_information": [{"code": "503T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.42, "maximum": 1044.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1044.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Analysis Of Data From CT Study Of Heart Blood Vessels To Assess Severity Of Heart Artery Disease, With Interpretation And Report", "code_information": [{"code": "501T", "type": "CPT"}], "standard_charges": [{"minimum": 1044.42, "maximum": 1044.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1044.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anesthesia For Diagnostic X-Ray Procedure (Accessed Through The Skin) On Spine And Spinal Cord", "code_information": [{"code": "1935", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anesthesia For X-Ray Procedure (Accessed Through The Skin) On Spine And Spinal Cord", "code_information": [{"code": "1936", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anesthesia General", "code_information": [{"code": "370", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Anesthesia Incident To Radiology", "code_information": [{"code": "371", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Angina Pectoris And Coronary Atherosclerosis, Major", "code_information": [{"code": "198.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9939.31, "maximum": 9939.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9939.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Angina Pectoris And Coronary Atherosclerosis, Minor", "code_information": [{"code": "198.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5373.33, "maximum": 5373.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5373.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Angina Pectoris And Coronary Atherosclerosis, Moderate", "code_information": [{"code": "198.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8210.57, "maximum": 8210.57, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8210.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Angina Pectoris And Coronary Atherosclerosis, Severe", "code_information": [{"code": "198.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20769.27, "maximum": 20769.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20769.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anoxic And Other Severe Brain Damage, Major", "code_information": [{"code": "59.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17761.59, "maximum": 17761.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17761.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anoxic And Other Severe Brain Damage, Minor", "code_information": [{"code": "59.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7644.15, "maximum": 7644.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7644.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anoxic And Other Severe Brain Damage, Moderate", "code_information": [{"code": "59.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12922.65, "maximum": 12922.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12922.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Anoxic And Other Severe Brain Damage, Severe", "code_information": [{"code": "59.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25729.96, "maximum": 25729.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25729.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum With O.R. Procedure, Major", "code_information": [{"code": "547.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21370.29, "maximum": 21370.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21370.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum With O.R. Procedure, Minor", "code_information": [{"code": "547.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8953.84, "maximum": 8953.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8953.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum With O.R. Procedure, Moderate", "code_information": [{"code": "547.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10738.97, "maximum": 10738.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10738.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum With O.R. Procedure, Severe", "code_information": [{"code": "547.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40478.74, "maximum": 40478.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40478.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum Without O.R. Procedure, Major", "code_information": [{"code": "566.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8423.3, "maximum": 8423.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8423.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum Without O.R. Procedure, Minor", "code_information": [{"code": "566.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4690.29, "maximum": 4690.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4690.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum Without O.R. Procedure, Moderate", "code_information": [{"code": "566.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5989.73, "maximum": 5989.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5989.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Antepartum Without O.R. Procedure, Severe", "code_information": [{"code": "566.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23296.39, "maximum": 23296.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23296.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complex Principal Diagnosis, Major", "code_information": [{"code": "233.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18894.44, "maximum": 18894.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18894.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complex Principal Diagnosis, Minor", "code_information": [{"code": "233.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12566.39, "maximum": 12566.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12566.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complex Principal Diagnosis, Moderate", "code_information": [{"code": "233.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17095.21, "maximum": 17095.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17095.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complex Principal Diagnosis, Severe", "code_information": [{"code": "233.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43578.69, "maximum": 43578.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43578.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complicated Principal Diagnosis With CC", "code_information": [{"code": "339", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9496.73, "maximum": 9496.73, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9496.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complicated Principal Diagnosis With MCC", "code_information": [{"code": "338", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10277.57, "maximum": 10277.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10277.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Appendectomy With Complicated Principal Diagnosis Without CC/MCC", "code_information": [{"code": "340", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6645.13, "maximum": 6645.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6645.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complex Principal Diagnosis, Major", "code_information": [{"code": "234.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21062.73, "maximum": 21062.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21062.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complex Principal Diagnosis, Minor", "code_information": [{"code": "234.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8138.81, "maximum": 8138.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8138.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complex Principal Diagnosis, Moderate", "code_information": [{"code": "234.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13945.28, "maximum": 13945.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13945.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complex Principal Diagnosis, Severe", "code_information": [{"code": "234.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40786.3, "maximum": 40786.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40786.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complicated Principal Diagnosis With CC", "code_information": [{"code": "342", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7089.65, "maximum": 7089.65, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7089.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complicated Principal Diagnosis With MCC", "code_information": [{"code": "341", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9944.94, "maximum": 9944.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9944.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Appendectomy Without Complicated Principal Diagnosis Without CC/MCC", "code_information": [{"code": "343", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5256.22, "maximum": 5256.22, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5256.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Assessment Of Hearing Loss Performed On A Group Of Patients", "code_information": [{"code": "92559", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Asthma, Major", "code_information": [{"code": "141.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9979.04, "maximum": 9979.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9979.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Asthma, Minor", "code_information": [{"code": "141.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5475.85, "maximum": 5475.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5475.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Asthma, Moderate", "code_information": [{"code": "141.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8296.43, "maximum": 8296.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8296.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Asthma, Severe", "code_information": [{"code": "141.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13692.83, "maximum": 13692.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13692.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Audiology, Diagnostic", "code_information": [{"code": "471", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Autologous Bone Marrow Transplant Or T-Cell Immunotherapy, Major", "code_information": [{"code": "8.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 78868.64, "maximum": 78868.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78868.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Autologous Bone Marrow Transplant Or T-Cell Immunotherapy, Minor", "code_information": [{"code": "8.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 45803.37, "maximum": 45803.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45803.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Autologous Bone Marrow Transplant Or T-Cell Immunotherapy, Moderate", "code_information": [{"code": "8.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 57409.92, "maximum": 57409.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 57409.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Autologous Bone Marrow Transplant Or T-Cell Immunotherapy, Severe", "code_information": [{"code": "8.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 110674.18, "maximum": 110674.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 110674.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Avf by tissue w thermal e", "code_information": [{"code": "G2170", "type": "HCPCS"}], "standard_charges": [{"minimum": 5104.6, "maximum": 5104.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Avf use magnetic/art/ven", "code_information": [{"code": "G2171", "type": "HCPCS"}], "standard_charges": [{"minimum": 5104.6, "maximum": 5104.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI ANTB 12 PRTN IGG", "code_information": [{"code": "42U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 27.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B BRGDRFERI ANTB 5 PRTN IGM", "code_information": [{"code": "41U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 27.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B CELLS TOTAL COUNT", "code_information": [{"code": "86355", "type": "CPT"}], "standard_charges": [{"minimum": 37.73, "maximum": 68.53, "discounted_cash": 60.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B-12 BINDING CAPACITY", "code_information": [{"code": "82608", "type": "CPT"}], "standard_charges": [{"minimum": 14.32, "maximum": 40.05, "discounted_cash": 23.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B1 MATRL QUAL TST MCRIND TIB", "code_information": [{"code": "547T", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ANALYSIS", "code_information": [{"code": "554T", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "B1 STR & FX RSK ASSESSMENT", "code_information": [{"code": "556T", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BABESIA MICROTI AMP PRB", "code_information": [{"code": "87469", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACITRACIN", "code_information": [{"code": "3400300010", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.5, "discounted_cash": 20.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BACITRACIN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300243", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 49.4, "discounted_cash": 74.1, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [{"code": "519", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9477.05, "maximum": 9477.05, "discounted_cash": 21978.56, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9477.05, "methodology": "fee schedule"}], "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": 9909.28, "maximum": 9909.28, "discounted_cash": 40770.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9909.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "520", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6628.53, "maximum": 6628.53, "discounted_cash": 15982.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6628.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACLOFEN 10 MG INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 177.87, "maximum": 177.87, "discounted_cash": 285.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 177.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACLOFEN INTRATHECAL TRIAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.91, "maximum": 57.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 57.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "95", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11799.89, "maximum": 11799.89, "discounted_cash": 26618.55, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11799.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "94", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21717.17, "maximum": 21717.17, "discounted_cash": 40445.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21717.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "96", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11799.89, "maximum": 11799.89, "discounted_cash": 24335.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11799.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BACTERICIDAL LEVEL SERUM", "code_information": [{"code": "87197", "type": "CPT"}], "standard_charges": [{"minimum": 15.02, "maximum": 24.03, "discounted_cash": 24.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BACTERIUM ANTIBODY", "code_information": [{"code": "86609", "type": "CPT"}], "standard_charges": [{"minimum": 12.88, "maximum": 30.26, "discounted_cash": 20.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BAG BECKER DRAINAGE", "code_information": [{"code": "3100100079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG BECKER DRAINAGE*", "code_information": [{"code": "3100205053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 602.58, "discounted_cash": 903.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG BECKER EDMS", "code_information": [{"code": "3100100080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 958.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG URO", "code_information": [{"code": "3100100081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAG URO", "code_information": [{"code": "3100102445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAGLEY*M0063401220", "code_information": [{"code": "3100206321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 737.34, "discounted_cash": 1106.01, "setting": "both", "billing_class": "facility"}]}, {"description": "BAHA 5 POWER, BROWN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAHA 5 SOUND PROCESS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAIRHUGGER", "code_information": [{"code": "3100100082", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAIRHUGGER", "code_information": [{"code": "3100102446", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BAIRHUGGER LOWER BOD", "code_information": [{"code": "3100207506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.52, "discounted_cash": 59.28, "setting": "both", "billing_class": "facility"}]}, {"description": "BAIRHUGGER UPPER BOD", "code_information": [{"code": "3100207725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.04, "discounted_cash": 64.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BAIRHUGGER UPPER BOD", "code_information": [{"code": "3100208001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.16, "discounted_cash": 36.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL ELECTR COOLCUT", "code_information": [{"code": "3100100083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALL TIP PROBE*94500", "code_information": [{"code": "3100203407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 666.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLAST 45X17.5*02-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2074.8, "maximum": 2875.08, "gross_charge": 2964.0, "discounted_cash": 4446.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2519.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2223.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2074.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2875.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2074.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2223.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2519.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2371.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLAST DBM 115X11*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3068.97, "maximum": 4252.72, "gross_charge": 4384.25, "discounted_cash": 6576.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3726.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3288.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3068.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4252.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3068.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3288.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3726.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3507.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLAST DBM 85X17.5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3068.97, "maximum": 4252.72, "gross_charge": 4384.25, "discounted_cash": 6576.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3726.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3288.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3068.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4252.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3068.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3288.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3726.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3507.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLISTOCARDIOGRAM", "code_information": [{"code": "S3902", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BALLOON *MAJ-233", "code_information": [{"code": "3100203761", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.52, "discounted_cash": 95.28, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON *MAJ-249", "code_information": [{"code": "3100203760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.24, "discounted_cash": 93.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE 10X12MM*", "code_information": [{"code": "3100205825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE 12X15MM*", "code_information": [{"code": "3100205826", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE 6X8MM*M0", "code_information": [{"code": "3100208189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.2, "discounted_cash": 897.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE 7.5X20MM", "code_information": [{"code": "3100207392", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.2, "discounted_cash": 897.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE 8X10MM*M", "code_information": [{"code": "3100205824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE WIRE", "code_information": [{"code": "3100104345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 867.0, "discounted_cash": 1300.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON CRE WIRE DIL", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100100084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 374.89, "maximum": 519.49, "gross_charge": 535.56, "discounted_cash": 803.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 455.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 401.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 519.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 374.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 401.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 455.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 428.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON CRE*18-20MM*", "code_information": [{"code": "3100207426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.2, "discounted_cash": 897.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON DIAL 6MM*998", "code_information": [{"code": "3100203487", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 652.35, "discounted_cash": 978.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON DILATE URTRL STRIX", "code_information": [{"code": "50706", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BALLOON EUST TUBE6X1", "code_information": [{"code": "3100202833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4258.48, "discounted_cash": 6387.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON EXPRESS 15/2", "code_information": [{"code": "3100203540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON GASTRIC *B-2", "code_information": [{"code": "3100202806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON INFLATION DE", "code_information": [{"code": "3100205056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.2, "discounted_cash": 447.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON INTRAGASTRIC", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100104262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3367.0, "maximum": 4665.7, "gross_charge": 4810.0, "discounted_cash": 7215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4665.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON KIT 10 X 15*", "code_information": [{"code": "3100204537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 668.16, "discounted_cash": 1002.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON KIT 10 X 15*", "code_information": [{"code": "3100204892", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.96, "discounted_cash": 829.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON OPTILUME*OPT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3100208214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON OPTILUME*OPT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3100208397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON PERF", "code_information": [{"code": "3100100085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 273.0, "discounted_cash": 409.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PERF", "code_information": [{"code": "3100102447", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON PERF", "code_information": [{"code": "3100102448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.0, "discounted_cash": 634.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BALLOON SINUS SYSTEM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100100086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3048.5, "maximum": 4224.35, "gross_charge": 4355.0, "discounted_cash": 6532.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3701.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3266.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3048.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4224.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3048.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3266.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3701.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3484.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON SINUS SYSTEM", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100102449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3658.2, "maximum": 5069.22, "gross_charge": 5226.0, "discounted_cash": 7839.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4442.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3919.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3658.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5069.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3658.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3919.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4442.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON URINARY CONT", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100100087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5609.74, "maximum": 7773.5, "gross_charge": 8013.92, "discounted_cash": 12020.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6811.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6010.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5609.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7773.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5609.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6010.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6811.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6411.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BALLOON UROFORCE 5X1", "code_information": [{"code": "3100204161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.48, "discounted_cash": 905.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BALO ANGIOP CTR DIAL", "code_information": [{"code": "36907", "type": "CPT"}, {"code": "3480103161", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BAMLAN AND ETESEV INFUS HOME", "code_information": [{"code": "M0246", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 750.0, "discounted_cash": 1205.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BAMLAN AND ETESEV INFUSION", "code_information": [{"code": "M0245", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 450.0, "discounted_cash": 723.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BAMLANIVIMAB AND ETESEVIMA", "code_information": [{"code": "Q0245", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BANDER SUPER", "code_information": [{"code": "3100100088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 893.0, "discounted_cash": 1339.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BAR MOD TIBIAL LOCIN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAR OMNIMAX ARCH", "code_information": [{"code": "3100104043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIATRIC SEQ CALF G", "code_information": [{"code": "3100203973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.4, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BARIUM SULFATE 1900C", "code_information": [{"code": "3100102125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BARRERA SLOR DL PER SQ CM", "code_information": [{"code": "Q4281", "type": "HCPCS"}], "standard_charges": [{"minimum": 884.67, "maximum": 884.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 884.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARRIGEL PROCED PACK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BARTONELLA ANTIBODY", "code_information": [{"code": "86611", "type": "CPT"}, {"code": "3440103118", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.18, "maximum": 36.86, "gross_charge": 38.0, "discounted_cash": 16.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA AMP PROBE", "code_information": [{"code": "87471", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BARTONELLA DNA QUANT", "code_information": [{"code": "87472", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BASE GLENOID MODULA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2739.1, "maximum": 3795.61, "gross_charge": 3913.0, "discounted_cash": 5869.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3326.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2934.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2739.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3795.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2739.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2934.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3326.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3130.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3632.3, "maximum": 5033.33, "gross_charge": 5189.0, "discounted_cash": 7783.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4410.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3891.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3632.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5033.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3632.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3891.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4410.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE & TAPER KI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4464.46, "maximum": 6186.46, "gross_charge": 6377.8, "discounted_cash": 9566.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5421.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4783.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4464.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6186.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4464.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4783.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5421.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5102.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2682.68, "maximum": 3717.42, "gross_charge": 3832.4, "discounted_cash": 5748.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3257.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2874.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2682.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3717.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2682.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2874.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3257.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3065.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM+2*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2682.68, "maximum": 3717.42, "gross_charge": 3832.4, "discounted_cash": 5748.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3257.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2874.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2682.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3717.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2682.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2874.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3257.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3065.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 24MM+4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2682.68, "maximum": 3717.42, "gross_charge": 3832.4, "discounted_cash": 5748.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3257.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2874.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2682.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3717.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2682.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2874.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3257.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3065.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 28MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3123.12, "maximum": 4327.75, "gross_charge": 4461.6, "discounted_cash": 6692.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3792.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3346.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3123.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4327.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3123.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3346.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3792.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3569.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 28MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 28MM*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE 28MM+2*AR-", "code_information": [{"code": "3100205664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE 28MM+4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2739.1, "maximum": 3795.61, "gross_charge": 3913.0, "discounted_cash": 5869.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3326.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2934.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2739.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3795.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2739.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2934.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3326.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3130.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3034.5, "maximum": 4204.95, "gross_charge": 4335.0, "discounted_cash": 6502.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3684.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3251.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3034.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4204.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3034.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3251.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3684.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2737.0, "maximum": 3792.7, "gross_charge": 3910.0, "discounted_cash": 5865.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3323.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2932.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2737.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3792.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2737.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2932.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3323.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE GLENOID 30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE MINI W ADA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3187.1, "maximum": 4416.41, "gross_charge": 4553.0, "discounted_cash": 6829.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3870.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3414.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3187.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4416.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3187.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3414.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3870.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3642.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE MINI W ADA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE PKR #2*562", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2567.29, "maximum": 3557.53, "gross_charge": 3667.56, "discounted_cash": 5501.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3117.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2750.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2567.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3557.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2567.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2750.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3117.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2934.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE REVISION*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9662.8, "maximum": 13389.88, "gross_charge": 13804.0, "discounted_cash": 20706.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11733.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10353.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9662.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13389.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9662.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10353.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11733.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11043.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE REVISION*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7536.98, "maximum": 10444.1, "gross_charge": 10767.12, "discounted_cash": 16150.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9152.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8075.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7536.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10444.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7536.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8075.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9152.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8613.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE REVISION*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6280.82, "maximum": 8703.42, "gross_charge": 8972.6, "discounted_cash": 13458.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7626.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6729.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6280.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8703.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6280.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6729.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7626.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7178.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE REVISION*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7536.98, "maximum": 10444.1, "gross_charge": 10767.12, "discounted_cash": 16150.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9152.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8075.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7536.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10444.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7536.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8075.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9152.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8613.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE S 24MM*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2681.0, "maximum": 3715.1, "gross_charge": 3830.0, "discounted_cash": 5745.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3255.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2872.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2681.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3715.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2681.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2872.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3255.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3327.1, "maximum": 4610.41, "gross_charge": 4753.0, "discounted_cash": 7129.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4040.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3564.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3327.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4610.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3327.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3564.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4040.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3802.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "3100104485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6667.0, "discounted_cash": 10000.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3109.4, "maximum": 4308.74, "gross_charge": 4442.0, "discounted_cash": 6663.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3775.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3331.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3109.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4308.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3109.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3331.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3775.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3553.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2567.6, "maximum": 3557.96, "gross_charge": 3668.0, "discounted_cash": 5502.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3117.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2751.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2567.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3557.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2567.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2751.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3117.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2934.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2395.4, "maximum": 3319.34, "gross_charge": 3422.0, "discounted_cash": 5133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2908.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2566.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2395.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3319.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2395.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2566.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2908.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2737.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2753.1, "maximum": 3815.01, "gross_charge": 3933.0, "discounted_cash": 5899.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3343.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2949.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2753.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3815.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2753.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2949.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3343.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3146.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL ZIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL ZIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE UNIV GLEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2496.9, "maximum": 3459.99, "gross_charge": 3567.0, "discounted_cash": 5350.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3031.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2675.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2496.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3459.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2496.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2675.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3031.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2853.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE UNIV GLN L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2497.04, "maximum": 3460.18, "gross_charge": 3567.2, "discounted_cash": 5350.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3032.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2675.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2497.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3460.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2497.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2675.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3032.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2853.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE UNIV GLN M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3588.9, "maximum": 4973.19, "gross_charge": 5127.0, "discounted_cash": 7690.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4357.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3845.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3588.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4973.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3588.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3845.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4357.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4101.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE W LG ADP*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3867.5, "maximum": 5359.25, "gross_charge": 5525.0, "discounted_cash": 8287.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5359.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE W MED ADP*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3867.5, "maximum": 5359.25, "gross_charge": 5525.0, "discounted_cash": 8287.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5359.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE W SM ADP*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3867.5, "maximum": 5359.25, "gross_charge": 5525.0, "discounted_cash": 8287.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5359.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIC METABOLIC CALC", "code_information": [{"code": "80047", "type": "CPT"}, {"code": "3440103000", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.73, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BASIC METABOLIC CALC", "code_information": [{"code": "80048", "type": "CPT"}, {"code": "3440100792", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.46, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 13.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BASIC VESTIBULAR EVALUATION", "code_information": [{"code": "92540", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BASILIXIMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 4487.0, "maximum": 4487.0, "discounted_cash": 7191.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4487.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIN SET(SPLASH)", "code_information": [{"code": "3100102126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BATTERY NEUROSTIMULA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15493.8, "maximum": 21469.98, "gross_charge": 22134.0, "discounted_cash": 33201.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18813.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16600.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15493.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 21469.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15493.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16600.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18813.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17707.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BATTERY STIMULATOR*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 37660.0, "maximum": 52186.0, "gross_charge": 53800.0, "discounted_cash": 80700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 45730.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 40350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 37660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 52186.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 37660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 40350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 45730.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAYONET KNIFE*1563-0", "code_information": [{"code": "3100203408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 781.5, "discounted_cash": 1172.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BB TAK MTP*AR-13227", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB-TAK LG THREADED*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB-TAK LG*AR-8970-09", "code_information": [{"code": "3100203244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BB-TAK SMALL*AR-1870", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BB-TAK THREADED*AR-1", "code_information": [{"code": "3100209404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BB-TAK*AR-18800-11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.9, "maximum": 346.29, "gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 346.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCAT1&IKZF1 PRMTR MTHYLN ALY", "code_information": [{"code": "229U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 616.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCG LIVE INTRAVESICAL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9030", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.89, "maximum": 2.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BCG VACCINE INTRAVESICAL", "code_information": [{"code": "90586", "type": "CPT"}], "standard_charges": [{"minimum": 144.48, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 144.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCG VACCINE PERCUT", "code_information": [{"code": "90585", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCKDHB GENE", "code_information": [{"code": "81205", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 94.99, "discounted_cash": 152.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 94.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MAJOR BP", "code_information": [{"code": "81206", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 163.96, "discounted_cash": 263.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 163.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MAJOR BP QUAN", "code_information": [{"code": "40U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 658.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE MINOR BP", "code_information": [{"code": "81207", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 144.84, "discounted_cash": 232.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 144.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BCR/ABL1 GENE OTHER BP", "code_information": [{"code": "81208", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 214.62, "discounted_cash": 344.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 214.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BDY POS CUR STAT 0%", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100311", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "BDY POS CUR STAT 0%", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100443", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "BDY POS CUR STAT 100", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100318", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "BDY POS CUR STAT 100", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100450", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "BDY POS CUR STAT 20-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100314", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "BDY POS CUR STAT 20-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100446", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "BDY POS CUR STAT 40-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100319", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "BDY POS CUR STAT 40-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100451", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "BDY POS CUR STAT 60-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100320", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "BDY POS CUR STAT 60-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100452", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "BDY POS CUR STAT 80-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100321", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "BDY POS CUR STAT 80-", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100453", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "BDY POS CUR STAT1-19", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3320100307", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "BDY POS CUR STAT1-19", "code_information": [{"code": "G8981", "type": "HCPCS"}, {"code": "3330100439", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "BDY POS D/C STAT 0%", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100317", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "BDY POS D/C STAT 0%", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100449", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "BDY POS D/C STAT 100", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100336", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "BDY POS D/C STAT 100", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100464", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "BDY POS D/C STAT 20-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100322", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "BDY POS D/C STAT 20-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100454", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "BDY POS D/C STAT 40-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100333", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "BDY POS D/C STAT 40-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100465", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "BDY POS D/C STAT 60-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100334", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "BDY POS D/C STAT 60-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100466", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "BDY POS D/C STAT 80-", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100467", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "BDY POS D/C STAT1-19", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100329", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "BDY POS D/C STAT1-19", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3330100461", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "BDY POS D/C STAT80-9", "code_information": [{"code": "G8983", "type": "HCPCS"}, {"code": "3320100332", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "BDY POS PR STAT 0% I", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100324", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "BDY POS PR STAT 0% I", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100456", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "BDY POS PR STAT 100%", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100325", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "BDY POS PR STAT 100%", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100457", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "BDY POS PR STAT 20-3", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100323", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "BDY POS PR STAT 20-3", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100455", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "BDY POS PR STAT 40-5", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100326", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "BDY POS PR STAT 40-5", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100458", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "BDY POS PR STAT 60-7", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100327", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "BDY POS PR STAT 60-7", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100459", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "BDY POS PR STAT 80-9", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100328", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "BDY POS PR STAT 80-9", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100460", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "BDY POS PR STAT1-19%", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3320100312", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "BDY POS PR STAT1-19%", "code_information": [{"code": "G8982", "type": "HCPCS"}, {"code": "3330100444", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "BDY SRF MPG PM/CVDFB TM IMPL", "code_information": [{"code": "695T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BDY SURF MAPG PM/CVDFB F/UP", "code_information": [{"code": "696T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BEACON MOUNT*7107-55", "code_information": [{"code": "3100209118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3738.15, "discounted_cash": 5607.23, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING ANAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2959.6, "maximum": 4101.16, "gross_charge": 4228.0, "discounted_cash": 6342.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3593.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3171.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2959.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4101.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2959.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3171.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3593.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING ANAT LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2369.5, "maximum": 3283.45, "gross_charge": 3385.0, "discounted_cash": 5077.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2877.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2538.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2369.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3283.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2369.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2538.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2877.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING ANAT LT MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING ANAT RT LRG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING ANAT RT MD S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING DUAL*EP-2001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING HUMERAL 3MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1916.88, "maximum": 2656.24, "gross_charge": 2738.4, "discounted_cash": 4107.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2656.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2190.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING HUMERAL STAN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1955.8, "maximum": 2710.18, "gross_charge": 2794.0, "discounted_cash": 4191.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2374.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2095.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1955.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2710.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1955.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2095.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2374.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2235.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 12X71/75M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 12X71/75M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 12X87/91M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 14X79/83M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 14X87/91M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 18X63/67M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 18X71/75M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING PS 20X79/83M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203949", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING ROT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 893.97, "maximum": 1238.78, "gross_charge": 1277.1, "discounted_cash": 1915.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1085.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 957.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 893.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1238.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 893.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 957.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1085.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1021.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1521.1, "maximum": 2107.81, "gross_charge": 2173.0, "discounted_cash": 3259.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1847.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1629.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1521.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2107.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1521.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1629.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1847.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1738.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1463.7, "maximum": 2028.27, "gross_charge": 2091.0, "discounted_cash": 3136.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1777.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1568.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1463.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2028.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1463.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1568.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1777.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1672.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1955.8, "maximum": 2710.18, "gross_charge": 2794.0, "discounted_cash": 4191.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2374.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2095.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1955.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2710.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1955.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2095.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2374.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2235.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL LG", "code_information": [{"code": "3100103740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5160.0, "discounted_cash": 7740.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BEARING TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5226.9, "maximum": 7242.99, "gross_charge": 7467.0, "discounted_cash": 11200.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6346.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5600.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5226.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7242.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5226.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5600.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6346.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5973.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4571.7, "maximum": 6335.07, "gross_charge": 6531.0, "discounted_cash": 9796.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5551.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4898.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4571.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6335.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4571.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4898.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5551.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5224.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4961.6, "maximum": 6875.36, "gross_charge": 7088.0, "discounted_cash": 10632.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6024.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5316.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4961.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6875.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4961.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5316.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6024.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEARING VNGD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4501.0, "maximum": 6237.1, "gross_charge": 6430.0, "discounted_cash": 9645.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5465.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4822.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4501.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6237.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4501.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4822.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5465.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEBTELOVIMAB 175 MG", "code_information": [{"code": "Q0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 2394.0, "maximum": 2394.0, "discounted_cash": 3845.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEBTELOVIMAB INJECTION", "code_information": [{"code": "M0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 350.5, "maximum": 350.5, "discounted_cash": 563.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 350.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEBTELOVIMAB INJECTION HOME", "code_information": [{"code": "M0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 550.5, "maximum": 550.5, "discounted_cash": 884.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BECLOMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7622", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEHAV HLTH DAY TREAT, PER HR", "code_information": [{"code": "H2012", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.91, "maximum": 12.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BEHAVIOR COUNSEL OBESITY 15M", "code_information": [{"code": "G0447", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BEHAVIOR MANAGEMENT", "code_information": [{"code": "D9920", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [{"code": "886", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3629.37, "maximum": 3629.37, "discounted_cash": 18775.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3629.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BEHAVRAL QUALIT ANALYS VOICE", "code_information": [{"code": "92524", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BELATACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0485", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.87, "maximum": 3.87, "discounted_cash": 6.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BELIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0490", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.1, "maximum": 54.1, "discounted_cash": 83.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 54.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BELLACELL HD, SUREDERM SQ CM", "code_information": [{"code": "Q4220", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BELT RECHARGING*FD90", "code_information": [{"code": "3100206010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [{"code": "725", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7883.4, "maximum": 7883.4, "discounted_cash": 13854.11, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7883.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [{"code": "726", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3208.2, "maximum": 3208.2, "discounted_cash": 8160.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3208.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENZOCAINE/TETRACAIN", "code_information": [{"code": "3400300209", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 223.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BENZODIAZEPINE", "code_information": [{"code": "80154", "type": "CPT"}, {"code": "3440100805", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 116.2, "maximum": 161.02, "gross_charge": 166.0, "discounted_cash": 249.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BENZODIAZEPINES 13 OR MORE", "code_information": [{"code": "80347", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BENZODIAZEPINES1-12", "code_information": [{"code": "80346", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BENZOIN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300258", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 19.1, "discounted_cash": 28.65, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "BENZTROPINE MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0515", "type": "HCPCS"}, {"code": "3400300051", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 16.45, "maximum": 123.19, "gross_charge": 127.0, "discounted_cash": 190.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 123.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETA 2 GLYCOPROTIEN", "code_information": [{"code": "86146", "type": "CPT"}, {"code": "3440101066", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 25.45, "maximum": 138.71, "gross_charge": 143.0, "discounted_cash": 40.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 138.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 114.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BETA-BSM", "code_information": [{"code": "3100104041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10296.0, "discounted_cash": 15444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BETAMETH ACET/BETAME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0702", "type": "HCPCS"}, {"code": "3400300154", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.89, "maximum": 67.9, "gross_charge": 70.0, "discounted_cash": 105.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 52.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 52.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BETAMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7624", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BETHANECHOL CHLORIDE INJECT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0520", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BEVACIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9035", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.16, "maximum": 74.16, "discounted_cash": 119.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 74.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING 1ST 15 MIN", "code_information": [{"code": "90912", "type": "CPT"}], "standard_charges": [{"minimum": 142.4, "maximum": 142.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BFB TRAINING EA ADDL 15 MIN", "code_information": [{"code": "90913", "type": "CPT"}], "standard_charges": [{"minimum": 142.4, "maximum": 142.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BH LTC RES R&B, PER DIEM", "code_information": [{"code": "T2048", "type": "HCPCS"}], "standard_charges": [{"minimum": 795.66, "maximum": 795.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 795.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BHV ID ASSMT BY PHYS/QHP", "code_information": [{"code": "97151", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT BY 1 TECH", "code_information": [{"code": "97152", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BHV ID SUPRT ASSMT EA 15 MIN", "code_information": [{"code": "362T", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIA WHOLE BODY", "code_information": [{"code": "358T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BICEPS REPAIR SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1749.3, "maximum": 2424.03, "gross_charge": 2499.0, "discounted_cash": 3748.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2424.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "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": 37358.54, "maximum": 37358.54, "discounted_cash": 76125.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37358.54, "methodology": "fee schedule"}], "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": 20283.37, "maximum": 20283.37, "discounted_cash": 31777.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20283.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 26.58, "maximum": 53.85, "discounted_cash": 42.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE ACIDS TOTAL", "code_information": [{"code": "82239", "type": "CPT"}], "standard_charges": [{"minimum": 17.12, "maximum": 40.05, "discounted_cash": 27.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE BAG", "code_information": [{"code": "3100100097", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BILE DUCT ENDOSCOPY ADD-ON", "code_information": [{"code": "47550", "type": "CPT"}], "standard_charges": [{"minimum": 5261.68, "maximum": 5261.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILE DUCT REVISION", "code_information": [{"code": "47701", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY BALLOON 4X10", "code_information": [{"code": "3100203611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 1030.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY BALLOON 4X4", "code_information": [{"code": "3100203608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 1030.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY BALLOON 4X6", "code_information": [{"code": "3100203609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 1030.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY BALLOON 4X8*", "code_information": [{"code": "3100203610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 687.0, "discounted_cash": 1030.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY DRN 10F 35C*", "code_information": [{"code": "3100206598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.12, "discounted_cash": 331.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY DRN 12F 35C*", "code_information": [{"code": "3100206597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.12, "discounted_cash": 331.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY DRN 14F 35C*", "code_information": [{"code": "3100206599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.12, "discounted_cash": 331.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY DRN 8F 35CM*", "code_information": [{"code": "3100206596", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.12, "discounted_cash": 331.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BILIARY ENDO PERQ DX W/SPECI", "code_information": [{"code": "47552", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5261.68, "discounted_cash": 11580.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5261.68, "discounted_cash": 11580.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47554", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5261.68, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47555", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5261.68, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47556", "type": "CPT"}], "standard_charges": [{"minimum": 5261.68, "maximum": 5261.68, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 10 X40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 10 X60", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 10 X60", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 10 X80", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 10X100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 8.5X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 8.5X5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 8.5X7*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY STENT 8.5X9*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "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": 17405.95, "maximum": 17405.95, "discounted_cash": 21852.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17405.95, "methodology": "fee schedule"}], "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": 17405.95, "maximum": 17405.95, "discounted_cash": 41556.74, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17405.95, "methodology": "fee schedule"}], "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": 10246.82, "maximum": 10246.82, "discounted_cash": 17474.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10246.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN DIRECT", "code_information": [{"code": "82248", "type": "CPT"}, {"code": "3440100861", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.02, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 8.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL", "code_information": [{"code": "82247", "type": "CPT"}, {"code": "3440100860", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.02, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 8.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILIRUBIN TOTAL TRANSCUT", "code_information": [{"code": "88720", "type": "CPT"}], "standard_charges": [{"minimum": 5.02, "maximum": 20.92, "discounted_cash": 8.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BILOBECTOMY", "code_information": [{"code": "32482", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BINDER ABD PANEL", "code_information": [{"code": "3100100098", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABD PANEL", "code_information": [{"code": "3100102459", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABD PANEL XL", "code_information": [{"code": "3100100099", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 91.0, "discounted_cash": 136.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BINDER ABD UNIVERSAL", "code_information": [{"code": "3100100100", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIO DBM PUTTY*777700", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIO MTRLS TO AID SOFT/OS REG", "code_information": [{"code": "D4265", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO-CONNEKT PER SQUARE CM", "code_information": [{"code": "Q4161", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.29, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 138.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO-GIDE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1725.27, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO4", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1725.27, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO4 10CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 10870.79, "gross_charge": 11207.0, "discounted_cash": 16810.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9525.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8405.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7844.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10870.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7844.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8405.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9525.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8965.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO4 2.5CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIO4 5CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOCARTILAGE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2661.68, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2661.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOCARTILAGE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7330", "type": "HCPCS"}, {"code": "3100102127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 325.04, "maximum": 2091.32, "gross_charge": 2156.0, "discounted_cash": 3234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2091.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 325.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOCARTILAGE KIT LG*", "code_information": [{"code": "3100203081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOCARTILAGE KIT*ABS", "code_information": [{"code": "3100202710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOCARTILAGE KIT*ABS", "code_information": [{"code": "3100206196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOCORKSCREW 5.5X15*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 745.5, "maximum": 1033.05, "gross_charge": 1065.0, "discounted_cash": 1597.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 905.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 798.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 745.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1033.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 745.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 798.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 905.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 852.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIODFENCE 1CM", "code_information": [{"code": "Q4140", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIODFENCE DRYFLEX, 1CM", "code_information": [{"code": "Q4138", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOEXPRESS GRT DEL*A", "code_information": [{"code": "3100204747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOFEEDBACK TRAIN ANY METH", "code_information": [{"code": "90901", "type": "CPT"}], "standard_charges": [{"minimum": 142.4, "maximum": 142.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOIMPEDANCE CV ANALYSIS", "code_information": [{"code": "93701", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOLOGICAL MATERIALS", "code_information": [{"code": "D3431", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPATCH", "code_information": [{"code": "3100100101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPATCH 2.5X7.0MM*4", "code_information": [{"code": "3100205690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.16, "discounted_cash": 33.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPOLAR SEALER", "code_information": [{"code": "3100100102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1568.0, "discounted_cash": 2352.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [{"code": "478", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10144.76, "maximum": 10144.76, "discounted_cash": 26612.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10144.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "477", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12199.54, "maximum": 12199.54, "discounted_cash": 37613.42, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12199.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [{"code": "479", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8235.7, "maximum": 8235.7, "discounted_cash": 20810.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8235.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24065", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ARM/ELBOW SOFT TISSUE", "code_information": [{"code": "24066", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY CONJUNCTIVA", "code_information": [{"code": "68100", "type": "CPT"}, {"code": "3480102216", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2837.63, "gross_charge": 2155.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2090.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYE MUSCLE", "code_information": [{"code": "67346", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2904.07, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY EYELID & LID MARGIN", "code_information": [{"code": "67810", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26105", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FINGER JOINT LINING", "code_information": [{"code": "26110", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY HAND JOINT LINING", "code_information": [{"code": "26100", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY KNEE JOINT LINING", "code_information": [{"code": "27330", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY LOWER LEG SOFT TISSUE", "code_information": [{"code": "27613", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY NAIL UNIT", "code_information": [{"code": "11755", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY NEEDLE 18GX11", "code_information": [{"code": "3100206682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY NEEDLE 18GX15", "code_information": [{"code": "3100206681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY NEEDLE 20GX11", "code_information": [{"code": "3100206684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY NEEDLE 20GX15", "code_information": [{"code": "3100206683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY OF BOWEL", "code_information": [{"code": "44100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX", "code_information": [{"code": "57500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CERVIX W/SCOPE", "code_information": [{"code": "57455", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF CORNEA", "code_information": [{"code": "65410", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 708.89, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF EPIDIDYMIS", "code_information": [{"code": "54800", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1927.74, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28050", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF FOOT JOINT LINING", "code_information": [{"code": "28052", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HEART LINING", "code_information": [{"code": "93505", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF LIP", "code_information": [{"code": "40490", "type": "CPT"}, {"code": "3340102483", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 886.58, "gross_charge": 914.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 776.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 639.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 886.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 639.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 776.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 731.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF MOUTH LESION", "code_information": [{"code": "40808", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF NERVE", "code_information": [{"code": "64795", "type": "CPT"}, {"code": "3480102197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE HARD", "code_information": [{"code": "D7285", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF ORAL TISSUE SOFT", "code_information": [{"code": "D7286", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF OVARY(S)", "code_information": [{"code": "58900", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PANCREAS OPEN", "code_information": [{"code": "48100", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54100", "type": "CPT"}, {"code": "3480103194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4198.16, "gross_charge": 4328.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3678.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3246.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3029.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4198.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3029.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3246.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3678.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3462.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54100", "type": "CPT"}, {"code": "3480103258", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5164.28, "gross_charge": 5324.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4525.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3993.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3726.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5164.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3726.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3993.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4525.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4259.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PENIS", "code_information": [{"code": "54105", "type": "CPT"}, {"code": "3340102451", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55700", "type": "CPT"}, {"code": "3480103196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55700", "type": "CPT"}, {"code": "3480103270", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF PROSTATE", "code_information": [{"code": "55705", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2013.63, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF RECTUM", "code_information": [{"code": "45100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SACROILIAC JOINT", "code_information": [{"code": "27050", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42400", "type": "CPT"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SHOULDER JOINT", "code_information": [{"code": "23100", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27041", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF STOMACH", "code_information": [{"code": "43605", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR GLAND", "code_information": [{"code": "68510", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TEAR SAC", "code_information": [{"code": "68525", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54500", "type": "CPT"}, {"code": "3480103296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8073.31, "gross_charge": 8323.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7074.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6242.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5826.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8073.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5826.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6242.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7074.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6658.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS", "code_information": [{"code": "54500", "type": "CPT"}, {"code": "3480103297", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 9359.53, "gross_charge": 9649.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8201.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7236.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6754.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9359.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6754.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7236.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8201.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7719.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TESTIS, IN", "code_information": [{"code": "54505", "type": "CPT"}, {"code": "3480102062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TOE JOINT LINING", "code_information": [{"code": "28054", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41105", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42806", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF URETHRA", "code_information": [{"code": "53200", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UTERUS LINING", "code_information": [{"code": "58100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57105", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56606", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF WRIST JOINT", "code_information": [{"code": "25100", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY", "code_information": [{"code": "89291", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OOCYTE POLAR BODY <=5", "code_information": [{"code": "89290", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OR EXCISION O", "code_information": [{"code": "38500", "type": "CPT"}, {"code": "3480101893", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6178.9, "gross_charge": 6370.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6178.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OR EXCISION O", "code_information": [{"code": "38510", "type": "CPT"}, {"code": "3480101894", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6178.9, "gross_charge": 6370.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6178.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY OR EXCISION O", "code_information": [{"code": "38525", "type": "CPT"}, {"code": "3480101895", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6178.9, "gross_charge": 6370.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6178.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY ROOF OF MOUTH", "code_information": [{"code": "42100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SHOULDER TISSUES", "code_information": [{"code": "23065", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY SOFT TISSUE OF BACK", "code_information": [{"code": "21920", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY THIGH SOFT TI", "code_information": [{"code": "27324", "type": "CPT"}, {"code": "3340102449", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38520", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOPSY/REMOVAL LYMPH NODES", "code_information": [{"code": "38530", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOVANCE 1 SQUARE CM", "code_information": [{"code": "Q4154", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.45, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 155.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIOVANCE TRI OR 3L, SQ CM", "code_information": [{"code": "Q4283", "type": "HCPCS"}], "standard_charges": [{"minimum": 1297.54, "maximum": 1297.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1297.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIPLANE BIOPSY GUIDE", "code_information": [{"code": "3100203431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.44, "discounted_cash": 96.66, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR 12 DEG LOOP*", "code_information": [{"code": "3100205891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR BAYONET *159", "code_information": [{"code": "3100205240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1359.0, "discounted_cash": 2038.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR BAYONET 190M", "code_information": [{"code": "3100203443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR CABLE ESG400", "code_information": [{"code": "3100206014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR CABLE*BIPCBE", "code_information": [{"code": "3100207519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR DORNIER DISC", "code_information": [{"code": "3100205890", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIPOLAR SPECIALTY 9*", "code_information": [{"code": "3100203188", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BIRTHING CLASS", "code_information": [{"code": "S9442", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIS XTRACELL FLUID ANALYSIS", "code_information": [{"code": "93702", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BIT COUNTERSINK", "code_information": [{"code": "3100100104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BITER PITUITARY DOWN", "code_information": [{"code": "3100100105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2738.0, "discounted_cash": 4107.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BITEWINGS - THREE IMAGES", "code_information": [{"code": "D0273", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BITEWINGS FOUR IMAGES", "code_information": [{"code": "D0274", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7628", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BITOLTEROL MESYLATE COMP UNT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7629", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BIVALIRUDIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0583", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BKBENCH PREP DON UTER ALGRFT", "code_information": [{"code": "668T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER ARTL", "code_information": [{"code": "670T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BKBENCH RCNSTJ DON UTER VEN", "code_information": [{"code": "669T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BL DRAW < 3 YRS FEM/JUGULAR", "code_information": [{"code": "36400", "type": "CPT"}], "standard_charges": [{"minimum": 11.57, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS OTHER VEIN", "code_information": [{"code": "36406", "type": "CPT"}], "standard_charges": [{"minimum": 11.57, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BL DRAW <3 YRS SCALP VEIN", "code_information": [{"code": "36405", "type": "CPT"}], "standard_charges": [{"minimum": 11.57, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BL SMEAR W/O DIFF WBC COUNT", "code_information": [{"code": "85008", "type": "CPT"}], "standard_charges": [{"minimum": 3.43, "maximum": 20.92, "discounted_cash": 5.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLADDER INSTILLATION", "code_information": [{"code": "51720", "type": "CPT"}, {"code": "3480102019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 829.51, "gross_charge": 813.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 691.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 609.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 569.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 788.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 569.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 609.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 691.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 650.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLADDER INSTILLATION", "code_information": [{"code": "51720", "type": "CPT"}, {"code": "3480103224", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.1, "gross_charge": 930.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 902.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLADE", "code_information": [{"code": "3100100134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 769.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE 4.4 DIAMOND SH", "code_information": [{"code": "3100203979", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1529.4, "discounted_cash": 2294.1, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ANGLED OSTOTOM", "code_information": [{"code": "3100100106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BEAVER", "code_information": [{"code": "3100100107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BEAVER", "code_information": [{"code": "3100102461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BEAVER", "code_information": [{"code": "3100102462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BEAVER", "code_information": [{"code": "3100102463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 91.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BEAVER MINI", "code_information": [{"code": "3100103989", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BONE SCALPEL", "code_information": [{"code": "3100104160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE BONESCALPEL", "code_information": [{"code": "3100104035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CHISEL FLEX*53", "code_information": [{"code": "3100202923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CLIPPER SENSIC", "code_information": [{"code": "3100100108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CUR CHISEL*530", "code_information": [{"code": "3100202922", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.8, "discounted_cash": 796.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CURVED", "code_information": [{"code": "3100100109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CURVED", "code_information": [{"code": "3100104411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 846.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CURVED", "code_information": [{"code": "3100104482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 279.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CUTTING", "code_information": [{"code": "3100102128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 865.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DENNIS", "code_information": [{"code": "3100100110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.7, "discounted_cash": 76.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DEPUY SAW OSCI", "code_information": [{"code": "3100100111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 801.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DERMATONE", "code_information": [{"code": "3100100112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DISPOSABLE ASS", "code_information": [{"code": "3100100113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 936.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DUAL KAHOOK*10", "code_information": [{"code": "3100203932", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EAR SICKLEDGE", "code_information": [{"code": "3100100114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ELECTRODE", "code_information": [{"code": "3100100115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EMERALD FIBER", "code_information": [{"code": "3100100116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 342.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENT AGGRESS PL", "code_information": [{"code": "3100100117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 685.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENT AGGRESS PL", "code_information": [{"code": "3100102464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE ENT AGGRESS PL", "code_information": [{"code": "3100102465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 506.0, "discounted_cash": 759.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EXCALIBUR", "code_information": [{"code": "3100100118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EXPLANT 50MM*0", "code_information": [{"code": "3100203479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2394.0, "discounted_cash": 3591.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EXPLANT 50MM*0", "code_information": [{"code": "3100203480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2394.0, "discounted_cash": 3591.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE EXT", "code_information": [{"code": "3100100119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FAST FIX SUTUR", "code_information": [{"code": "3100100120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.0, "discounted_cash": 781.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FAST FIX ULTRA", "code_information": [{"code": "3100100121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 1548.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FAST FIX ULTRA", "code_information": [{"code": "3100102466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 1548.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FEMORAL CUP", "code_information": [{"code": "3100100122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE FULL RAD RESEC", "code_information": [{"code": "3100100123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HELICAL", "code_information": [{"code": "3100100124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2028.0, "discounted_cash": 3042.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HELICAL", "code_information": [{"code": "3100104540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2237.0, "discounted_cash": 3355.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HELICAL SYNTHE", "code_information": [{"code": "3100103894", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2615.0, "discounted_cash": 3922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HI PERF", "code_information": [{"code": "3100102399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 249.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HOLDER", "code_information": [{"code": "3100100125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INFERIOR ROTAT", "code_information": [{"code": "3100100126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 723.0, "discounted_cash": 1084.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INFERIOR ROTAT", "code_information": [{"code": "3100104363", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 767.82, "discounted_cash": 1151.73, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INFERIOR ROTAT", "code_information": [{"code": "3100104365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INFERIOR TUR 2", "code_information": [{"code": "3100204459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 633.69, "discounted_cash": 950.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INSULATED COAT", "code_information": [{"code": "3100100127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE INTRA ORAL", "code_information": [{"code": "3100100128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KIT SZ 1*AR-60", "code_information": [{"code": "3100206356", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 894.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KIT SZ 2*AR-60", "code_information": [{"code": "3100205188", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 894.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KIT SZ 3*AR-60", "code_information": [{"code": "3100206778", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 596.0, "discounted_cash": 894.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE ACL DBL", "code_information": [{"code": "3100100129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 713.0, "discounted_cash": 1069.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE CARPAL T", "code_information": [{"code": "3100100130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.84, "discounted_cash": 281.76, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE GRAFT DB", "code_information": [{"code": "3100100131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE HALF MOO", "code_information": [{"code": "3100206239", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE PARALLEL", "code_information": [{"code": "3100100132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE RETRACTA", "code_information": [{"code": "3100100133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE SICKLE S", "code_information": [{"code": "3100100135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 774.0, "discounted_cash": 1161.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE SLIT", "code_information": [{"code": "3100102283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE SLIT ANG", "code_information": [{"code": "3100100136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.5, "discounted_cash": 107.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE ST COLD", "code_information": [{"code": "3100100137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 873.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE KNIFE TRIANGLE", "code_information": [{"code": "3100100138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LAMELLAR", "code_information": [{"code": "3100100139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE LAMELLAR", "code_information": [{"code": "3100102467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MEDTRONIC", "code_information": [{"code": "3100100159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MICROAIRE SAW", "code_information": [{"code": "3100100140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MYRINGOTOMY *1", "code_information": [{"code": "3100203562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.2, "discounted_cash": 82.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE MYRINGOTOMY20*", "code_information": [{"code": "3100203563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.2, "discounted_cash": 82.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OFFSET ARTHREX", "code_information": [{"code": "3100103880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSC 70X8MM*510", "code_information": [{"code": "3100203383", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSCILLATOR*502", "code_information": [{"code": "3100207061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.92, "discounted_cash": 31.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEO 8X3*SBLD", "code_information": [{"code": "3100209916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME", "code_information": [{"code": "3100100141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME", "code_information": [{"code": "3100102468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME", "code_information": [{"code": "3100102469", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME RADI", "code_information": [{"code": "3100100142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME*ARS7", "code_information": [{"code": "3100204664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1404.0, "discounted_cash": 2106.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE OSTEOTOME*ARS7", "code_information": [{"code": "3100204768", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 1053.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PATELLA REAM*0", "code_information": [{"code": "3100204054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PATELLA REAM*0", "code_information": [{"code": "3100206756", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE PRECISION*2296", "code_information": [{"code": "3100208342", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.24, "discounted_cash": 127.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE QUADCUT ROTATA", "code_information": [{"code": "3100100143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 886.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100100144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 795.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102472", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 879.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102473", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 814.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 565.0, "discounted_cash": 847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 633.0, "discounted_cash": 949.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RAD", "code_information": [{"code": "3100102477", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.0, "discounted_cash": 1122.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIP", "code_information": [{"code": "3100100145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.0, "discounted_cash": 163.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIP", "code_information": [{"code": "3100102478", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIP", "code_information": [{"code": "3100102479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIP", "code_information": [{"code": "3100102480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIP", "code_information": [{"code": "3100102481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 484.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RECIP 75X8*510", "code_information": [{"code": "3100203384", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE RENAL SWIVEL", "code_information": [{"code": "3100100146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SABRE CURVED", "code_information": [{"code": "3100100147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL", "code_information": [{"code": "3100100148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 229.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL", "code_information": [{"code": "3100102482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL", "code_information": [{"code": "3100102483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL", "code_information": [{"code": "3100102484", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL", "code_information": [{"code": "3100102485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 313.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL", "code_information": [{"code": "3100104427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL ARTHR", "code_information": [{"code": "3100103879", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL MAKO", "code_information": [{"code": "3100205146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.58, "discounted_cash": 782.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL MAKO", "code_information": [{"code": "3100205147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.97, "discounted_cash": 778.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL*2108-", "code_information": [{"code": "3100205372", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.56, "discounted_cash": 270.84, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL*2108-", "code_information": [{"code": "3100205462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.92, "discounted_cash": 116.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAGITTAL*6213-", "code_information": [{"code": "3100202778", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.48, "discounted_cash": 297.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100100149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 135.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100102486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100102487", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100102488", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 139.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100102489", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100102490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 211.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100102491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100104382", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100104487", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW", "code_information": [{"code": "3100104549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 709.0, "discounted_cash": 1063.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 25X90*BR1-", "code_information": [{"code": "3100206322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.96, "discounted_cash": 113.94, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 3.0MM SHOR", "code_information": [{"code": "3100203242", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.75, "discounted_cash": 1063.13, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW 4.0MM SHOR", "code_information": [{"code": "3100205508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1239.0, "discounted_cash": 1858.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW ARTHREX", "code_information": [{"code": "3100103878", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW DIAMOND", "code_information": [{"code": "3100100150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW GIGLI", "code_information": [{"code": "3100100151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 142.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW MIKA", "code_information": [{"code": "3100100152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW STRYKER", "code_information": [{"code": "3100100153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 562.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW TPS", "code_information": [{"code": "3100100154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 149.0, "discounted_cash": 223.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW TPS", "code_information": [{"code": "3100102129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW TPS", "code_information": [{"code": "3100104426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.8, "discounted_cash": 127.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW ZIMMER", "code_information": [{"code": "3100100155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW ZIMMER", "code_information": [{"code": "3100102492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SAW ZIMMER", "code_information": [{"code": "3100102493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SET OSTEOTOME", "code_information": [{"code": "3100100156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10880.0, "discounted_cash": 16320.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER 3.5*AR-", "code_information": [{"code": "3100203327", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER DOUBLEC", "code_information": [{"code": "3100100157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHAVER LARYNGE", "code_information": [{"code": "3100208739", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4297.83, "discounted_cash": 6446.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SHIELD OSTEOTO", "code_information": [{"code": "3100100158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SPIRAL 60MM*04", "code_information": [{"code": "3100205670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1482.78, "discounted_cash": 2224.17, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SPIRAL 70MM*04", "code_information": [{"code": "3100204925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1941.75, "discounted_cash": 2912.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SPIRAL 75MM*04", "code_information": [{"code": "3100205063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2226.54, "discounted_cash": 3339.81, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE SPIRAL 80MM*04", "code_information": [{"code": "3100206266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1884.51, "discounted_cash": 2826.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STEERABLE", "code_information": [{"code": "3100102130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE STRYKER", "code_information": [{"code": "3100103888", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 349.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TENDON STRP 10", "code_information": [{"code": "3100204385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TENDON STRP 9M", "code_information": [{"code": "3100204131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRICUT", "code_information": [{"code": "3100104366", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 918.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE TRUCLEAR INCIS", "code_information": [{"code": "3100100160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1977.0, "discounted_cash": 2965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE VERSACUT SET*0", "code_information": [{"code": "3100204611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADELESS TROCAR", "code_information": [{"code": "3100102131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 327.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADEOFFST 9X.64X35*", "code_information": [{"code": "3100203325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.16, "discounted_cash": 150.24, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADES DENNIS STR", "code_information": [{"code": "3100102132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLASTOMYCES AB", "code_information": [{"code": "86612", "type": "CPT"}, {"code": "3440101092", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.9, "maximum": 98.94, "gross_charge": 102.0, "discounted_cash": 20.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD DRV T LYMPHCYT CAR-T CLL", "code_information": [{"code": "537T", "type": "CPT"}], "standard_charges": [{"minimum": 186.01, "maximum": 186.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD DRV T LYMPHCYT PREP TRNS", "code_information": [{"code": "538T", "type": "CPT"}], "standard_charges": [{"minimum": 186.01, "maximum": 186.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD EXCHANGE TRUJ OTH THN NB", "code_information": [{"code": "36455", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLD PUSH TFUJ 2 YR/<", "code_information": [{"code": "36440", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 299.49, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLEEDING TIME", "code_information": [{"code": "85002", "type": "CPT"}, {"code": "3440101023", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 4.82, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 7.74, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLENDING CONN W MIXE", "code_information": [{"code": "3100204681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLEOMYCIN SULFATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9040", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.12, "maximum": 23.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY LOWER", "code_information": [{"code": "15821", "type": "CPT"}, {"code": "3480101376", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5126.45, "gross_charge": 5285.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5126.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPLASTY UPPER", "code_information": [{"code": "15823", "type": "CPT"}, {"code": "3480101377", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5126.45, "gross_charge": 5285.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5126.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLEPHAROPTOSIS LEVAT", "code_information": [{"code": "67904", "type": "CPT"}, {"code": "3480102211", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLIND INTERATRIAL SHUNT IDE", "code_information": [{"code": "C9758", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 28114.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLINDED CONV. TX MDD CLIN TR", "code_information": [{"code": "G2000", "type": "HCPCS"}], "standard_charges": [{"minimum": 382.26, "maximum": 382.26, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 382.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLINK REFLEX TEST", "code_information": [{"code": "95933", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLM GENE", "code_information": [{"code": "81209", "type": "CPT"}], "standard_charges": [{"minimum": 39.31, "maximum": 79.66, "discounted_cash": 63.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOCK CORNEAL CUTTIN", "code_information": [{"code": "3100100161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 193.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEM AUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.3, "maximum": 2123.33, "gross_charge": 2189.0, "discounted_cash": 3283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK FEM AUG 5MM*62", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1474.7, "maximum": 2043.51, "gross_charge": 2106.72, "discounted_cash": 3160.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1790.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1580.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1474.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2043.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1474.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1580.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1790.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1685.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK ILIOINGUINAL", "code_information": [{"code": "64425", "type": "CPT"}, {"code": "3480102171", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOCK INTERCOSTAL MU", "code_information": [{"code": "64421", "type": "CPT"}, {"code": "3480102170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOCK INTERCOSTAL SI", "code_information": [{"code": "64420", "type": "CPT"}, {"code": "3480102169", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOCK LORD SR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1654.1, "maximum": 2292.11, "gross_charge": 2363.0, "discounted_cash": 3544.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2008.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1654.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2292.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1654.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2008.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1890.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK OTHER PERIPHER", "code_information": [{"code": "64450", "type": "CPT"}, {"code": "3480102173", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOCK PARA FACET LUM", "code_information": [{"code": "64476", "type": "CPT"}, {"code": "3430100751", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1164.8, "maximum": 1614.08, "gross_charge": 1664.0, "discounted_cash": 2496.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1614.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1331.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK PARAVERT FACET", "code_information": [{"code": "64475", "type": "CPT"}, {"code": "3430100750", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1164.8, "maximum": 1614.08, "gross_charge": 1664.0, "discounted_cash": 2496.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1614.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1331.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK SCIATIC", "code_information": [{"code": "64445", "type": "CPT"}, {"code": "3480102172", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOCK TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3376.1, "maximum": 4678.31, "gross_charge": 4823.0, "discounted_cash": 7234.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4099.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3617.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3376.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4678.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3376.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3617.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4099.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3858.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCKER OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCKER SECURIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCKER XIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 401.1, "maximum": 555.81, "gross_charge": 573.0, "discounted_cash": 859.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 487.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 401.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 555.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 401.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 487.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 458.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCKER XIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCKER XIA*48230000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMIN UP TO 2", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "3340100561", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 621.77, "gross_charge": 641.0, "discounted_cash": 664.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 544.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 458.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 480.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 621.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 456.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 480.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 527.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 544.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 512.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMIN UP TO 4", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "3340100562", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 869.12, "gross_charge": 896.0, "discounted_cash": 664.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 458.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 627.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 869.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 627.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 456.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 527.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 716.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ADMIN UP TO >4", "code_information": [{"code": "36430", "type": "CPT"}, {"code": "3340100563", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1118.41, "gross_charge": 1153.0, "discounted_cash": 664.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 980.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 458.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 864.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 807.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1118.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 807.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 456.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 864.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 527.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 980.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 922.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD ALCOHOL", "code_information": [{"code": "82055", "type": "CPT"}, {"code": "3440100847", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 67.9, "maximum": 94.09, "gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 94.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 20.37, "maximum": 59.63, "discounted_cash": 32.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT RETRACTION", "code_information": [{"code": "85170", "type": "CPT"}], "standard_charges": [{"minimum": 16.3, "maximum": 20.47, "discounted_cash": 26.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD CNT AUTO DIF W", "code_information": [{"code": "85004", "type": "CPT"}, {"code": "3440101024", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.47, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD CNT SMR MAN DI", "code_information": [{"code": "85007", "type": "CPT"}, {"code": "3440101025", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 3.8, "maximum": 31.04, "gross_charge": 32.0, "discounted_cash": 6.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 22.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 31.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 22.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 25.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COMPONENT/PRODUCT NOC", "code_information": [{"code": "P9099", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 50.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT HEMAGLOB", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "3440101029", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.37, "maximum": 24.25, "gross_charge": 25.0, "discounted_cash": 3.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT HEMATOCR", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "3440101026", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.37, "maximum": 24.25, "gross_charge": 25.0, "discounted_cash": 3.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT HEMATOCR", "code_information": [{"code": "85014", "type": "CPT"}, {"code": "3440101027", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.37, "maximum": 24.25, "gross_charge": 25.0, "discounted_cash": 3.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT HEMOGLOB", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "3440101028", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.37, "maximum": 24.25, "gross_charge": 25.0, "discounted_cash": 3.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT LEUKO WB", "code_information": [{"code": "85048", "type": "CPT"}, {"code": "3440101033", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.54, "maximum": 25.22, "gross_charge": 26.0, "discounted_cash": 4.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT PLATELET", "code_information": [{"code": "85049", "type": "CPT"}, {"code": "3440101034", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 4.48, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 7.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD COUNT RETICULC", "code_information": [{"code": "85045", "type": "CPT"}, {"code": "3440101032", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 3.99, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD FUNGUS CULTURE", "code_information": [{"code": "87103", "type": "CPT"}], "standard_charges": [{"minimum": 20.46, "maximum": 24.03, "discounted_cash": 32.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES ANY COMB", "code_information": [{"code": "82803", "type": "CPT"}, {"code": "3440100912", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 26.07, "maximum": 167.81, "gross_charge": 173.0, "discounted_cash": 41.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 167.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 33.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES O2 SAT ONLY", "code_information": [{"code": "82810", "type": "CPT"}], "standard_charges": [{"minimum": 9.77, "maximum": 20.92, "discounted_cash": 15.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES PH ONLY", "code_information": [{"code": "82800", "type": "CPT"}, {"code": "3440100911", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.0, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 17.67, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.78, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.78, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES W/O2 SATURATION", "code_information": [{"code": "82805", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 181.56, "discounted_cash": 126.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD GLUCOSE LEVEL TEST", "code_information": [{"code": "D0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.92, "maximum": 20.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD MUCOPROTEIN", "code_information": [{"code": "P2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 7.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD OCCULT QUAL FE", "code_information": [{"code": "82270", "type": "CPT"}, {"code": "3440100862", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.38, "maximum": 26.19, "gross_charge": 27.0, "discounted_cash": 7.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE CUFF", "code_information": [{"code": "3100100165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE CUFF", "code_information": [{"code": "3100100166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE CUFF", "code_information": [{"code": "3100102495", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE CUFF", "code_information": [{"code": "3100102496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRESSURE CUFF", "code_information": [{"code": "3100102497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOD PRODUCT/IRRADIATION", "code_information": [{"code": "86945", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD SMEAR INTERPRE", "code_information": [{"code": "85060", "type": "CPT"}, {"code": "3440101035", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 12.39, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD SPLIT UNIT", "code_information": [{"code": "P9011", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 239.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD THYMOL TURBIDITY", "code_information": [{"code": "P2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.6, "maximum": 35.6, "discounted_cash": 7.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPE AG DONOR", "code_information": [{"code": "86902", "type": "CPT"}, {"code": "3440101145", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 6.35, "maximum": 436.49, "gross_charge": 117.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPE AG SCREEN", "code_information": [{"code": "86904", "type": "CPT"}, {"code": "3440101070", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.34, "maximum": 113.49, "gross_charge": 117.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING ABO", "code_information": [{"code": "86900", "type": "CPT"}, {"code": "3440101143", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 2.99, "maximum": 155.12, "gross_charge": 66.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING ANTIGEN SYSTEM", "code_information": [{"code": "86911", "type": "CPT"}], "standard_charges": [{"minimum": 35.6, "maximum": 35.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATERNITY TEST", "code_information": [{"code": "86910", "type": "CPT"}], "standard_charges": [{"minimum": 35.6, "maximum": 35.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING RH D", "code_information": [{"code": "86901", "type": "CPT"}, {"code": "3440101144", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 2.99, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 61.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING RH PHEN", "code_information": [{"code": "86906", "type": "CPT"}, {"code": "3440101148", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.75, "maximum": 64.99, "gross_charge": 67.0, "discounted_cash": 61.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 50.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 50.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPNG RBC OTH/", "code_information": [{"code": "86905", "type": "CPT"}, {"code": "3440101046", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 3.83, "maximum": 436.49, "gross_charge": 117.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD VISCOSITY EXAMINATION", "code_information": [{"code": "85810", "type": "CPT"}], "standard_charges": [{"minimum": 11.67, "maximum": 20.92, "discounted_cash": 18.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD VOLUME", "code_information": [{"code": "78122", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, CMV-NEG", "code_information": [{"code": "P9051", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 268.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, FROZ/DEGLY/WASH", "code_information": [{"code": "P9054", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 345.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLOOD, L/R, IRRADIATED", "code_information": [{"code": "P9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 147.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"minimum": 1767.1, "maximum": 1767.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BLUEPRINT GLENOID MO", "code_information": [{"code": "3100205259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUNT PIN* 500374", "code_information": [{"code": "3100208165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BMC ANGEL KIT", "code_information": [{"code": "S2150", "type": "HCPCS"}, {"code": "3100104226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BMC ANGEL KIT PRP*AB", "code_information": [{"code": "3100202575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BMC ANGEL KIT PRP*AB", "code_information": [{"code": "3100204312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BMC ANGEL KIT*ABS-10", "code_information": [{"code": "3100202827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BME IMPLANT KIT*EL-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3538.08, "maximum": 4902.76, "gross_charge": 5054.4, "discounted_cash": 7581.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4296.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3790.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3538.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4902.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3538.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3790.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4296.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4043.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOB BATTERY PACK*50-", "code_information": [{"code": "3100203830", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 372.0, "discounted_cash": 558.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BODY FLUID CELL COUN", "code_information": [{"code": "89050", "type": "CPT"}, {"code": "3440103015", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.72, "maximum": 35.16, "gross_charge": 36.0, "discounted_cash": 7.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BODY HIP ZIMMER CONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7712.6, "maximum": 10687.46, "gross_charge": 11018.0, "discounted_cash": 16527.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9365.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8263.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7712.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10687.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7712.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8263.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9365.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8814.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BODY HIP ZIMMER CONE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7371.0, "maximum": 10214.1, "gross_charge": 10530.0, "discounted_cash": 15795.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8950.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7897.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7371.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10214.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7371.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7897.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8950.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8424.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOLT 10MM*103200", "code_information": [{"code": "3100209120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.12, "discounted_cash": 55.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 16MM*103201", "code_information": [{"code": "3100209121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.12, "discounted_cash": 55.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT 20MM*103203", "code_information": [{"code": "3100209122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.12, "discounted_cash": 55.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT EXTRACT SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.8, "maximum": 450.08, "gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOLT EXTRACT SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 358.4, "maximum": 496.64, "gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 496.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 409.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOLT EXTRACT SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 753.2, "maximum": 1043.72, "gross_charge": 1076.0, "discounted_cash": 1614.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 914.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 807.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 753.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1043.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 753.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 807.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 914.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 860.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOLT FEMORAL NECK *0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1122.66, "maximum": 1555.68, "gross_charge": 1603.8, "discounted_cash": 2405.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1202.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1122.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1555.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1122.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1202.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1363.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1283.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE 8X11X14MM*07012", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE ACCESS KIT*OCN0", "code_information": [{"code": "3100209884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.75, "discounted_cash": 1985.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ACCESS KIT*T15J", "code_information": [{"code": "3100207659", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE ALLO LORD", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3204.88, "gross_charge": 3304.0, "discounted_cash": 4956.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2478.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2312.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3204.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2312.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2478.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2643.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ALLODERM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 11575.98, "gross_charge": 11934.0, "discounted_cash": 17901.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10143.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8950.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8353.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11575.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8353.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8950.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10143.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9547.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ALLOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5447.52, "gross_charge": 5616.0, "discounted_cash": 8424.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4212.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3931.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5447.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3931.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4212.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4492.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ALLOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1563.8, "maximum": 2166.98, "gross_charge": 2234.0, "discounted_cash": 3351.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1898.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1675.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1563.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2166.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1563.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1675.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1898.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1787.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ALLOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ALLOGRAFT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE BIOPSY SZ 3*F05", "code_information": [{"code": "3100203080", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE BIOSPY DEVICE*F", "code_information": [{"code": "3100205541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANC 15CC*ABS-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 531.17, "maximum": 736.05, "gross_charge": 758.82, "discounted_cash": 1138.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 644.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 569.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 531.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 736.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 531.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 569.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 644.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 607.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC 30CC*ABS-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 920.7, "maximum": 1275.83, "gross_charge": 1315.29, "discounted_cash": 1972.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1117.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 986.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 920.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1275.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 920.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 986.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1117.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1052.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC 5CC*800102", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC 60CC*80011", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1767.86, "maximum": 2449.75, "gross_charge": 2525.52, "discounted_cash": 3788.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2146.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1894.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1767.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2449.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1767.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1894.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2146.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2020.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC CHIPS 15CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 706.65, "maximum": 979.21, "gross_charge": 1009.5, "discounted_cash": 1514.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 858.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 757.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 706.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 979.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 706.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 757.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 858.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 807.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC CHIPS 30CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1072.63, "maximum": 1486.36, "gross_charge": 1532.34, "discounted_cash": 2298.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1302.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1149.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1072.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1486.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1072.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1149.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1302.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1225.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC CRSE 15CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 559.96, "maximum": 775.95, "gross_charge": 799.95, "discounted_cash": 1199.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 679.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 599.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 559.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 775.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 559.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 599.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 679.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 639.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC CRUSH 5CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANC CRUSHED 15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 680.4, "maximum": 942.84, "gross_charge": 972.0, "discounted_cash": 1458.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 942.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 777.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANCELL 15CC*BN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 742.05, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANCELL 30CC*BN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 823.2, "maximum": 1140.72, "gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANCELL 5CC*BNE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANCELLLOUS 15C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANCELLLOUS 30C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS ACF", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3704.43, "gross_charge": 3819.0, "discounted_cash": 5728.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3246.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2864.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2673.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3704.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2673.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2864.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3246.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3055.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS STRY", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS STRY", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3114.67, "gross_charge": 3211.0, "discounted_cash": 4816.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2729.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2408.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2247.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3114.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2247.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2408.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2729.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2568.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS STRY", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3322.25, "gross_charge": 3425.0, "discounted_cash": 5137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2911.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2568.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2397.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3322.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2397.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2568.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2911.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2740.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CELLULAR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5825.82, "gross_charge": 6006.0, "discounted_cash": 9009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5105.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4504.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4204.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5825.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4204.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4504.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5105.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4804.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CELLULAR 1CC LI", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1176.0, "maximum": 1725.27, "gross_charge": 1680.0, "discounted_cash": 2520.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1344.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CEMENT*CX01B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 10MM*BALC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 10MM*BALC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 11MM*BALC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 12MM*BALC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 6MM*BALC0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 7MM*BALCX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 8MM*BALC0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 8MM*BALCX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 9MM*BALC0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1680.0, "maximum": 2328.0, "gross_charge": 2400.0, "discounted_cash": 3600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2040.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2328.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2040.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERV 9MM*BALCX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL 10MM*B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL 6MM*BA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL 7MM*BA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL 8MM*BA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL 9MM*BA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL ALPHAT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 4413.5, "gross_charge": 4550.0, "discounted_cash": 6825.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4413.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CERVICAL APLPHA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 15CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 1725.27, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 15CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 347.9, "maximum": 1725.27, "gross_charge": 497.0, "discounted_cash": 745.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 422.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 372.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 347.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 482.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 347.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 372.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 422.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 15CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 669.9, "maximum": 1725.27, "gross_charge": 957.0, "discounted_cash": 1435.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 928.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 765.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 30CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1136.1, "maximum": 1725.27, "gross_charge": 1623.0, "discounted_cash": 2434.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1379.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1217.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1136.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1574.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1136.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1217.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1379.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1298.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 30CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1043.0, "maximum": 1725.27, "gross_charge": 1490.0, "discounted_cash": 2235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1266.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1043.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1445.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1043.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1266.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1192.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 30CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1131.9, "maximum": 1725.27, "gross_charge": 1617.0, "discounted_cash": 2425.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1374.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1212.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1131.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1131.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1212.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1374.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1293.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 30CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 766.39, "maximum": 1725.27, "gross_charge": 1094.85, "discounted_cash": 1642.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 930.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 821.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 766.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1062.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 766.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 821.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 930.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 875.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 5CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 375.9, "maximum": 1725.27, "gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 60CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1422.4, "maximum": 1971.04, "gross_charge": 2032.0, "discounted_cash": 3048.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1727.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1524.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1971.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1422.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1524.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1727.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1625.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS CANC 60CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1045.1, "maximum": 1725.27, "gross_charge": 1493.0, "discounted_cash": 2239.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1269.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1119.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1045.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1448.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1045.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1119.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1269.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1194.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS INTEGRA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 821.1, "maximum": 1725.27, "gross_charge": 1173.0, "discounted_cash": 1759.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 997.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1137.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 997.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS INTEGRA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1725.27, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CHIPS STRYKER", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 1725.27, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CORT/CANC 30CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 772.84, "maximum": 1070.93, "gross_charge": 1104.06, "discounted_cash": 1656.09, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 938.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 828.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 772.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1070.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 772.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 828.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 938.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 883.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CORTICO CAN CER", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3969.24, "gross_charge": 4092.0, "discounted_cash": 6138.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3478.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3069.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2864.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3969.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2864.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3069.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3478.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3273.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CORTICO CANC CE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3853.81, "gross_charge": 3973.0, "discounted_cash": 5959.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3377.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2979.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2781.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3853.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2781.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2979.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3377.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3178.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CORTICO CANC CE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3560.87, "gross_charge": 3671.0, "discounted_cash": 5506.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3120.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2753.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2569.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3560.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2569.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2753.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3120.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2936.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CORTICO CANC CE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3853.81, "gross_charge": 3973.0, "discounted_cash": 5959.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3377.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2979.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2781.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3853.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2781.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2979.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3377.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3178.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING BODY MANDIBLE", "code_information": [{"code": "D7945", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING RAMUS CLOSED", "code_information": [{"code": "D7941", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING SEGMENTED", "code_information": [{"code": "D7944", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DERMA MATRIX", "code_information": [{"code": "C9358", "type": "HCPCS"}, {"code": "3100100183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 480.9, "maximum": 1725.27, "gross_charge": 687.0, "discounted_cash": 1030.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 515.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 480.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 480.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 515.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 549.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [{"code": "553", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7298.08, "maximum": 7298.08, "discounted_cash": 15088.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7298.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [{"code": "554", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4077.58, "maximum": 4077.58, "discounted_cash": 9175.04, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4077.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE DOWEL KIT13*ABS", "code_information": [{"code": "3100207686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE DOWEL KIT14*ABS", "code_information": [{"code": "3100206902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE DOWEL KIT16*ABS", "code_information": [{"code": "3100206903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1732.5, "discounted_cash": 2598.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE DOWEL KIT18*ABS", "code_information": [{"code": "3100206904", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1732.5, "discounted_cash": 2598.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE DRILL", "code_information": [{"code": "3100102409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE FIBULA STRUT 70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE FILLER SZ 3*748", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT MATRIX ST", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100100184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3534.68, "gross_charge": 3644.0, "discounted_cash": 5466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3097.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2550.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3534.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2550.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3097.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2915.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT MATRIX ST", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100102515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT PERI EACH ADDL", "code_information": [{"code": "D3429", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT PERI PER TOOTH", "code_information": [{"code": "D3428", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT REPAIR PERIMPLANT", "code_information": [{"code": "D6103", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE GRAFT TIME OF IMPLANT", "code_information": [{"code": "D6104", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE HARVEST,AUTO GRAFT PROC", "code_information": [{"code": "D7295", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE HYDROSET XT*897", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2891.91, "maximum": 4007.36, "gross_charge": 4131.3, "discounted_cash": 6196.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3511.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3098.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2891.91, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4007.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2891.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3098.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3511.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3305.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE HYDROSET XT*897", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1941.92, "maximum": 2690.95, "gross_charge": 2774.18, "discounted_cash": 4161.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2358.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2080.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1941.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2690.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1941.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2080.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2358.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2219.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE HYDROSET XT*897", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5670.15, "maximum": 7857.21, "gross_charge": 8100.22, "discounted_cash": 12150.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6885.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6075.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5670.15, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7857.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5670.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6075.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6885.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6480.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING 3 PHASE", "code_information": [{"code": "78315", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING LIMITED AREA", "code_information": [{"code": "78300", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING MULTIPLE AREAS", "code_information": [{"code": "78305", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE IMAGING WHOLE BODY", "code_information": [{"code": "78306", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE INFUSE XSM*7510", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3949.4, "maximum": 5472.74, "gross_charge": 5642.0, "discounted_cash": 8463.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4795.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4231.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3949.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5472.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3949.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4231.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4795.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4513.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE INFUSE XXSM*751", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1983.8, "maximum": 2748.98, "gross_charge": 2834.0, "discounted_cash": 4251.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2748.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2267.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE LASR 6X14X11*40", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE LIFENET ILIAC C", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1725.27, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE LIFENET ILIAC C", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2908.06, "gross_charge": 2998.0, "discounted_cash": 4497.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2908.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2398.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE LORDOTIC 7MM*07", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE LORDOTIC 8MM*07", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5816.72, "maximum": 8060.31, "gross_charge": 8309.6, "discounted_cash": 12464.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7063.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6232.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5816.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8060.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5816.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6232.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7063.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6647.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MAGNIFUSE 1 X 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4022.2, "maximum": 5573.62, "gross_charge": 5746.0, "discounted_cash": 8619.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4884.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5573.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4884.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4596.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MAGNIFUSE 1 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5955.95, "maximum": 8253.24, "gross_charge": 8508.5, "discounted_cash": 12762.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7232.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6381.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5955.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5955.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6381.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7232.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6806.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MAGNIFUSE 1 X 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2436.52, "maximum": 3376.32, "gross_charge": 3480.75, "discounted_cash": 5221.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2958.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3376.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2958.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MAGNIFUSE 1.75", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4254.25, "maximum": 5895.17, "gross_charge": 6077.5, "discounted_cash": 9116.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5165.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5165.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MAGNIFUSE 1.75X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MAGNIFUSE 7.5X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIR BONE GRFG", "code_information": [{"code": "20939", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATI", "code_information": [{"code": "38220", "type": "CPT"}, {"code": "3480101891", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1968.77, "gross_charge": 946.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 917.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1290.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPR KIT", "code_information": [{"code": "3100104099", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MARROW BIOPSY", "code_information": [{"code": "38221", "type": "CPT"}, {"code": "3480101892", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1968.77, "gross_charge": 946.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 917.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1290.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST ALLOGEN", "code_information": [{"code": "38230", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST AUTOLOG", "code_information": [{"code": "38232", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 7083.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING LTD", "code_information": [{"code": "78102", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING MULT", "code_information": [{"code": "78103", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MARROW SMEAR IN", "code_information": [{"code": "85097", "type": "CPT"}, {"code": "3440101036", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 55.38, "maximum": 1044.18, "gross_charge": 252.0, "discounted_cash": 1316.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 907.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 903.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1044.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MASTERGRAFT MAT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2551.0, "discounted_cash": 3826.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MASTERGRAFT MAT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3159.0, "discounted_cash": 4738.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MASTERGRAFT MAT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1443.0, "discounted_cash": 2164.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MASTERGRAFT MAT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100102517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3812.0, "discounted_cash": 5718.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MASTERGRAFT MAT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100102518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX 10CC*290", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX 1CC*290-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX 2.5CC*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1270.5, "maximum": 1760.55, "gross_charge": 1815.0, "discounted_cash": 2722.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1542.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1361.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1760.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1361.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1542.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1452.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX 5CC*290-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX FIBERCEL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6588.4, "maximum": 9129.64, "gross_charge": 9412.0, "discounted_cash": 14118.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8000.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7059.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6588.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9129.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6588.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7059.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8000.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7529.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX FIBERCEL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4105.92, "maximum": 5689.63, "gross_charge": 5865.6, "discounted_cash": 8798.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4985.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4399.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4105.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5689.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4105.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4399.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4985.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4692.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX FIBERCEL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8959.86, "maximum": 12415.8, "gross_charge": 12799.8, "discounted_cash": 19199.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10879.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9599.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8959.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12415.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8959.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9599.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10879.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10239.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MEDTRONIC INFUS", "code_information": [{"code": "3100100189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11138.0, "discounted_cash": 16707.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MEDTRONIC INFUS", "code_information": [{"code": "3100100192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10816.0, "discounted_cash": 16224.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MEDTRONIC INFUS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 12605.15, "gross_charge": 12995.0, "discounted_cash": 19492.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11045.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9746.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9096.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12605.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9096.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9746.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11045.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10396.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MEDTRONIC INFUS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 10869.82, "gross_charge": 11206.0, "discounted_cash": 16809.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9525.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8404.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7844.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10869.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7844.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8404.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9525.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8964.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MEDTRONIC LASR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MORSELS COLLAGE", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100100194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1587.6, "maximum": 2199.96, "gross_charge": 2268.0, "discounted_cash": 3402.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1927.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1701.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1587.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2199.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1587.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1701.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1927.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1814.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MORSELS COLLAGE", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100102519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 1725.27, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MORSELS COLLAGE", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100102520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 913.5, "maximum": 1725.27, "gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1265.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MORSELS COLLAGE", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100102521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1106.7, "maximum": 1725.27, "gross_charge": 1581.0, "discounted_cash": 2371.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1343.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1533.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1185.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1343.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1264.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MORSELS COLLAGE", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100102522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1548.4, "maximum": 2145.64, "gross_charge": 2212.0, "discounted_cash": 3318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1880.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1548.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2145.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1548.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1880.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1769.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MTF GRANULES 1", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 795.9, "maximum": 1725.27, "gross_charge": 1137.0, "discounted_cash": 1705.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 966.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 852.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 795.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1102.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 795.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 852.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 966.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 909.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MTF GRANULES 30", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1136.1, "maximum": 1725.27, "gross_charge": 1623.0, "discounted_cash": 2434.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1379.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1217.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1136.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1574.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1136.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1217.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1379.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1298.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MTF SHAFT FIB 1", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1626.8, "maximum": 2254.28, "gross_charge": 2324.0, "discounted_cash": 3486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1975.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1743.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1626.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2254.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1626.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1743.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1975.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1859.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MTF SHAFT FIB 4", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MTF SHAFT HUMRL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2597.66, "gross_charge": 2678.0, "discounted_cash": 4017.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2276.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2276.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE MTF SHAFT HUMRL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2706.3, "gross_charge": 2790.0, "discounted_cash": 4185.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2371.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2092.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2706.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2092.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2371.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2232.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ORTHOVITA VITOS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100100200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5532.88, "gross_charge": 5704.0, "discounted_cash": 8556.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4848.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4278.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3992.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5532.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3992.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4278.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4848.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4563.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE ORTHOVITA VITOS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100102524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3155.02, "gross_charge": 3252.6, "discounted_cash": 4878.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2764.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2439.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2276.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3155.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2276.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2439.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2764.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2602.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE OSTEO PLUS CELL", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1466.0, "discounted_cash": 2199.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE OSTEO PLUS CLLR", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 9724.0, "discounted_cash": 14586.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE OSTEO PLUS CLLR", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 11934.0, "discounted_cash": 17901.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE OSTEOCEL", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 6032.0, "discounted_cash": 9048.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE OSTEOTECH GRAFT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3254.0, "discounted_cash": 4881.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE PASTE / 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE PEARL MATRIX 2.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5723.9, "maximum": 7931.69, "gross_charge": 8177.0, "discounted_cash": 12265.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6950.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6132.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5723.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7931.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5723.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6132.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6950.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6541.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PEARL MATRIX*73", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7735.0, "maximum": 10718.5, "gross_charge": 11050.0, "discounted_cash": 16575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9392.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10718.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9392.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PEARL MATRIX*73", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8044.4, "maximum": 11147.24, "gross_charge": 11492.0, "discounted_cash": 17238.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9768.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8044.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11147.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8044.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9768.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9193.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PIN 3.2 X 110*2", "code_information": [{"code": "3100205157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.6, "discounted_cash": 680.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 3.2 X 110/2", "code_information": [{"code": "3100207467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.2, "discounted_cash": 477.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 3.2 X 140*2", "code_information": [{"code": "3100205156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.6, "discounted_cash": 842.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 3.2 X 140/2", "code_information": [{"code": "3100207468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.2, "discounted_cash": 477.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 4 X 110*144", "code_information": [{"code": "3100205375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.6, "discounted_cash": 680.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 4 X 140*144", "code_information": [{"code": "3100205179", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.6, "discounted_cash": 842.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 4 X 140*144", "code_information": [{"code": "3100205374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.32, "discounted_cash": 636.48, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PIN 4 X 170*144", "code_information": [{"code": "3100205376", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.68, "discounted_cash": 637.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PLUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 315.7, "maximum": 437.47, "gross_charge": 451.0, "discounted_cash": 676.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 383.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 338.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 315.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 437.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 315.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 338.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 383.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 360.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PLUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 245.7, "maximum": 340.47, "gross_charge": 351.0, "discounted_cash": 526.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 298.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 263.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 340.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 263.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 298.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PLUG", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100102525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 1725.27, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE PLUG TUNNEL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 148.4, "maximum": 1725.27, "gross_charge": 212.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 205.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 169.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE PUNCH KERRISON", "code_information": [{"code": "3100100208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2086.0, "discounted_cash": 3129.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY BIO", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100100209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 841.4, "maximum": 1725.27, "gross_charge": 1202.0, "discounted_cash": 1803.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1021.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 901.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 841.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 841.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 901.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1021.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 961.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE PUTTY I-FACT 1C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PUTTY I-FACT 2.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PUTTY I-FACT 5C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE REPLACEMENT GRAFT", "code_information": [{"code": "D7953", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE REPLCE GRAFT EACH ADD", "code_information": [{"code": "D4264", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE REPLCE GRAFT FIRST SITE", "code_information": [{"code": "D4263", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SCAFFOLD MOZIAI", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100100210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3095.34, "gross_charge": 3191.08, "discounted_cash": 4786.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2712.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2393.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3095.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2393.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2712.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2552.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SCREW 20MM*5260", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SCREW 30MM*5260", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SCREW 40MM*5260", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SCREW 6.5X25*62", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 362.25, "maximum": 501.97, "gross_charge": 517.5, "discounted_cash": 776.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 439.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 501.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 388.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 439.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 414.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SHAFT FEMORAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3147.65, "gross_charge": 3245.0, "discounted_cash": 4867.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2758.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2271.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3147.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2271.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2758.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2596.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE STRYKER ALLOGRA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE STRYKER ALLOGRA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE STRYKER GRAFT I", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 1725.27, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE STRYKER SHAFT F", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2698.54, "gross_charge": 2782.0, "discounted_cash": 4173.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2364.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2086.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1947.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2698.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1947.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2086.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2364.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2225.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE STRYKER SHAFT F", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2852.77, "gross_charge": 2941.0, "discounted_cash": 4411.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2499.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2205.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2058.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2852.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2058.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2205.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2499.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2352.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SUB SYNTHETIC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100100217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1465.8, "maximum": 2031.18, "gross_charge": 2094.0, "discounted_cash": 3141.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1570.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1465.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2031.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1465.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1570.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1675.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SUB SYNTHETIC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100102526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE TAMP*KEX152NB", "code_information": [{"code": "3100207915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5040.91, "discounted_cash": 7561.37, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP", "code_information": [{"code": "3100100218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP", "code_information": [{"code": "3100102527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP", "code_information": [{"code": "3100102528", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP", "code_information": [{"code": "3100102529", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP", "code_information": [{"code": "3100103813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VIVIGEN 1CC*BL1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1113.84, "maximum": 1543.46, "gross_charge": 1591.2, "discounted_cash": 2386.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1352.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1193.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1113.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1543.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1113.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1193.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1352.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1272.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VIVIGEN 5CC*BL1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3931.2, "maximum": 5447.52, "gross_charge": 5616.0, "discounted_cash": 8424.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4212.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3931.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5447.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3931.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4212.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4492.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER INJ", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 8123.0, "discounted_cash": 12184.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER INJ", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 4133.0, "discounted_cash": 6199.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER*07.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3688.62, "maximum": 5111.38, "gross_charge": 5269.47, "discounted_cash": 7904.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4479.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3952.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3688.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5111.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3688.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3952.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4479.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4215.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE WAX", "code_information": [{"code": "3100100221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX", "code_information": [{"code": "3100102530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONEMILL DISP FINE", "code_information": [{"code": "3100100222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 710.82, "discounted_cash": 1066.23, "setting": "both", "billing_class": "facility"}]}, {"description": "BONEMILL FINE*5400-7", "code_information": [{"code": "3100207621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 748.23, "discounted_cash": 1122.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BONEMILL PREP*5420-P", "code_information": [{"code": "3100209768", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2020.17, "discounted_cash": 3030.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BONESYNC 10CC*ABS-31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4767.94, "maximum": 6607.0, "gross_charge": 6811.35, "discounted_cash": 10217.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5789.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5108.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4767.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6607.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4767.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5108.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5789.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5449.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONESYNC 3CC*ABS-310", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2388.75, "maximum": 3310.12, "gross_charge": 3412.5, "discounted_cash": 5118.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2900.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2559.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3310.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2559.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2900.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONESYNC 5CC*ABS-310", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOOT ENDO LARGE", "code_information": [{"code": "3100100223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOT FOOT TRACTION", "code_information": [{"code": "3100100224", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 533.0, "discounted_cash": 799.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOT PADS TENZOR TRA", "code_information": [{"code": "3100100225", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 2570.0, "discounted_cash": 3855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOT TRACTION", "code_information": [{"code": "3100104708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4218.0, "discounted_cash": 6327.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOT TRACTION", "code_information": [{"code": "3100104709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4169.0, "discounted_cash": 6253.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BORDETELLA AB", "code_information": [{"code": "86615", "type": "CPT"}, {"code": "3440101093", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.19, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BORRELIA ANTIBODY", "code_information": [{"code": "86619", "type": "CPT"}], "standard_charges": [{"minimum": 13.38, "maximum": 30.26, "discounted_cash": 21.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BORRELIA BURGDORFERI", "code_information": [{"code": "86617", "type": "CPT"}, {"code": "3440101094", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.49, "maximum": 134.83, "gross_charge": 139.0, "discounted_cash": 24.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BORRELIA MIYAMOTOI AMP PRB", "code_information": [{"code": "87478", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BOTULINUM ANTITOXIN", "code_information": [{"code": "90287", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOTULISM IG IV", "code_information": [{"code": "90288", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BOVIE BALL TIP TEFLO", "code_information": [{"code": "3100100226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOVIE BALL TIP TEFLO", "code_information": [{"code": "3100102531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOVIE BALL TIP TEFLO", "code_information": [{"code": "3100102532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOVIE BALL TIP TEFLO", "code_information": [{"code": "3100102533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BOVIE BALL TIP TEFLO", "code_information": [{"code": "3100104467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWEL TO BOWEL FUSION", "code_information": [{"code": "44130", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BOWL MIXING & SPATUL", "code_information": [{"code": "3100100227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BOWL MIXING & SPATUL", "code_information": [{"code": "3100102534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BPCI ADVANCED IN HOME VISIT", "code_information": [{"code": "G9987", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BPCI HOME VISIT", "code_information": [{"code": "G9187", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRA POSTOP SIZE", "code_information": [{"code": "3100100228", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA POSTOP SIZE", "code_information": [{"code": "3100102535", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRA ULTRA COMFORT SU", "code_information": [{"code": "3100100229", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE BACK VIST TLSO", "code_information": [{"code": "L0456", "type": "HCPCS"}, {"code": "3100104109", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 732.2, "maximum": 1014.62, "gross_charge": 1046.0, "discounted_cash": 1569.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 889.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 784.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 732.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1014.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 732.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 784.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 889.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 836.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACE EXTENSION HORI", "code_information": [{"code": "3100100230", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 77.0, "discounted_cash": 115.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE LO 627*SP20627", "code_information": [{"code": "3100206344", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.8, "discounted_cash": 475.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE LO HORIZON", "code_information": [{"code": "L0627", "type": "HCPCS"}, {"code": "3100100231", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACE LSO *PANTHER M", "code_information": [{"code": "3100205346", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 336.6, "discounted_cash": 504.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE SHOULDER SLING", "code_information": [{"code": "3100100232", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 285.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE TLSO 464*SP204", "code_information": [{"code": "3100206345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 665.28, "discounted_cash": 997.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BRACE TLSO HORIZON", "code_information": [{"code": "L0456", "type": "HCPCS"}, {"code": "3100100233", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACE TLSO HORIZON", "code_information": [{"code": "L0456", "type": "HCPCS"}, {"code": "3100102536", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 478.1, "maximum": 662.51, "gross_charge": 683.0, "discounted_cash": 1024.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 662.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 546.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHY LINEAR, NON-STR,P-103", "code_information": [{"code": "C2636", "type": "HCPCS"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "discounted_cash": 86.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHY,NON-STR,YTTERBIUM-169", "code_information": [{"code": "C2637", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTHERAPY RADIOELEMENTS", "code_information": [{"code": "Q3001", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX CESIUM-131 CHLORIDE", "code_information": [{"code": "C2644", "type": "HCPCS"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE COMPLEX", "code_information": [{"code": "77318", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE INTERMED", "code_information": [{"code": "77317", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX PLANAR, P-103", "code_information": [{"code": "C2645", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 7.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, GOLD-198", "code_information": [{"code": "C1716", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 435.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, I-125", "code_information": [{"code": "C2634", "type": "HCPCS"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "discounted_cash": 242.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR, HA, P-103", "code_information": [{"code": "C2635", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 95.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,HDR IR-192", "code_information": [{"code": "C1717", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 557.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STR,YTTRIUM-90", "code_information": [{"code": "C2616", "type": "HCPCS"}], "standard_charges": [{"minimum": 19514.14, "maximum": 19514.14, "discounted_cash": 27594.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19514.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED, NOS", "code_information": [{"code": "C2699", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,C-131", "code_information": [{"code": "C2643", "type": "HCPCS"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "discounted_cash": 129.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NON-STRANDED,I-125", "code_information": [{"code": "C2639", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 56.15, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, NS, NON-HDRIR-192", "code_information": [{"code": "C1719", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 559.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, C-131", "code_information": [{"code": "C2642", "type": "HCPCS"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "discounted_cash": 156.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, I-125", "code_information": [{"code": "C2638", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 67.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, NOS", "code_information": [{"code": "C2698", "type": "HCPCS"}], "standard_charges": [{"minimum": 347.55, "maximum": 347.55, "discounted_cash": 67.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 347.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRACHYTX, STRANDED, P-103", "code_information": [{"code": "C2640", "type": "HCPCS"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "discounted_cash": 122.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAF GENE", "code_information": [{"code": "81210", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 175.4, "discounted_cash": 281.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61697", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN FLOW IMAGING ONLY", "code_information": [{"code": "78610", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW 4 + VIEWS", "code_information": [{"code": "78606", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78608", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78609", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1 BRCA2 MRNA SEQ ALYS", "code_information": [{"code": "138U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 752.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81166", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 301.35, "discounted_cash": 484.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL SEQ ALYS", "code_information": [{"code": "81165", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 282.88, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81215", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 375.25, "discounted_cash": 602.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 185&5385&6174 VRNT", "code_information": [{"code": "81212", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 440.0, "discounted_cash": 706.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 440.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FUL DUP/DEL ALYS", "code_information": [{"code": "81164", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.23, "discounted_cash": 938.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FULL SEQ DUP/DEL", "code_information": [{"code": "81162", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1824.88, "discounted_cash": 2931.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1824.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GENE FULL SEQ ALYS", "code_information": [{"code": "81163", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 468.0, "discounted_cash": 751.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81167", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 282.88, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL SEQ ALYS", "code_information": [{"code": "81216", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.12, "discounted_cash": 297.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81217", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 375.25, "discounted_cash": 602.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST \"\"STACKED\"\" DIEP/GAP", "code_information": [{"code": "S2067", "type": "HCPCS"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY OPEN I", "code_information": [{"code": "19102", "type": "CPT"}, {"code": "3480101391", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1531.6, "maximum": 2122.36, "gross_charge": 2188.0, "discounted_cash": 3282.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2122.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1750.4, "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": 8713.43, "maximum": 8713.43, "discounted_cash": 21866.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8713.43, "methodology": "fee schedule"}], "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": 8713.43, "maximum": 8713.43, "discounted_cash": 18801.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8713.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST CYST ASPIR /P", "code_information": [{"code": "19000", "type": "CPT"}, {"code": "3480101385", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1172.73, "gross_charge": 1209.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1027.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 906.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 846.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1172.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 846.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 906.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1027.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 967.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST EXC LES BY RA", "code_information": [{"code": "19125", "type": "CPT"}, {"code": "3270100002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6756.05, "gross_charge": 6965.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5920.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5223.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4875.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6756.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4875.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5223.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5920.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5572.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST EXC LES BY RA", "code_information": [{"code": "19126", "type": "CPT"}, {"code": "3270100004", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8107.26, "gross_charge": 8358.0, "discounted_cash": 12537.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7104.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6268.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5850.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8107.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5850.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6268.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7104.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6686.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST EXCISE CYST /", "code_information": [{"code": "19120", "type": "CPT"}, {"code": "3480101392", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6324.4, "gross_charge": 6520.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6324.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST EXPAND 450CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST EXPAND 550CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2993.9, "maximum": 4148.69, "gross_charge": 4277.0, "discounted_cash": 6415.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3635.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3207.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2993.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4148.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2993.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3207.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3635.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3421.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST EXPAND 550CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST EXPANDER*SMXP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3712.8, "maximum": 5144.88, "gross_charge": 5304.0, "discounted_cash": 7956.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5144.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST EXPANDER*SMXP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3712.8, "maximum": 5144.88, "gross_charge": 5304.0, "discounted_cash": 7956.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5144.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST EXPANDER*SMXP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2970.24, "maximum": 4115.9, "gross_charge": 4243.2, "discounted_cash": 6364.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3606.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4115.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3606.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3394.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST GAP FLAP RECONST", "code_information": [{"code": "S2066", "type": "HCPCS"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST IMPLANT", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100104116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST IMPLANT MENTO", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100100236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST IMPLANT MENTO", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1871.8, "maximum": 2593.78, "gross_charge": 2674.0, "discounted_cash": 4011.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST INCISION/DRN", "code_information": [{"code": "19020", "type": "CPT"}, {"code": "3480101386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4478.49, "gross_charge": 4617.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3924.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3462.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3231.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4478.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3231.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3462.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3924.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3693.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "3100102539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100100237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1871.8, "maximum": 2593.78, "gross_charge": 2674.0, "discounted_cash": 4011.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1302.0, "maximum": 1804.2, "gross_charge": 1860.0, "discounted_cash": 2790.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1395.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1804.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1395.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1354.5, "maximum": 1876.95, "gross_charge": 1935.0, "discounted_cash": 2902.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1644.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1451.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1354.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1876.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1354.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1451.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1644.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1407.0, "maximum": 1949.7, "gross_charge": 2010.0, "discounted_cash": 3015.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1708.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1507.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1407.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1949.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1407.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1507.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1708.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1608.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1773.8, "maximum": 2457.98, "gross_charge": 2534.0, "discounted_cash": 3801.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2457.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2027.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1817.2, "maximum": 2518.12, "gross_charge": 2596.0, "discounted_cash": 3894.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2206.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1947.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1817.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2518.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1817.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1947.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2206.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2076.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1822.8, "maximum": 2525.88, "gross_charge": 2604.0, "discounted_cash": 3906.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2213.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2525.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2213.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100102551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2811.9, "maximum": 3896.49, "gross_charge": 4017.0, "discounted_cash": 6025.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3414.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3896.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3414.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST PROSTHESIS SI", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100100238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2584.4, "maximum": 3581.24, "gross_charge": 3692.0, "discounted_cash": 5538.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3138.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2769.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2584.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3581.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2584.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2769.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3138.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2953.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECONSTR W LA", "code_information": [{"code": "19361", "type": "CPT"}, {"code": "3480101412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2792.3, "maximum": 7541.42, "gross_charge": 3989.0, "discounted_cash": 5983.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3390.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2991.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2792.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3869.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2792.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2991.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3390.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3191.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST SIZER", "code_information": [{"code": "3100100239", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST SIZER", "code_information": [{"code": "3100102552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST SIZER", "code_information": [{"code": "3100102553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST SIZER MENTOR", "code_information": [{"code": "3100100240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77063", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS UNI", "code_information": [{"code": "77061", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 181.56, "maximum": 181.56, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 94.41, "maximum": 181.56, "discounted_cash": 151.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 94.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREATH TST ATTAIN/ANAL C-14", "code_information": [{"code": "78267", "type": "CPT"}], "standard_charges": [{"minimum": 11.06, "maximum": 40.05, "discounted_cash": 17.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRENTUXIMAB VEDOTIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9042", "type": "HCPCS"}], "standard_charges": [{"minimum": 230.74, "maximum": 230.74, "discounted_cash": 370.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 230.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREST LOC W DEV 1ST", "code_information": [{"code": "19285", "type": "CPT"}, {"code": "3480101393", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 717.96, "maximum": 1551.72, "gross_charge": 1238.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1052.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 928.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 866.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1200.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 866.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 928.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1052.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 990.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREST LOC W DEV AD L", "code_information": [{"code": "19286", "type": "CPT"}, {"code": "3480101394", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 732.2, "maximum": 1551.72, "gross_charge": 1046.0, "discounted_cash": 1569.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 889.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 784.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 732.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1014.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 732.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 784.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 889.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 836.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BREXUCABTAGENE CAR POS T", "code_information": [{"code": "Q2053", "type": "HCPCS"}], "standard_charges": [{"minimum": 449440.0, "maximum": 449440.0, "discounted_cash": 722025.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 449440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE ADJ", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE ADJ", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE ALPHATEC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1887.2, "maximum": 2615.12, "gross_charge": 2696.0, "discounted_cash": 4044.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2291.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1887.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2615.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1887.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2291.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE BASE METAL CAST", "code_information": [{"code": "D6211", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE NOBLE METAL CAST", "code_information": [{"code": "D6212", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN BASE METAL", "code_information": [{"code": "D6241", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN HIGH NOBLE", "code_information": [{"code": "D6240", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN NOBEL METAL", "code_information": [{"code": "D6242", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE PORCELAIN/CERAMIC", "code_information": [{"code": "D6245", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN BASE METAL", "code_information": [{"code": "D6251", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN W/HIGH NOBLE", "code_information": [{"code": "D6250", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE RESIN W/NOBLE METAL", "code_information": [{"code": "D6252", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIDGE ST 20X20*EL-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4108.65, "maximum": 5693.41, "gross_charge": 5869.5, "discounted_cash": 8804.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4989.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4402.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4108.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5693.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4108.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4402.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4989.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4695.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE VARI 32-37MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIDGE VARIABLE 47-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRIEF ALCOHOL MISUSE COUNSEL", "code_information": [{"code": "G0443", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIEF CHECK IN BY MD/QHP", "code_information": [{"code": "G2012", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN BY MD/QHP, 11-20", "code_information": [{"code": "G2252", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIEF CHKIN, 5-10, NON-E/M", "code_information": [{"code": "G2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1756.42, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1756.42, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BROACH TIBIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1113.0, "maximum": 1542.3, "gross_charge": 1590.0, "discounted_cash": 2385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1351.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1113.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1542.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1113.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1351.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BROMPHENIRAMINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0945", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS IVNTJ PERPH LES", "code_information": [{"code": "31654", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 2/> LOBES", "code_information": [{"code": "31661", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCH W/BALLOON OCCLUSION", "code_information": [{"code": "31634", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL ALLERGY TESTS", "code_information": [{"code": "95070", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL BRUSH BIOPSY", "code_information": [{"code": "31717", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3179.97, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITH CC/MCC", "code_information": [{"code": "202", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4073.28, "maximum": 4073.28, "discounted_cash": 10690.07, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4073.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHITIS AND ASTHMA WITHOUT CC/MCC", "code_information": [{"code": "203", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2961.04, "maximum": 2961.04, "discounted_cash": 7758.26, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2961.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE/FX REPR", "code_information": [{"code": "31630", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3179.97, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY REVISE STENT", "code_information": [{"code": "31638", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3179.97, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY STENT ADD-ON", "code_information": [{"code": "31637", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3179.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY TREAT BLOCKAGE", "code_information": [{"code": "31641", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3179.97, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/FB REMOVAL", "code_information": [{"code": "31635", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1756.42, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 1756.42, "maximum": 1756.42, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/TUMOR EXCISE", "code_information": [{"code": "31640", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3179.97, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY, (RIGID", "code_information": [{"code": "31622", "type": "CPT"}, {"code": "3480101870", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2593.78, "gross_charge": 2674.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY, (RIGID", "code_information": [{"code": "31625", "type": "CPT"}, {"code": "3480101872", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2593.78, "gross_charge": 2674.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY, (RIGID", "code_information": [{"code": "31628", "type": "CPT"}, {"code": "3480101873", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4547.44, "gross_charge": 2674.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX ADDL", "code_information": [{"code": "31632", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1756.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX ADDL", "code_information": [{"code": "31633", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1756.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/NEEDLE BX EACH", "code_information": [{"code": "31629", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1756.42, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST PROSTHESIS 350C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1 PDCL TRAM FLAP", "code_information": [{"code": "19367", "type": "CPT"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 1PDCL TRAM ANAST", "code_information": [{"code": "19368", "type": "CPT"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ 2 PDCL TRAM FLAP", "code_information": [{"code": "19369", "type": "CPT"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRST RCNSTJ FREE FLAP", "code_information": [{"code": "19364", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRUCELLA AB", "code_information": [{"code": "86622", "type": "CPT"}, {"code": "3440101096", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 8.93, "maximum": 71.78, "gross_charge": 74.0, "discounted_cash": 14.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRUSH BIOPSY", "code_information": [{"code": "D7288", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BRUSH CYTOLOGY", "code_information": [{"code": "3100102133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH CYTOLOGY*M0054", "code_information": [{"code": "3100203613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 618.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BRUSH INTRA", "code_information": [{"code": "3100100243", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BSO OMENTECTOMY W/TAH", "code_information": [{"code": "58956", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BTK GENE COMMON VARIANTS", "code_information": [{"code": "81233", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 175.4, "discounted_cash": 281.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUCCAL/LABIAL FRENECTOMY", "code_information": [{"code": "D7961", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7634", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7627", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.21, "maximum": 0.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7633", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUDESONIDE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7626", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.2, "maximum": 1.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUILD-IT FR A2 MINI", "code_information": [{"code": "3100100244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.6, "discounted_cash": 140.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BUILDIT DENTAL", "code_information": [{"code": "3100102134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 160.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUN (POC)", "code_information": [{"code": "84520", "type": "CPT"}, {"code": "3440101014", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.95, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUN - UREA NITROGEN", "code_information": [{"code": "84520", "type": "CPT"}, {"code": "3440101013", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.95, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUNDLE OF HIS RECORDING", "code_information": [{"code": "93600", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUNIONECTOMY", "code_information": [{"code": "28290", "type": "CPT"}, {"code": "3480101764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8336.18, "gross_charge": 8594.0, "discounted_cash": 12891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7304.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6015.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8336.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6015.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7304.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6875.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUPIVACAINE HCL", "code_information": [{"code": "3400300087", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.9, "discounted_cash": 10.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE HCL", "code_information": [{"code": "3400300286", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.19, "discounted_cash": 12.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE HCL", "code_information": [{"code": "3400300288", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.5, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPIVACAINE/EPINEPH", "code_information": [{"code": "3400300287", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUPRENORPH XR 100 MG OR LESS", "code_information": [{"code": "Q9991", "type": "HCPCS"}], "standard_charges": [{"minimum": 1874.9, "maximum": 1874.9, "discounted_cash": 3031.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1874.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPRENORPHINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0592", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.93, "maximum": 3.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUPRENORPHINE XR OVER 100 MG", "code_information": [{"code": "Q9992", "type": "HCPCS"}], "standard_charges": [{"minimum": 1874.9, "maximum": 1874.9, "discounted_cash": 3031.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1874.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUR 1.2MMX8MM SOLO 8", "code_information": [{"code": "3100202285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 255.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUR CUT 5.0*BR5820-0", "code_information": [{"code": "3100209607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR", "code_information": [{"code": "3100104370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.04, "discounted_cash": 664.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 2.0MM CARB EX*5", "code_information": [{"code": "3100204215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.33, "discounted_cash": 1080.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 2.0MM DIAMOND*5", "code_information": [{"code": "3100204216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.08, "discounted_cash": 634.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 3.0 PREC RND*58", "code_information": [{"code": "3100204214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.69, "discounted_cash": 1054.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 3.7 X 320MM*16-", "code_information": [{"code": "3100205930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1365.0, "discounted_cash": 2047.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR 6.0 PREC RND*58", "code_information": [{"code": "3100204213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.69, "discounted_cash": 1054.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ACORN", "code_information": [{"code": "3100100245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.0, "discounted_cash": 718.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR AGGR RND FLUTED", "code_information": [{"code": "3100100246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 539.0, "discounted_cash": 808.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ANSPACH JAKE", "code_information": [{"code": "3100100247", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ARTH EXCALIBUR", "code_information": [{"code": "3100100248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ARTH EXCALIBUR", "code_information": [{"code": "3100102555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ARTH HIP", "code_information": [{"code": "3100102135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR BALL", "code_information": [{"code": "3100100249", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR BLURR ARTHREX", "code_information": [{"code": "3100100250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 606.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARBIDE", "code_information": [{"code": "3100100251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARBIDE", "code_information": [{"code": "3100102556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 211.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CARBIDE", "code_information": [{"code": "3100104664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER CARBIDE", "code_information": [{"code": "3100100252", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 1044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTER DIAMOND", "code_information": [{"code": "3100100253", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR CUTTING RND NON", "code_information": [{"code": "3100100254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DENTAL", "code_information": [{"code": "3100102136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DENTAL DIAMOND", "code_information": [{"code": "3100100255", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.2, "discounted_cash": 58.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND", "code_information": [{"code": "3100100256", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.92, "discounted_cash": 682.38, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND CURVED", "code_information": [{"code": "3100100257", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 1110.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND CURVED", "code_information": [{"code": "3100102557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 951.0, "discounted_cash": 1426.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND MIDWEST", "code_information": [{"code": "3100100258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND RND 5.0", "code_information": [{"code": "3100203713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DIAMOND SOLO", "code_information": [{"code": "3100100259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DISECTING TOOL", "code_information": [{"code": "3100100260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR DISECTING TOOL", "code_information": [{"code": "3100102558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.19, "discounted_cash": 750.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EGG MED", "code_information": [{"code": "3100100261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 539.0, "discounted_cash": 808.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EGG SM", "code_information": [{"code": "3100100262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.0, "discounted_cash": 295.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR EXTRA LONG", "code_information": [{"code": "3100100263", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 681.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTED", "code_information": [{"code": "3100100264", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTED", "code_information": [{"code": "3100102559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTED", "code_information": [{"code": "3100102560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTED", "code_information": [{"code": "3100104415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTED", "code_information": [{"code": "3100104422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR FLUTED 4.0MM*58", "code_information": [{"code": "3100207312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.08, "discounted_cash": 634.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE COVER", "code_information": [{"code": "3100100265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 659.0, "discounted_cash": 988.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE COVER", "code_information": [{"code": "3100102561", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.0, "discounted_cash": 1116.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE COVER", "code_information": [{"code": "3100104348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 743.0, "discounted_cash": 1114.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR HOLE COVER 20MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 572.73, "maximum": 793.64, "gross_charge": 818.19, "discounted_cash": 1227.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.64, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BURR HOLE FOR PUNCTURE", "code_information": [{"code": "61120", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BURR HOURGLASS COARS", "code_information": [{"code": "3100100266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MATCH HEAD", "code_information": [{"code": "3100102299", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 706.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MIDAS", "code_information": [{"code": "3100104385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 469.0, "discounted_cash": 703.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR MILLING*00-5927", "code_information": [{"code": "3100209666", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR NEURO", "code_information": [{"code": "3100100267", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 539.0, "discounted_cash": 808.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR OVAL DENTAL", "code_information": [{"code": "3100100268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR PILOT MED", "code_information": [{"code": "3100100269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 539.0, "discounted_cash": 808.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR PRECISION", "code_information": [{"code": "3100100270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR PRECISION", "code_information": [{"code": "3100104492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ROUND DIAM5.0*5", "code_information": [{"code": "3100203711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.08, "discounted_cash": 634.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SHANNON", "code_information": [{"code": "3100100271", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 377.0, "discounted_cash": 565.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SOFT 6.0MM *582", "code_information": [{"code": "3100203714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 423.08, "discounted_cash": 634.62, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR SOFT-TOUCH", "code_information": [{"code": "3100100272", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ST 19.5MM*AR-30", "code_information": [{"code": "3100208783", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ST 20MM*AR-300-", "code_information": [{"code": "3100208119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ST 8MM*AR-300-B", "code_information": [{"code": "3100209915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR TIBIAL ZIMMER", "code_information": [{"code": "3100103823", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1830.0, "discounted_cash": 2745.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR TMJ DIAMOND", "code_information": [{"code": "3100104746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 1548.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR WIRE PASS", "code_information": [{"code": "3100100273", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 313.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ZEPHER ROUND", "code_information": [{"code": "3100100274", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.89, "discounted_cash": 736.34, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ZEPHER ROUND", "code_information": [{"code": "3100102562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BURR ZEPHER ROUND FL", "code_information": [{"code": "3100100275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.0, "discounted_cash": 1093.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BURRHOLE COVER 7MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 531.99, "maximum": 737.19, "gross_charge": 759.99, "discounted_cash": 1139.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 645.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 569.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 531.99, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 737.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 531.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 569.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 645.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 607.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSHING DIS FEM SM*6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 559.44, "maximum": 775.22, "gross_charge": 799.2, "discounted_cash": 1198.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 679.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 599.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 559.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 775.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 559.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 599.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 679.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 639.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSHING/AXLE PACK*56", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4129.94, "maximum": 5722.92, "gross_charge": 5899.92, "discounted_cash": 8849.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5014.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4424.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4129.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5722.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4129.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4424.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5014.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4719.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUSULFAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0594", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.04, "maximum": 1.04, "discounted_cash": 2.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL TARTRATE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0595", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.58, "maximum": 3.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BUTORPHANOL TARTRATE, NASAL", "code_information": [{"code": "S0012", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY W/DBRDMT", "code_information": [{"code": "27057", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BUTTON", "code_information": [{"code": "3100104753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1297.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON", "code_information": [{"code": "402238", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1297.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON 12/30 DEG*WA2", "code_information": [{"code": "3100204705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1431.36, "discounted_cash": 2147.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON BICEPS", "code_information": [{"code": "3100100276", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON DOG BONE ARTH", "code_information": [{"code": "3100100277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON INSERTER", "code_information": [{"code": "3100100278", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON LONG OVAL*WA2", "code_information": [{"code": "3100204060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1431.36, "discounted_cash": 2147.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROP CLAV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BONE OPEN DEEP", "code_information": [{"code": "20245", "type": "CPT"}, {"code": "3480101423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BONE OPEN THORAC", "code_information": [{"code": "20250", "type": "CPT"}, {"code": "3480101424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BONE OPN LUMB/CE", "code_information": [{"code": "20251", "type": "CPT"}, {"code": "3480101425", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 8074.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BONE OPN SUPERFI", "code_information": [{"code": "20240", "type": "CPT"}, {"code": "3480101422", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BONE TROCR/NDL D", "code_information": [{"code": "20225", "type": "CPT"}, {"code": "3480101421", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BONE TROCR/NDL S", "code_information": [{"code": "20220", "type": "CPT"}, {"code": "3480101420", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1981.71, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION STRTCTC", "code_information": [{"code": "19081", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1968.77, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION MR IMAG", "code_information": [{"code": "19086", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION STRTCTC", "code_information": [{"code": "19082", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US IMAG", "code_information": [{"code": "19084", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST NDL CORE W", "code_information": [{"code": "19100", "type": "CPT"}, {"code": "3480101388", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1968.77, "gross_charge": 1209.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1027.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 906.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 846.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1172.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 846.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 906.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1027.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 967.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST OPN INCISI", "code_information": [{"code": "19101", "type": "CPT"}, {"code": "3480101389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6324.4, "gross_charge": 6520.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6324.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREAST OPN INCISI", "code_information": [{"code": "19101", "type": "CPT"}, {"code": "3480101390", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6324.4, "gross_charge": 6520.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6324.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX BREST W DEV/SPEC", "code_information": [{"code": "19083", "type": "CPT"}, {"code": "3480101375", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1224.3, "maximum": 1968.77, "gross_charge": 1749.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1486.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1311.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1224.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1696.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1224.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1311.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1486.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1399.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX DONE W/COLPOSCOPY ADD-ON", "code_information": [{"code": "58110", "type": "CPT"}], "standard_charges": [{"minimum": 551.8, "maximum": 551.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX EXTERNAL EAR", "code_information": [{"code": "69100", "type": "CPT"}, {"code": "3480102221", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 779.88, "gross_charge": 804.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 683.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 603.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 779.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 603.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 683.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 643.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX EXTERNAL EAR CAN", "code_information": [{"code": "69105", "type": "CPT"}, {"code": "3480102222", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3895.52, "gross_charge": 4016.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX FLOOR OF MOUTH", "code_information": [{"code": "41108", "type": "CPT"}, {"code": "3480101905", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1968.77, "gross_charge": 1177.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1141.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 941.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX FOREARM/WRIST S.T", "code_information": [{"code": "25065", "type": "CPT"}, {"code": "3480101581", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2919.2, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX LOWER LEG SOFT T", "code_information": [{"code": "27614", "type": "CPT"}, {"code": "3480101714", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX MUSCLE DEEP", "code_information": [{"code": "20205", "type": "CPT"}, {"code": "3480101418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX MUSCLE PERC NEED", "code_information": [{"code": "20206", "type": "CPT"}, {"code": "3480101419", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2122.36, "gross_charge": 2188.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2122.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX MUSCLE SUPERFICI", "code_information": [{"code": "20200", "type": "CPT"}, {"code": "3480101417", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX NASOPHAR SIMPLE", "code_information": [{"code": "42804", "type": "CPT"}, {"code": "3390100605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57460", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX OF NECK AND CHES", "code_information": [{"code": "21550", "type": "CPT"}, {"code": "3480101472", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX OF THROAT", "code_information": [{"code": "42800", "type": "CPT"}, {"code": "3480101926", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3895.52, "gross_charge": 4016.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX SHLDR TISSUE DEEP", "code_information": [{"code": "23066", "type": "CPT"}, {"code": "3480101532", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX SKIN ADD-ON", "code_information": [{"code": "11101", "type": "CPT"}, {"code": "3480101305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 175.0, "maximum": 595.41, "gross_charge": 250.0, "discounted_cash": 375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 212.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 242.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 212.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX SKIN LESION-SINGL", "code_information": [{"code": "11100", "type": "CPT"}, {"code": "3480101304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 261.8, "maximum": 595.41, "gross_charge": 374.0, "discounted_cash": 561.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 317.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 362.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 317.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 299.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX SOFT TISSUE BACK/", "code_information": [{"code": "21925", "type": "CPT"}, {"code": "3480101477", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX THIGH SOFT TISSUE", "code_information": [{"code": "27323", "type": "CPT"}, {"code": "3480101683", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/CURETT OF CERVIX W/SCOPE", "code_information": [{"code": "57454", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN CERVL", "code_information": [{"code": "63285", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRC", "code_information": [{"code": "63286", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL IMED LESN THRLMB", "code_information": [{"code": "63287", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN CRVL", "code_information": [{"code": "63280", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN SCRL", "code_information": [{"code": "63283", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC IDRL SPINE LESN THRC", "code_information": [{"code": "63281", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN LMBR", "code_information": [{"code": "63277", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN SCRL", "code_information": [{"code": "63278", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL/IDRL LSN ANY LVL", "code_information": [{"code": "63290", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT PATENCY/PATCH", "code_information": [{"code": "35685", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BYPASS GRAFT/AV FIST PATENCY", "code_information": [{"code": "35686", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bacterial And Tuberculous Infections Of Nervous System, Major", "code_information": [{"code": "49.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29530.89, "maximum": 29530.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bacterial And Tuberculous Infections Of Nervous System, Minor", "code_information": [{"code": "49.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15171.68, "maximum": 15171.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15171.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bacterial And Tuberculous Infections Of Nervous System, Moderate", "code_information": [{"code": "49.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26509.11, "maximum": 26509.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26509.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bacterial And Tuberculous Infections Of Nervous System, Severe", "code_information": [{"code": "49.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48495.8, "maximum": 48495.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48495.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Balloon Catheter Enlargement Of Opening Between Two Upper Heart Chambers", "code_information": [{"code": "92992", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bamlanivimab-xxxx infusion", "code_information": [{"code": "M0239", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Behavioral Disorders, Major", "code_information": [{"code": "758.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11547.6, "maximum": 11547.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11547.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Behavioral Disorders, Minor", "code_information": [{"code": "758.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7392.97, "maximum": 7392.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7392.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Behavioral Disorders, Moderate", "code_information": [{"code": "758.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7531.38, "maximum": 7531.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7531.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Behavioral Disorders, Severe", "code_information": [{"code": "758.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16084.11, "maximum": 16084.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16084.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Biomechanical Mapping Accessed Through The Vagina", "code_information": [{"code": "487T", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bionextpatch, per sq cm", "code_information": [{"code": "Q4228", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bipolar Disorders, Major", "code_information": [{"code": "753.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15103.76, "maximum": 15103.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15103.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bipolar Disorders, Minor", "code_information": [{"code": "753.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7654.4, "maximum": 7654.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7654.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bipolar Disorders, Moderate", "code_information": [{"code": "753.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10790.23, "maximum": 10790.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10790.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bipolar Disorders, Severe", "code_information": [{"code": "753.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22296.82, "maximum": 22296.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22296.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Body pos current status", "code_information": [{"code": "G8981", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Body pos d/c status", "code_information": [{"code": "G8983", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Body pos goal status", "code_information": [{"code": "G8982", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Bone marrow aspirate &biopsy", "code_information": [{"code": "G0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 1290.06, "maximum": 1290.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1290.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period, Major", "code_information": [{"code": "132.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15634.3, "maximum": 15634.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15634.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period, Minor", "code_information": [{"code": "132.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6352.4, "maximum": 6352.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6352.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period, Moderate", "code_information": [{"code": "132.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6375.46, "maximum": 6375.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6375.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bpd And Other Chronic Respiratory Diseases Arising In Perinatal Period, Severe", "code_information": [{"code": "132.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29351.48, "maximum": 29351.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29351.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma, Major", "code_information": [{"code": "56.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17742.37, "maximum": 17742.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17742.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma, Minor", "code_information": [{"code": "56.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8787.25, "maximum": 8787.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8787.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma, Moderate", "code_information": [{"code": "56.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12885.48, "maximum": 12885.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12885.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Brain Contusion Or Laceration And Complicated Skull Fracture, Coma < 1 Hour Or No Coma, Severe", "code_information": [{"code": "56.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28417.26, "maximum": 28417.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28417.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Breast Enlargement Without A Prosthesis", "code_information": [{"code": "19324", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Breast Procedures Except Mastectomy, Major", "code_information": [{"code": "363.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29386.08, "maximum": 29386.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29386.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Breast Procedures Except Mastectomy, Minor", "code_information": [{"code": "363.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14439.94, "maximum": 14439.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14439.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Breast Procedures Except Mastectomy, Moderate", "code_information": [{"code": "363.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27795.74, "maximum": 27795.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27795.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Breast Procedures Except Mastectomy, Severe", "code_information": [{"code": "363.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 47296.32, "maximum": 47296.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47296.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bronchiolitis And Rsv Pneumonia, Major", "code_information": [{"code": "138.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10772.29, "maximum": 10772.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10772.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bronchiolitis And Rsv Pneumonia, Minor", "code_information": [{"code": "138.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4783.84, "maximum": 4783.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4783.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bronchiolitis And Rsv Pneumonia, Moderate", "code_information": [{"code": "138.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6935.48, "maximum": 6935.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6935.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bronchiolitis And Rsv Pneumonia, Severe", "code_information": [{"code": "138.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11564.26, "maximum": 11564.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11564.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Bulking/spacer material impl", "code_information": [{"code": "C9743", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Burns With Skin Graft Except Extensive Third Degree Burns, Major", "code_information": [{"code": "842.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39340.77, "maximum": 39340.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39340.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Burns With Skin Graft Except Extensive Third Degree Burns, Minor", "code_information": [{"code": "842.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21276.74, "maximum": 21276.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21276.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Burns With Skin Graft Except Extensive Third Degree Burns, Moderate", "code_information": [{"code": "842.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39303.61, "maximum": 39303.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39303.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Burns With Skin Graft Except Extensive Third Degree Burns, Severe", "code_information": [{"code": "842.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 118254.26, "maximum": 118254.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 118254.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C DIFF TOX AG DETCJ IA STOOL", "code_information": [{"code": "107U", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "discounted_cash": 25.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED LWR LIMBS", "code_information": [{"code": "95929", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C MOTOR EVOKED UPPR LIMBS", "code_information": [{"code": "95928", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C REACTIVE PROTEIN", "code_information": [{"code": "86140", "type": "CPT"}, {"code": "3440101064", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 35.89, "gross_charge": 37.0, "discounted_cash": 8.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, BERINERT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0597", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.43, "maximum": 64.43, "discounted_cash": 103.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-1 ESTERASE, CINRYZE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0598", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.56, "maximum": 62.56, "discounted_cash": 100.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-LAMINOPLASTY W/GRAFT/PLATE", "code_information": [{"code": "63051", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG CORNEOSCLRL LENS", "code_information": [{"code": "92313", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA 1", "code_information": [{"code": "92315", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH APHAKIA OU", "code_information": [{"code": "92316", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH CORNEOSCLRL", "code_information": [{"code": "92317", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-LENS FITG TECH OU", "code_information": [{"code": "92314", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-PEPTIDE", "code_information": [{"code": "84681", "type": "CPT"}, {"code": "3440101019", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.81, "maximum": 181.39, "gross_charge": 187.0, "discounted_cash": 33.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-REACTIVE PROTEIN H", "code_information": [{"code": "86141", "type": "CPT"}, {"code": "3440101065", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.95, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "C-STEM CEMENTED OFFS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4050.9, "maximum": 5613.39, "gross_charge": 5787.0, "discounted_cash": 8680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4918.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4340.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4050.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5613.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4050.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4340.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4918.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4629.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-STEM CEMENTED OFFS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5381.6, "maximum": 7457.36, "gross_charge": 7688.0, "discounted_cash": 11532.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6534.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5766.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5381.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7457.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5381.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5766.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6534.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6150.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-STEM HIP CENTRALIZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 197.4, "maximum": 273.54, "gross_charge": 282.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 273.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "C-STEM HIP CENTRALIZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 205.1, "maximum": 284.21, "gross_charge": 293.0, "discounted_cash": 439.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 284.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABAZITAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 211.76, "maximum": 211.76, "discounted_cash": 338.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 211.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABERGOLINE, ORAL 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8515", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.55, "maximum": 10.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ART-VEIN SIX OR MORE", "code_information": [{"code": "33523", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL FOUR OR MORE", "code_information": [{"code": "33536", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN SINGLE", "code_information": [{"code": "33517", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CABKE NERVE STIM", "code_information": [{"code": "3100100279", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE DALL GRIP 2.0M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2007.53, "maximum": 2781.86, "gross_charge": 2867.9, "discounted_cash": 4301.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2437.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2150.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2007.53, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2781.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2007.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2150.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2437.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2294.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABLE DOUBLE CRIMP", "code_information": [{"code": "3100100280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2181.0, "discounted_cash": 3271.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE GRIP 1.8MM*223", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.05, "maximum": 1252.75, "gross_charge": 1291.5, "discounted_cash": 1937.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1097.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 968.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1252.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 968.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1097.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABLE GRIP W CRIMP", "code_information": [{"code": "3100100281", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 1980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE GRIP W CRIMP", "code_information": [{"code": "3100102563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1623.0, "discounted_cash": 2434.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE GRIP W CRIMP", "code_information": [{"code": "3100104333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE MEDTRONIC", "code_information": [{"code": "3100103911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE MEDTRONIC", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100103864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABLE MULTIHEAD", "code_information": [{"code": "3100104364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE POWEREASE NIM*", "code_information": [{"code": "3100203068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE SONGER", "code_information": [{"code": "3100102376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1581.0, "discounted_cash": 2371.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE STRYKER", "code_information": [{"code": "3100103856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 961.92, "discounted_cash": 1442.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE TWIST LOCK*35", "code_information": [{"code": "3100202634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE W/EXT", "code_information": [{"code": "3100104598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLESLEEVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 733.6, "maximum": 1016.56, "gross_charge": 1048.0, "discounted_cash": 1572.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 890.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 733.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1016.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 733.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 786.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 890.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 838.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CACNA1A FULL GENE ANALYSIS", "code_information": [{"code": "231U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1359.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN DETC ABNOR ALLEL", "code_information": [{"code": "81184", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CACNA1A GEN KNOWN FAMIL VRNT", "code_information": [{"code": "81186", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CACNA1A GENE FULL GENE SEQ", "code_information": [{"code": "81185", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 846.27, "discounted_cash": 1359.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CADMIUM", "code_information": [{"code": "82300", "type": "CPT"}, {"code": "3440100863", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.03, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 37.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 30.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 25.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAFFEINE", "code_information": [{"code": "80155", "type": "CPT"}, {"code": "3440100806", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 122.22, "gross_charge": 126.0, "discounted_cash": 61.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAFFEINE CITRATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0706", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.47, "maximum": 1.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8246.7, "maximum": 11427.57, "gross_charge": 11781.0, "discounted_cash": 17671.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10013.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8835.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8246.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11427.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8246.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8835.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10013.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9424.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X10X28*TX1010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X10X28*TX1010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X112X28*TX101", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X12X28*TX1012", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X12X28*TX1012", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X13X28*TX1013", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X14X28*TX1014", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X15X28*TX1015", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X23X6*4895010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X26X 4DEG*483", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X28X6*4895510", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X30*320-10103", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8645.0, "maximum": 11979.5, "gross_charge": 12350.0, "discounted_cash": 18525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11979.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X55X22*492205", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X8X28*TX10082", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 10X9X28*TX10092", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X11X33*TX1211", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X12X33*TX1212", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X12X33*TX1212", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X13X33*TX1213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X14X33*TX1214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X45X22*492224", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 12X55X22*492225", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 14.8X12.5X6*106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 14.8X12.5X7*106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 14.8X12.5X9*106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 16X13.5X6*1061-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 16X13.5X7*1061-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 16X13.5X8*1061-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 16X55X22*492265", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 17.5X15X6*1061-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 17.5X15X7*1061-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 17.5X15X8*1061-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 18X15X6*P52815-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 18X15X8*P52815-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 18X30X30*TX1830", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 22X12X60*3203-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8008.0, "maximum": 11096.8, "gross_charge": 11440.0, "discounted_cash": 17160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11096.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 6 DEG 10X50X18*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 6X16X14MM*50306", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2330.32, "maximum": 3229.16, "gross_charge": 3329.04, "discounted_cash": 4993.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2829.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2496.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2330.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3229.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2330.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2496.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2829.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2663.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 8 X 25*320-0810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8645.0, "maximum": 11979.5, "gross_charge": 12350.0, "discounted_cash": 18525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11979.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 8X23X6*48951086", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7826.0, "maximum": 10844.6, "gross_charge": 11180.0, "discounted_cash": 16770.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9503.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8385.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7826.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10844.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7826.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8385.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9503.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8944.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 9X23X6*48950096", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE 9X28X6*48955096", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE A LIFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ALIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ALIF ROI LDR SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8400.0, "maximum": 11640.0, "gross_charge": 12000.0, "discounted_cash": 18000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11640.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR 5X12X14X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1763.3, "maximum": 2443.43, "gross_charge": 2519.0, "discounted_cash": 3778.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2141.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1889.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1763.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2443.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1763.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1889.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2141.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2015.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR 8X12X14X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR 9X14X16X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR-C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8458.8, "maximum": 11721.48, "gross_charge": 12084.0, "discounted_cash": 18126.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10271.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9063.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8458.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11721.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8458.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9063.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10271.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9667.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR-C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7900.9, "maximum": 10948.39, "gross_charge": 11287.0, "discounted_cash": 16930.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9593.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8465.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7900.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10948.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7900.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8465.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9593.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9029.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR-C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8099.7, "maximum": 11223.87, "gross_charge": 11571.0, "discounted_cash": 17356.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9835.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8678.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8099.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11223.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8099.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8678.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9835.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9256.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANCHOR-C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE ANT CERVICAL C*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE AVS 8X30X4 DEG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CAPSTONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7098.0, "maximum": 9835.8, "gross_charge": 10140.0, "discounted_cash": 15210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7605.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7098.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9835.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7098.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7605.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CAPSTONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8584.1, "maximum": 11895.11, "gross_charge": 12263.0, "discounted_cash": 18394.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10423.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9197.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8584.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11895.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8584.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9197.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10423.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9810.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CAPSTONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8759.1, "maximum": 12137.61, "gross_charge": 12513.0, "discounted_cash": 18769.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10636.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9384.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8759.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12137.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8759.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9384.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10636.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10010.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CDALE PTC*49862", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CERVICAL ROI L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 25X12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 25X14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 30X10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 30X12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 30X13MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 30X14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 30X8MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CRESENT 30X9MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CURVED 11X28*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CURVED 11X28*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CURVED 11X28*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CURVED 11X32*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207157", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CURVED 11X32*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE CURVED 11X32*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE HYBRID*AX123608", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE INTERBODY10X50X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE INTERBODY10X55X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE INTERBODY12X55X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LAT 22X10X45*27", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8008.0, "maximum": 11096.8, "gross_charge": 11440.0, "discounted_cash": 17160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11096.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LAT 22X10X55*27", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8008.0, "maximum": 11096.8, "gross_charge": 11440.0, "discounted_cash": 17160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11096.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LAT 22X12X55*27", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8008.0, "maximum": 11096.8, "gross_charge": 11440.0, "discounted_cash": 17160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11096.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LAT 22X8X55*270", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8008.0, "maximum": 11096.8, "gross_charge": 11440.0, "discounted_cash": 17160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11096.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LAT 8X45X18*270", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8008.0, "maximum": 11096.8, "gross_charge": 11440.0, "discounted_cash": 17160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11096.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8580.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LIFT CONCORD*19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3881.5, "maximum": 5378.65, "gross_charge": 5545.0, "discounted_cash": 8317.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4713.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3881.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5378.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3881.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4713.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4436.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LT MEDIUM*89416", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE LT SMALL*894142", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE MEDTRONIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE MEDTRONIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE NARROW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5193.3, "maximum": 7196.43, "gross_charge": 7419.0, "discounted_cash": 11128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7196.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5935.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE NAVIGATOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PATHWAY PLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PATHWAY PLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PEEK PLIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3704.4, "maximum": 5133.24, "gross_charge": 5292.0, "discounted_cash": 7938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5133.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4233.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PEEK SMALL SUGN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8856.4, "maximum": 12272.44, "gross_charge": 12652.0, "discounted_cash": 18978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10754.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9489.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8856.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12272.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8856.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9489.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10754.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PILF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3704.4, "maximum": 5133.24, "gross_charge": 5292.0, "discounted_cash": 7938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5133.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4233.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PL 12X25X4 DEG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PLIF 8X22X8MM*P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PLIF AVS PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5193.3, "maximum": 7196.43, "gross_charge": 7419.0, "discounted_cash": 11128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7196.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5935.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PLIF K2M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PLIF LARDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3704.4, "maximum": 5133.24, "gross_charge": 5292.0, "discounted_cash": 7938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5133.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4233.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE PROLIFT 12X28*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE SCREW SIZER*AR-", "code_information": [{"code": "3100206015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAGE SIGNATURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8856.4, "maximum": 12272.44, "gross_charge": 12652.0, "discounted_cash": 18978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10754.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9489.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8856.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12272.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8856.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9489.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10754.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE SPACER SUSTAIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7920.5, "maximum": 10975.55, "gross_charge": 11315.0, "discounted_cash": 16972.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9617.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8486.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7920.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10975.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7920.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8486.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9617.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9052.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7338.1, "maximum": 10168.51, "gross_charge": 10483.0, "discounted_cash": 15724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8910.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7862.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10168.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7862.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8910.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8881.6, "maximum": 12307.36, "gross_charge": 12688.0, "discounted_cash": 19032.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10784.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9516.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8881.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12307.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8881.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9516.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10150.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER ANCHOR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8458.8, "maximum": 11721.48, "gross_charge": 12084.0, "discounted_cash": 18126.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10271.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9063.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8458.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11721.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8458.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9063.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10271.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9667.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER ANCHOR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7900.9, "maximum": 10948.39, "gross_charge": 11287.0, "discounted_cash": 16930.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9593.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8465.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7900.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10948.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7900.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8465.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9593.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9029.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER PATHWAY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER PATHWAY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5616.1, "maximum": 7782.31, "gross_charge": 8023.0, "discounted_cash": 12034.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6819.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6017.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5616.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7782.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5616.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6017.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6819.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6418.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER PLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5193.3, "maximum": 7196.43, "gross_charge": 7419.0, "discounted_cash": 11128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7196.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5935.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER PLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7990.5, "maximum": 11072.55, "gross_charge": 11415.0, "discounted_cash": 17122.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9702.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8561.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7990.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11072.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7990.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8561.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9702.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER TCIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7338.1, "maximum": 10168.51, "gross_charge": 10483.0, "discounted_cash": 15724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8910.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7862.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10168.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7862.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8910.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER TCIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER TCIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8881.6, "maximum": 12307.36, "gross_charge": 12688.0, "discounted_cash": 19032.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10784.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9516.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8881.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12307.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8881.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9516.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10150.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE STRYKER V LIFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8813.7, "maximum": 12213.27, "gross_charge": 12591.0, "discounted_cash": 18886.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10702.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9443.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8813.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12213.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8813.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9443.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10702.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10072.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE SYNFIX PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13265.0, "maximum": 18381.5, "gross_charge": 18950.0, "discounted_cash": 28425.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16107.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14212.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13265.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18381.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13265.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14212.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16107.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TCIF 9X25X4 DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TELAMON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7065.1, "maximum": 9790.21, "gross_charge": 10093.0, "discounted_cash": 15139.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8579.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7569.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7065.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9790.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7065.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7569.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8579.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8074.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE THREADED*742000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE THREADED*742000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102577", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE TLIF IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE V-LIFT 22X25*48", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9769.84, "maximum": 13538.21, "gross_charge": 13956.92, "discounted_cash": 20935.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11863.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10467.69, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9769.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13538.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9769.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10467.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11863.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11165.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE VBOXX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6833.4, "maximum": 9469.14, "gross_charge": 9762.0, "discounted_cash": 14643.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8297.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7321.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6833.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9469.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6833.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7321.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8297.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7809.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE*7512-21446L0-G3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9450.0, "maximum": 13095.0, "gross_charge": 13500.0, "discounted_cash": 20250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11475.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13095.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11475.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAGE*7512-21646L0-G3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9450.0, "maximum": 13095.0, "gross_charge": 13500.0, "discounted_cash": 20250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11475.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13095.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11475.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCITONIN SALMON INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0630", "type": "HCPCS"}], "standard_charges": [{"minimum": 1101.74, "maximum": 1101.74, "discounted_cash": 1718.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1101.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCITONIN STIMUL PANEL", "code_information": [{"code": "80410", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 80.37, "discounted_cash": 129.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCIUM (POC)", "code_information": [{"code": "82310", "type": "CPT"}, {"code": "3440100866", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.16, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCIUM CHLORIDE", "code_information": [{"code": "3400300088", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.8, "discounted_cash": 20.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CALCIUM GLUCON (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0612", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "discounted_cash": 0.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM GLUCONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0613", "type": "HCPCS"}, {"code": "3400300156", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.09, "maximum": 0.09, "gross_charge": 7.9, "discounted_cash": 0.15, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CALCIUM GLYCER & LACT/10 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0620", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CALCIUM INFUSION TEST", "code_information": [{"code": "82331", "type": "CPT"}], "standard_charges": [{"minimum": 13.34, "maximum": 40.05, "discounted_cash": 21.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCIUM IONIZED", "code_information": [{"code": "82330", "type": "CPT"}, {"code": "3440100867", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.68, "maximum": 118.34, "gross_charge": 122.0, "discounted_cash": 21.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 118.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 97.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCIUM IONIZED (POC", "code_information": [{"code": "82330", "type": "CPT"}, {"code": "3440100868", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.68, "maximum": 118.34, "gross_charge": 122.0, "discounted_cash": 21.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 118.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 97.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCIUM TOTAL", "code_information": [{"code": "82310", "type": "CPT"}, {"code": "3440100865", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.16, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCIUM URINE QUANT", "code_information": [{"code": "82340", "type": "CPT"}, {"code": "3440100869", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.03, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 9.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCULUS ASSAY QUANT", "code_information": [{"code": "82360", "type": "CPT"}], "standard_charges": [{"minimum": 12.87, "maximum": 40.05, "discounted_cash": 20.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCULUS INFRRD SPEC", "code_information": [{"code": "82365", "type": "CPT"}, {"code": "3440100871", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.9, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALCULUS STONE ANALY", "code_information": [{"code": "82355", "type": "CPT"}, {"code": "3440100870", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.58, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 18.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALORIC VESTIBULAR TEST", "code_information": [{"code": "92533", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92537", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALORIC VSTBLR TEST W/REC", "code_information": [{"code": "92538", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CALR GENE COM VARIANTS", "code_information": [{"code": "81219", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 121.63, "discounted_cash": 195.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 121.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAM CERVIX UTERI DRG COLP", "code_information": [{"code": "57465", "type": "CPT"}], "standard_charges": [{"minimum": 551.8, "maximum": 551.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAMPYLOBACTER ANTIBODY", "code_information": [{"code": "86625", "type": "CPT"}], "standard_charges": [{"minimum": 13.12, "maximum": 30.26, "discounted_cash": 21.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAN SCREW 4.0X32MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 763.16, "maximum": 1057.53, "gross_charge": 1090.24, "discounted_cash": 1635.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 926.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 817.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 763.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1057.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 763.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 817.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 926.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 872.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAN SCREW 4.0X46MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 763.16, "maximum": 1057.53, "gross_charge": 1090.24, "discounted_cash": 1635.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 926.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 817.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 763.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1057.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 763.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 817.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 926.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 872.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANAKINUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0638", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.48, "maximum": 124.48, "discounted_cash": 199.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 124.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANAL PREP/FITTING OF DOWEL", "code_information": [{"code": "D3950", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANALITH REPOSITIONING PROC", "code_information": [{"code": "95992", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANC COARSE 5CC*ABS-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 351.54, "maximum": 487.13, "gross_charge": 502.2, "discounted_cash": 753.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 426.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 376.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 351.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 487.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 351.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 376.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 426.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 401.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CANCELLOUS CORTIAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 1725.27, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANCELLOUS MARS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 823.2, "maximum": 1725.27, "gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANCELLOUS MARS", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 1725.27, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANCER TREATMENT PLAN CHANGE", "code_information": [{"code": "S0354", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANCER TREATMENTPLAN INITIAL", "code_information": [{"code": "S0353", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANDIDA ANTIBODY", "code_information": [{"code": "86628", "type": "CPT"}], "standard_charges": [{"minimum": 12.01, "maximum": 30.26, "discounted_cash": 19.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA AMP PROBE", "code_information": [{"code": "87481", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA DIR PROBE", "code_information": [{"code": "87480", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANDIDA DNA QUANT", "code_information": [{"code": "87482", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 55.74, "discounted_cash": 89.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANDIDA SPECIES PNL AMP PRB", "code_information": [{"code": "68U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 82.77, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANISTER KIT*AQL-BEM", "code_information": [{"code": "3100203079", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANISTER S&C NO TRP*", "code_information": [{"code": "3100206072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.16, "discounted_cash": 37.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CANN DRILL 2.2MM*Z40", "code_information": [{"code": "3100210275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.5, "discounted_cash": 1023.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNABINOID SYNTHETIC 7/MORE", "code_information": [{"code": "80352", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS NATURAL", "code_information": [{"code": "80349", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 1-3", "code_information": [{"code": "80350", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANNABINOIDS SYNTHETIC 4-6", "code_information": [{"code": "80351", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANNULA", "code_information": [{"code": "3100104552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA & TAMPS TRAU", "code_information": [{"code": "3100100309", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.0, "discounted_cash": 436.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 2ND GEN*AR-3", "code_information": [{"code": "3100210068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 3.OMM*PAL-30", "code_information": [{"code": "3100202589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 309.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 4.0MM*PAL-40", "code_information": [{"code": "3100202608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 4.0MM*PAL-40", "code_information": [{"code": "3100203321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 309.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 4.OMM*PAL-40", "code_information": [{"code": "3100202590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 309.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 5.0MM*PAL-50", "code_information": [{"code": "3100202607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 372.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 5.OMM*PAL-50", "code_information": [{"code": "3100202591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 309.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA 5M 20G*0406-", "code_information": [{"code": "3100207733", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 213.24, "discounted_cash": 319.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA ARTHREX", "code_information": [{"code": "3100100310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA AXIS", "code_information": [{"code": "3100100312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.0, "discounted_cash": 400.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CLEAR OPEN", "code_information": [{"code": "3100100313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA CRYSTAL W/RI", "code_information": [{"code": "3100205183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA DECLOTTING", "code_information": [{"code": "36861", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5001.8, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CANNULA FACE PC", "code_information": [{"code": "3100100314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA MONO CRV", "code_information": [{"code": "3100104627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL MED*11", "code_information": [{"code": "3100206349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL SM*113", "code_information": [{"code": "3100206348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA NASAL SM*113", "code_information": [{"code": "3100206350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA PASSPORT", "code_information": [{"code": "3100100315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.4, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA RF", "code_information": [{"code": "3100100316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SHOEHORN", "code_information": [{"code": "3100100317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SHOULDER", "code_information": [{"code": "3100100318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA SINGLE STR", "code_information": [{"code": "3100104203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 562.0, "discounted_cash": 843.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA STRYKER CEME", "code_information": [{"code": "3100100319", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 333.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA STYKER", "code_information": [{"code": "3100100320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA T15 HEXALOB*", "code_information": [{"code": "3100210180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA TRIPLE DAM*A", "code_information": [{"code": "3100202643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA UTERINE", "code_information": [{"code": "3100104157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 356.0, "discounted_cash": 534.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VERTIPORT", "code_information": [{"code": "3100100321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 265.0, "discounted_cash": 397.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VESSEL", "code_information": [{"code": "3100104672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 204.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA VIERS", "code_information": [{"code": "3100100322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULA/STYLET 10GA*", "code_information": [{"code": "3100209508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 653.43, "discounted_cash": 980.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CANNULAE", "code_information": [{"code": "3100104576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP END STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 479.5, "maximum": 664.45, "gross_charge": 685.0, "discounted_cash": 1027.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 664.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP END STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 531.3, "maximum": 736.23, "gross_charge": 759.0, "discounted_cash": 1138.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 645.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 569.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 531.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 736.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 531.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 569.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 645.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 607.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP HEALING", "code_information": [{"code": "3100100324", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP HEALING W/PLUG", "code_information": [{"code": "3100104139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP LOCK CLOSE TULIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 455.0, "maximum": 630.5, "gross_charge": 650.0, "discounted_cash": 975.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 552.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 487.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 455.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 630.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 455.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 487.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 552.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 520.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCK CLOSE TULIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 546.7, "maximum": 757.57, "gross_charge": 781.0, "discounted_cash": 1171.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 663.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 585.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 757.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 585.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 663.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCK PRECEPT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 833.7, "maximum": 1155.27, "gross_charge": 1191.0, "discounted_cash": 1786.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1012.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 893.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 833.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1155.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 833.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 893.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1012.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 952.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCK RELINE OPEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING INNOVASI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING INTEGRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING REVERE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.5, "maximum": 2129.15, "gross_charge": 2195.0, "discounted_cash": 3292.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING REVOLVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 213.5, "maximum": 295.85, "gross_charge": 305.0, "discounted_cash": 457.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 295.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP LOCKING TI MATRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2644.6, "maximum": 3664.66, "gross_charge": 3778.0, "discounted_cash": 5667.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3211.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2833.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2644.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3664.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2644.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2833.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3211.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3022.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP RUBBER", "code_information": [{"code": "3100104646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAP SYNTHES TI TIBIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 501.2, "maximum": 694.52, "gross_charge": 716.0, "discounted_cash": 1074.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 608.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 608.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 572.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAP Z NAIL RET FEMOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 519.4, "maximum": 719.74, "gross_charge": 742.0, "discounted_cash": 1113.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 630.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 519.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 719.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 519.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 630.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPECITABINE, ORAL, 150 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8520", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.32, "maximum": 0.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPECITABINE, ORAL, 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8521", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.79, "maximum": 0.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 12MM 22X17*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 12MM 35X17*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 15MM 22X17*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 15MM 22X23*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 15MM 35X23*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 15MM 35X23*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 7.5MM POST*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1008.0, "maximum": 1396.8, "gross_charge": 1440.0, "discounted_cash": 2160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1396.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPITATE 7.5MM POST*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1008.0, "maximum": 1396.8, "gross_charge": 1440.0, "discounted_cash": 2160.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1396.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSAICIN 8% PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7336", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.32, "maximum": 3.32, "discounted_cash": 5.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 15X22*40215", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 22 X 10*399", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 22 X 11*399", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 22 X 12*399", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 22 X 8*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 22 X 9*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 10*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 11*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 12*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 13*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 14*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 8*39926", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X 9*39926", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE 26X6MM*3992", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE CAGE MEDTRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8759.1, "maximum": 12137.61, "gross_charge": 12513.0, "discounted_cash": 18769.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10636.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9384.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8759.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12137.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8759.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9384.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10636.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10010.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE OUTER CASE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 698.4, "gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8584.1, "maximum": 11895.11, "gross_charge": 12263.0, "discounted_cash": 18394.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10423.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9197.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8584.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11895.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8584.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9197.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10423.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9810.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6349.0, "maximum": 8797.9, "gross_charge": 9070.0, "discounted_cash": 13605.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7709.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6802.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6349.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8797.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6349.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6802.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7709.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSTONE SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7098.0, "maximum": 9835.8, "gross_charge": 10140.0, "discounted_cash": 15210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7605.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7098.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9835.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7098.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7605.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULAR TENSION RIN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULAR TENSION RIN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULAR TENSION RIN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULAR TENSION RIN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAPSULE AGILE", "code_information": [{"code": "3100100338", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULE BLADE/HANDLE", "code_information": [{"code": "3100206941", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULE BLADE/HANDLE", "code_information": [{"code": "3100209070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 677.25, "discounted_cash": 1015.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULE FUGI II", "code_information": [{"code": "3100100339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULE PILLCAM / EN", "code_information": [{"code": "3100100340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1458.0, "discounted_cash": 2187.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPSULE PILLCAM*FGS-", "code_information": [{"code": "3100210129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1687.2, "discounted_cash": 2530.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPTIFLEX OVAL", "code_information": [{"code": "3100104168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 82.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPTIVATOR EMR DEVIC", "code_information": [{"code": "3100203575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAPTIVATOR II", "code_information": [{"code": "3100104167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.64, "discounted_cash": 63.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CAR ION CHNLPTHY GEN SEQ PNL", "code_information": [{"code": "237U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.9, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.9, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"minimum": 186.01, "maximum": 186.01, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE FREE", "code_information": [{"code": "80157", "type": "CPT"}, {"code": "3440100808", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARBAMAZEPINE TOTAL", "code_information": [{"code": "80156", "type": "CPT"}, {"code": "3440100807", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.57, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 23.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARBIDOPA LEVODOPA ENT 100ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7340", "type": "HCPCS"}], "standard_charges": [{"minimum": 228.01, "maximum": 228.01, "discounted_cash": 365.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 228.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARBON DIOXIDE BICAR", "code_information": [{"code": "82374", "type": "CPT"}, {"code": "3440100872", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.88, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 7.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARBON DIOXIDE BICAR", "code_information": [{"code": "82374", "type": "CPT"}, {"code": "3440100873", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.88, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 7.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARBON MONOXIDE QUAN", "code_information": [{"code": "82375", "type": "CPT"}, {"code": "3440100874", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.32, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 19.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARBOPLATIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9045", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.72, "maximum": 3.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARCENOLMBYONIC ANTG", "code_information": [{"code": "82378", "type": "CPT"}, {"code": "3440100875", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.96, "maximum": 164.9, "gross_charge": 170.0, "discounted_cash": 30.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.31, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.31, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARD HRT TRNSPL 96 DNA SEQ", "code_information": [{"code": "55U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5205.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [{"code": "297", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4333.35, "maximum": 4333.35, "discounted_cash": 8134.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4333.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [{"code": "296", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7602.42, "maximum": 7602.42, "discounted_cash": 17899.04, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7602.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC", "code_information": [{"code": "298", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3001.62, "maximum": 3001.62, "discounted_cash": 4900.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3001.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [{"code": "309", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3796.6, "maximum": 3796.6, "discounted_cash": 8314.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3796.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [{"code": "308", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5576.54, "maximum": 5576.54, "discounted_cash": 13422.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5576.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "310", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2981.94, "maximum": 2981.94, "discounted_cash": 6174.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2981.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [{"code": "306", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11467.27, "maximum": 11467.27, "discounted_cash": 17157.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11467.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [{"code": "307", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4677.04, "maximum": 4677.04, "discounted_cash": 10523.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4677.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC DRUG STRESS TEST", "code_information": [{"code": "93024", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRAIN", "code_information": [{"code": "C9762", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRESS", "code_information": [{"code": "C9763", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "258", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19687.6, "maximum": 19687.6, "discounted_cash": 30240.35, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19687.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [{"code": "259", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11116.81, "maximum": 11116.81, "discounted_cash": 20839.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11116.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [{"code": "261", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10561.62, "maximum": 10561.62, "discounted_cash": 21009.48, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10561.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [{"code": "260", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17156.94, "maximum": 17156.94, "discounted_cash": 37012.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17156.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "262", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8709.74, "maximum": 8709.74, "discounted_cash": 18369.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8709.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB", "code_information": [{"code": "93797", "type": "CPT"}], "standard_charges": [{"minimum": 186.9, "maximum": 186.9, "discounted_cash": 202.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB/MONITOR", "code_information": [{"code": "93798", "type": "CPT"}], "standard_charges": [{"minimum": 186.9, "maximum": 186.9, "discounted_cash": 202.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHABILITATION PROGR", "code_information": [{"code": "S9472", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.9, "maximum": 186.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIAC SHUNT IMAGING", "code_information": [{"code": "78428", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "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": 35494.98, "maximum": 35494.98, "discounted_cash": 71065.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35494.98, "methodology": "fee schedule"}], "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": 68670.81, "maximum": 68670.81, "discounted_cash": 108355.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68670.81, "methodology": "fee schedule"}], "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": 32240.67, "maximum": 32240.67, "discounted_cash": 63601.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32240.67, "methodology": "fee schedule"}], "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": 29079.19, "maximum": 29079.19, "discounted_cash": 58553.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29079.19, "methodology": "fee schedule"}], "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": 36068.01, "maximum": 36068.01, "discounted_cash": 86092.19, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36068.01, "methodology": "fee schedule"}], "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": 24829.46, "maximum": 24829.46, "discounted_cash": 51899.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24829.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST EXTERNAL", "code_information": [{"code": "92971", "type": "CPT"}], "standard_charges": [{"minimum": 903.35, "maximum": 903.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 903.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOASSIST INTERNAL", "code_information": [{"code": "92970", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOKYMOGRAPHY", "code_information": [{"code": "Q0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOLIPIN AB EA IG", "code_information": [{"code": "86147", "type": "CPT"}, {"code": "3440101067", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 25.45, "maximum": 138.71, "gross_charge": 143.0, "discounted_cash": 40.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 138.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 114.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOLOGY HRT TRNSPL MRNA", "code_information": [{"code": "81595", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3240.0, "discounted_cash": 5205.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3240.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOPULM EXERCISE TESTING", "code_information": [{"code": "94621", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93015", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93016", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93017", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVASCULAR STRESS TEST", "code_information": [{"code": "93018", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC EXT", "code_information": [{"code": "92960", "type": "CPT"}], "standard_charges": [{"minimum": 903.35, "maximum": 903.35, "discounted_cash": 996.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 903.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARDIOVERSION ELECTRIC INT", "code_information": [{"code": "92961", "type": "CPT"}], "standard_charges": [{"minimum": 903.35, "maximum": 903.35, "discounted_cash": 996.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 903.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE AFTER DELIVERY", "code_information": [{"code": "59430", "type": "CPT"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 176.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE COORD AT HOSPICE", "code_information": [{"code": "G9477", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 20 MI", "code_information": [{"code": "G0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 30 M", "code_information": [{"code": "G0082", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 45 M", "code_information": [{"code": "G0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 60 M", "code_information": [{"code": "G0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN H V EXT PT 75 M", "code_information": [{"code": "G0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 30 M", "code_information": [{"code": "G0086", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MAN HOME CARE PLAN 60 M", "code_information": [{"code": "G0087", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 20 M", "code_information": [{"code": "G0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 30 M", "code_information": [{"code": "G0077", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 45 M", "code_information": [{"code": "G0078", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 60 M", "code_information": [{"code": "G0079", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MANAG H VST NEW PT 75 M", "code_information": [{"code": "G0080", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARE MGMT SVC BHVL HLTH COND", "code_information": [{"code": "99484", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARECOORDINATION PRENATAL", "code_information": [{"code": "H1002", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAREGIVER HEALTH RISK ASSMT", "code_information": [{"code": "96161", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAREPATCH PER SQ CM", "code_information": [{"code": "Q4236", "type": "HCPCS"}], "standard_charges": [{"minimum": 601.07, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 601.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARIES MED APP PER TOOTH", "code_information": [{"code": "D1355", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS HIGH RISK", "code_information": [{"code": "D0603", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS LOW RISK", "code_information": [{"code": "D0601", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARIES RISK ASSESS MOD RISK", "code_information": [{"code": "D0602", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARIES SUSCEPTIBILITY TEST", "code_information": [{"code": "D0425", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARMUSTINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 280.92, "maximum": 280.92, "discounted_cash": 436.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 280.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [{"code": "35", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12061.81, "maximum": 12061.81, "discounted_cash": 25672.92, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12061.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [{"code": "34", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15076.34, "maximum": 15076.34, "discounted_cash": 43557.44, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15076.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "36", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10301.54, "maximum": 10301.54, "discounted_cash": 20187.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10301.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAROTID INTIMA ATHEROMA EVAL", "code_information": [{"code": "93895", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARPAL PLATE SZ 2*34", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5234.77, "maximum": 7253.9, "gross_charge": 7478.25, "discounted_cash": 11217.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6356.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5608.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5234.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7253.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5234.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5608.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6356.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5982.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARPAL POLY SZ 1*348", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1694.42, "maximum": 2347.98, "gross_charge": 2420.6, "discounted_cash": 3630.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARPAL POLY SZ 1*348", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1955.1, "maximum": 2709.21, "gross_charge": 2793.0, "discounted_cash": 4189.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2374.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2374.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARPAL POLY SZ 2*348", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARPAL POLY SZ 2*348", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1694.42, "maximum": 2347.98, "gross_charge": 2420.6, "discounted_cash": 3630.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO +30MIN", "code_information": [{"code": "94781", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARS/BD TST INFT-12MO 60 MIN", "code_information": [{"code": "94780", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARTICIL IMPLANT, SU", "code_information": [{"code": "29877", "type": "CPT"}, {"code": "3480101811", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CARTILAGE BIO", "code_information": [{"code": "3100100341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1875.0, "discounted_cash": 2812.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SNAP 125*S", "code_information": [{"code": "3100203999", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CARTRIDGE SNAP 75*SN", "code_information": [{"code": "3100204001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT", "code_information": [{"code": "T1016", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASE MANAGEMENT, PER MONTH", "code_information": [{"code": "T2022", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, APPT BARRIERS", "code_information": [{"code": "D9991", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, CARE COORDINATION", "code_information": [{"code": "D9992", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, INTERVIEWING", "code_information": [{"code": "D9993", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASE MGMT, PT EDUCATION", "code_information": [{"code": "D9994", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASE PRESENTATION TX PLAN", "code_information": [{"code": "D9450", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASIRI AND IMDEV REPEAT", "code_information": [{"code": "M0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 450.0, "discounted_cash": 723.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASIRI AND IMDEV REPEAT HM", "code_information": [{"code": "M0241", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 750.0, "discounted_cash": 1205.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI 1200 MG", "code_information": [{"code": "Q0244", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI 600 MG", "code_information": [{"code": "Q0240", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI INJ", "code_information": [{"code": "M0243", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 450.0, "discounted_cash": 723.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASIRIVI AND IMDEVI INJ HM", "code_information": [{"code": "M0244", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 750.0, "discounted_cash": 1205.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CASIRIVIMAB AND IMDEVIMAB", "code_information": [{"code": "Q0243", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CASPOFUNGIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0637", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.63, "maximum": 6.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CASSETTE IRRIGATI*54", "code_information": [{"code": "3100204212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.4, "discounted_cash": 204.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CASSETTE TUBE SET AR", "code_information": [{"code": "3100100342", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST COVER ADULT", "code_information": [{"code": "3100100343", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 97.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST NOBLE METAL INLAY 2 SUR", "code_information": [{"code": "D6606", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAST ORTHOGLASS", "code_information": [{"code": "3100100344", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST ORTHOGLASS", "code_information": [{"code": "3100102583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST SCOTCHCAST", "code_information": [{"code": "3100100345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST SCOTCHCAST", "code_information": [{"code": "3100102584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST SCOTCHCAST", "code_information": [{"code": "3100102585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CAST SOUTHWEST", "code_information": [{"code": "3100104469", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CAT EXTRAC RMVL W/IO", "code_information": [{"code": "66984", "type": "CPT"}, {"code": "3410102289", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 3004.2, "gross_charge": 2500.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2125.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1750.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2425.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1750.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1875.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2125.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2000.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAT RMVL EXTRAC W/IO", "code_information": [{"code": "66982", "type": "CPT"}, {"code": "3410100683", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5875.29, "gross_charge": 6057.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5875.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4845.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAT RMVL INTRAC W/IO", "code_information": [{"code": "66983", "type": "CPT"}, {"code": "3410100699", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5875.29, "gross_charge": 6057.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5875.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4845.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATECHOLAMINES FRACT", "code_information": [{"code": "82384", "type": "CPT"}, {"code": "3440100876", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 25.25, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 40.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATH 20FR 5CC 3WY*01", "code_information": [{"code": "3100203198", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.52, "discounted_cash": 42.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH 22FR 30CC 3WY*0", "code_information": [{"code": "3100203199", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.4, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH ACCESS PORT KIT", "code_information": [{"code": "3100208375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH BALLOON PTA", "code_information": [{"code": "3100102397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH BALLOON RELIANT", "code_information": [{"code": "3100205140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1416.0, "discounted_cash": 2124.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH BALLOON*H74939", "code_information": [{"code": "3100209983", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 314.28, "discounted_cash": 471.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH BARRX CHAN/ENDO", "code_information": [{"code": "3100204291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4027.14, "discounted_cash": 6040.71, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH COBRA 4X100*410", "code_information": [{"code": "3100206626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH COUDE 16FR*0213", "code_information": [{"code": "3100203298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.8, "discounted_cash": 53.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH COUDE 22 3W*255", "code_information": [{"code": "3100205447", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.68, "discounted_cash": 92.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH COUDE FOLLOW 10", "code_information": [{"code": "3100203301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.76, "discounted_cash": 53.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH EMBOL", "code_information": [{"code": "3100104685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FLOWONIX", "code_information": [{"code": "C1755", "type": "HCPCS"}, {"code": "3100102385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH FLY COUDE 22FR*", "code_information": [{"code": "3100203146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.64, "discounted_cash": 47.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FLY SIL 14FR*17", "code_information": [{"code": "3100205167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.88, "discounted_cash": 64.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FLY SIL 16FR*DY", "code_information": [{"code": "3100203141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.32, "discounted_cash": 6.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FLY SIL 22FR*18", "code_information": [{"code": "3100203149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.76, "discounted_cash": 19.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 12FR*BRD0", "code_information": [{"code": "3100203142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.64, "discounted_cash": 18.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 18FR*BRD1", "code_information": [{"code": "3100203145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.32, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 18FR*RSH1", "code_information": [{"code": "3100203147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.12, "discounted_cash": 18.18, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 20FR*RSH1", "code_information": [{"code": "3100203148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.12, "discounted_cash": 31.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 22FR*BRD1", "code_information": [{"code": "3100203144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.32, "discounted_cash": 18.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 24FR*BRD0", "code_information": [{"code": "3100203332", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.68, "discounted_cash": 17.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY18FR 3WAY*", "code_information": [{"code": "3100203143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.52, "discounted_cash": 47.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH GUIDE SINUS", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100102138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 672.0, "maximum": 931.2, "gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 931.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH HEADHUNTER*4100", "code_information": [{"code": "3100206632", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH HOCKEY STICK*41", "code_information": [{"code": "3100206633", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IMAGER II", "code_information": [{"code": "3100102176", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH KIT 20GA X 8CM*", "code_information": [{"code": "3100209867", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.4, "discounted_cash": 267.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH KUMPE*44038KA2", "code_information": [{"code": "3100206638", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH KUMPE*46538KA2", "code_information": [{"code": "3100206631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH KUMPE*H78710734", "code_information": [{"code": "3100206639", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH OMNIFLUSH*49035", "code_information": [{"code": "3100206627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PICC DUAL LUMEN", "code_information": [{"code": "3100205282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 701.7, "discounted_cash": 1052.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PIGTAIL*4653510", "code_information": [{"code": "3100206629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PIGTAIL*H787107", "code_information": [{"code": "3100206630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PIGTAIL*H787107", "code_information": [{"code": "3100206637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PIGTAIL*H787107", "code_information": [{"code": "3100206678", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RIM*46535RIM", "code_information": [{"code": "3100206634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RR 14FR*351014", "code_information": [{"code": "3100203299", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.12, "discounted_cash": 4.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RR 16FR*351016", "code_information": [{"code": "3100203297", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.12, "discounted_cash": 7.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 12*221", "code_information": [{"code": "3100203100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 14*221", "code_information": [{"code": "3100203101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 16*221", "code_information": [{"code": "3100203102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 18*221", "code_information": [{"code": "3100203103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 20*221", "code_information": [{"code": "3100203104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 22*221", "code_information": [{"code": "3100203110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 24*221", "code_information": [{"code": "3100203111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.28, "discounted_cash": 16.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH RUSCH SZ 24*RSH", "code_information": [{"code": "3100203150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.8, "discounted_cash": 19.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH SIDEWINDER*4100", "code_information": [{"code": "3100206628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH SOFT-VU 4FRX40*", "code_information": [{"code": "3100205720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH SPENO", "code_information": [{"code": "3100103943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH URET/CONE TIP*0", "code_information": [{"code": "3100203007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.2, "discounted_cash": 66.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH URETERAL OPEN*0", "code_information": [{"code": "3100202991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.25, "discounted_cash": 54.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH URETERAL OPEN*0", "code_information": [{"code": "3100203006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.24, "discounted_cash": 54.36, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH URO BALLOON", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100100346", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 488.6, "maximum": 677.06, "gross_charge": 698.0, "discounted_cash": 1047.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 593.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 523.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 488.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 677.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 488.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 523.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 593.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 558.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH URO BALLOON DIL", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100100347", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1614.9, "maximum": 2237.79, "gross_charge": 2307.0, "discounted_cash": 3460.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1960.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1614.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1614.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1960.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH URO COUNCIL*019", "code_information": [{"code": "3100209056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.72, "discounted_cash": 61.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH VERTEBRAL BRAID", "code_information": [{"code": "3100206636", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH VERTEBRAL*H7871", "code_information": [{"code": "3100206635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER", "code_information": [{"code": "3100104115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 5FR*1072270", "code_information": [{"code": "3100209681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.6, "discounted_cash": 110.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ABLATION BA", "code_information": [{"code": "C1886", "type": "HCPCS"}, {"code": "3100100348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1607.2, "maximum": 2227.12, "gross_charge": 2296.0, "discounted_cash": 3444.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1951.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1722.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1607.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2227.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1607.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1722.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1951.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1836.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER ABLATION BA", "code_information": [{"code": "C1886", "type": "HCPCS"}, {"code": "3100102586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1606.5, "maximum": 2226.15, "gross_charge": 2295.0, "discounted_cash": 3442.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1950.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2226.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1950.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER ACC-FLO 91C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 360.25, "maximum": 499.21, "gross_charge": 514.65, "discounted_cash": 771.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 437.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 385.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 360.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 499.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 360.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 385.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 437.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 411.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER BARRX 90 FO", "code_information": [{"code": "3100204289", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3772.08, "discounted_cash": 5658.12, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BARRX RFA E", "code_information": [{"code": "3100204287", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6011.46, "discounted_cash": 9017.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BARRX ULT/L", "code_information": [{"code": "3100204290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4782.96, "discounted_cash": 7174.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CHOLANGIOGR", "code_information": [{"code": "3100100349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CHOLANGIOGR", "code_information": [{"code": "3100102587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 142.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE", "code_information": [{"code": "3100100350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE", "code_information": [{"code": "3100102588", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE", "code_information": [{"code": "3100102589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER COUDE", "code_information": [{"code": "3100104481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER CV", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100104605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 518.7, "maximum": 718.77, "gross_charge": 741.0, "discounted_cash": 1111.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 629.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 555.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 518.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 718.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 518.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 555.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 629.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 592.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER DIAG", "code_information": [{"code": "3100100351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DIALYSIS*CF", "code_information": [{"code": "3100205688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 537.66, "discounted_cash": 806.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER DUAL LUMEN", "code_information": [{"code": "3100103890", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 2272.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EMBOLECTOMY", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "3100100352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER EMBOLECTOMY", "code_information": [{"code": "C1757", "type": "HCPCS"}, {"code": "3100102590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER EPIDURAL", "code_information": [{"code": "C1755", "type": "HCPCS"}, {"code": "3100100353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16.8, "maximum": 23.28, "gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100100354", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100102591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100102592", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100102593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100102594", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100104431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100104468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY", "code_information": [{"code": "3100104471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY PED", "code_information": [{"code": "3100100355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY PED", "code_information": [{"code": "3100102595", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOR HYSTEROGRAPHY", "code_information": [{"code": "58340", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATHETER GROSHONG", "code_information": [{"code": "3100100356", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER GROSHONG", "code_information": [{"code": "3100102596", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1496.0, "discounted_cash": 2244.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER INTRATHECAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1341.9, "maximum": 1859.49, "gross_charge": 1917.0, "discounted_cash": 2875.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1629.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1437.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1341.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1859.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1341.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1437.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1629.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1533.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER INTRATHECAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 464.1, "maximum": 643.11, "gross_charge": 663.0, "discounted_cash": 994.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 643.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER INTRATHECAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER INTRATHECAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1474.2, "maximum": 2042.82, "gross_charge": 2106.0, "discounted_cash": 3159.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1790.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1474.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2042.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1474.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1790.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1684.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER IV", "code_information": [{"code": "3100100357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER KIT FOLEY*8", "code_information": [{"code": "3100206194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.76, "discounted_cash": 38.64, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MELKER CUFF", "code_information": [{"code": "3100100358", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1325.0, "discounted_cash": 1987.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PASSER", "code_information": [{"code": "3100100359", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PASSER*8591", "code_information": [{"code": "3100205941", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PERITONEAL*", "code_information": [{"code": "3100205689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 599.46, "discounted_cash": 899.19, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PICC", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "3100100360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.0, "maximum": 1978.8, "gross_charge": 2040.0, "discounted_cash": 3060.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER PTA CONQ", "code_information": [{"code": "3100104530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SET ARROW R", "code_information": [{"code": "3100100363", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER SILICONE 16", "code_information": [{"code": "3100203466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.36, "discounted_cash": 240.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER THORACIC", "code_information": [{"code": "3100100364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER THORACIC", "code_information": [{"code": "3100102597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER TRACH CARE", "code_information": [{"code": "3100100365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER TRAY FOLEY", "code_information": [{"code": "3100100366", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL", "code_information": [{"code": "3100100367", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL", "code_information": [{"code": "3100102598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL", "code_information": [{"code": "3100102599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URETERAL", "code_information": [{"code": "3100102600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 118.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO COUNCIL", "code_information": [{"code": "3100203295", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.28, "discounted_cash": 205.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO FOLEY 1", "code_information": [{"code": "3100203292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.28, "discounted_cash": 205.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO FOLEY 1", "code_information": [{"code": "3100203293", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.28, "discounted_cash": 205.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO FOLEY 1", "code_information": [{"code": "3100203294", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.28, "discounted_cash": 205.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO FOLEY 2", "code_information": [{"code": "3100203269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.12, "discounted_cash": 16.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO FOLEY 2", "code_information": [{"code": "3100203296", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.28, "discounted_cash": 205.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO OPEN EN", "code_information": [{"code": "3100100368", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER URO OPEN EN", "code_information": [{"code": "3100102601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER*8781", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2325.96, "maximum": 3223.11, "gross_charge": 3322.8, "discounted_cash": 4984.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2824.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2492.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2325.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3223.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2325.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2492.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2824.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2658.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER, GUIDING", "code_information": [{"code": "C1887", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETER, URETERAL", "code_information": [{"code": "C1758", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CATHETERIZATION FOR", "code_information": [{"code": "P9612", "type": "HCPCS"}, {"code": "3340100597", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.46, "maximum": 63.05, "gross_charge": 65.0, "discounted_cash": 14.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 63.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CATHETERIZATION FOR", "code_information": [{"code": "P9612", "type": "HCPCS"}, {"code": "3500102283", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.46, "maximum": 63.05, "gross_charge": 65.0, "discounted_cash": 14.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 63.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAUTERIZATION AND/OR", "code_information": [{"code": "30802", "type": "CPT"}, {"code": "3480101836", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3895.52, "gross_charge": 4016.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAUTERIZATION OF CERVIX", "code_information": [{"code": "57510", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAUTERY HIGH TEMP*P2", "code_information": [{"code": "3100203241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.88, "discounted_cash": 52.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CAUTRY&/ABLT SFT TIS", "code_information": [{"code": "30801", "type": "CPT"}, {"code": "3480103030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1977.63, "gross_charge": 2038.8, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1732.98, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1529.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1427.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1977.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1427.16, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1529.1, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1732.98, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1631.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CAVOPULMONARY SHUNTING", "code_information": [{"code": "33768", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CBC COMP AUTO W AUTO", "code_information": [{"code": "85025", "type": "CPT"}, {"code": "3440101030", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 7.77, "maximum": 68.87, "gross_charge": 71.0, "discounted_cash": 12.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 68.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CBC COMP AUTOMATED", "code_information": [{"code": "85027", "type": "CPT"}, {"code": "3440101031", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.47, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CBC WITHOUT PLATELET", "code_information": [{"code": "G0307", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.47, "maximum": 20.92, "discounted_cash": 10.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CBC/DIFFWBC W/O PLATELET", "code_information": [{"code": "G0306", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.77, "maximum": 20.92, "discounted_cash": 12.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CBM 6CC GRAFT*210-06", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CCIIV3 VAC NO PRSV 0.5 ML IM", "code_information": [{"code": "90661", "type": "CPT"}], "standard_charges": [{"minimum": 25.94, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VAC NO PRSV 0.5 ML IM", "code_information": [{"code": "90674", "type": "CPT"}], "standard_charges": [{"minimum": 34.17, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CCIIV4 VACC ABX FREE IM", "code_information": [{"code": "90756", "type": "CPT"}], "standard_charges": [{"minimum": 32.37, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CCM/BHI BY RHC/FQHC 20MIN MO", "code_information": [{"code": "G0511", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CCND1/IGH TRANSLOCATION ALYS", "code_information": [{"code": "81168", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R", "code_information": [{"code": "92548", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CDP-SOT 6 COND W/I&R MCT&ADT", "code_information": [{"code": "92549", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CDTB&VINCULIN IGG ANTB IA", "code_information": [{"code": "176U", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 103.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CEBPA GENE FULL SEQUENCE", "code_information": [{"code": "81218", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 241.9, "discounted_cash": 388.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 241.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CEFAZOLIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0690", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.82, "maximum": 0.82, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFEPIME HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0692", "type": "HCPCS"}, {"code": "3400300260", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.34, "maximum": 11.83, "gross_charge": 12.2, "discounted_cash": 18.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFOTAXIME SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0698", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.21, "maximum": 31.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFOXITIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0694", "type": "HCPCS"}, {"code": "3400300261", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.9, "maximum": 10.67, "gross_charge": 11.0, "discounted_cash": 16.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTAROLINE FOSAMIL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0712", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.86, "maximum": 3.86, "discounted_cash": 6.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTAZIDIME AND AVIBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0714", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.44, "maximum": 95.44, "discounted_cash": 153.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 95.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTAZIDIME PENTAHYD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0713", "type": "HCPCS"}, {"code": "3400300124", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.66, "maximum": 26.77, "gross_charge": 27.6, "discounted_cash": 41.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 22.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFTIZOXIME SODIUM / 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0715", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEFTRIAXONE SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0696", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.45, "maximum": 0.45, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEFUROXIME SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0697", "type": "HCPCS"}, {"code": "3400300226", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.89, "maximum": 10.47, "gross_charge": 10.8, "discounted_cash": 16.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELECOXIB", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300015", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 21.5, "discounted_cash": 32.25, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "CELERA PER SQ CM", "code_information": [{"code": "Q4259", "type": "HCPCS"}], "standard_charges": [{"minimum": 1007.0, "maximum": 1007.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1007.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELL COUNT MISC FLUI", "code_information": [{"code": "89051", "type": "CPT"}, {"code": "3440101249", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.6, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELL CRYOPRESERVE/STORAGE", "code_information": [{"code": "88240", "type": "CPT"}], "standard_charges": [{"minimum": 13.07, "maximum": 35.16, "discounted_cash": 21.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELL ENUMERATION & ID", "code_information": [{"code": "86152", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 250.78, "discounted_cash": 402.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 250.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELL ENUMERATION PHYS INTERP", "code_information": [{"code": "86153", "type": "CPT"}], "standard_charges": [{"minimum": 44.23, "maximum": 68.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELL FUNCTION ASSAY W/STIM", "code_information": [{"code": "86352", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 135.86, "discounted_cash": 218.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 135.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELL MARKER STUDY", "code_information": [{"code": "88182", "type": "CPT"}, {"code": "3440103020", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 43.61, "maximum": 226.98, "gross_charge": 234.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 226.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 187.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 96.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELL SAVER ASPIRATOR", "code_information": [{"code": "3100100369", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CELL SAVER ASPIRATOR", "code_information": [{"code": "3100102602", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CELL SAVER BOWL", "code_information": [{"code": "3100100370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 775.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CELL SAVER BOWL", "code_information": [{"code": "3100104391", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CELL SAVER FILTER*SB", "code_information": [{"code": "3100205441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.07, "discounted_cash": 219.11, "setting": "both", "billing_class": "facility"}]}, {"description": "CELL SAVER RESERVOIR", "code_information": [{"code": "3100100371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CELLESTA CORD PER SQ CM", "code_information": [{"code": "Q4214", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELLESTA FLOWAB AMNION 0.5CC", "code_information": [{"code": "Q4185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELLESTA OR DUO PER SQ CM", "code_information": [{"code": "Q4184", "type": "HCPCS"}], "standard_charges": [{"minimum": 624.34, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 624.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELLULAR THERAPY", "code_information": [{"code": "M0075", "type": "HCPCS"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CELLULITIS WITH MCC", "code_information": [{"code": "602", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8165.0, "maximum": 8165.0, "discounted_cash": 16607.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8165.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CELLULITIS WITHOUT MCC", "code_information": [{"code": "603", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4224.52, "maximum": 4224.52, "discounted_cash": 9877.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4224.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEM. BONE PALACOS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT BIOMET R*1100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 162.14, "maximum": 224.69, "gross_charge": 231.64, "discounted_cash": 347.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 162.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 185.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT BONE MIXER*02", "code_information": [{"code": "3100205215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.01, "discounted_cash": 246.02, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 193.2, "maximum": 267.72, "gross_charge": 276.0, "discounted_cash": 414.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 207.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 193.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 267.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 193.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 207.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 220.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT BONE PALACOS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.1, "maximum": 924.41, "gross_charge": 953.0, "discounted_cash": 1429.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 810.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 810.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT CARTRIDGE*CC0", "code_information": [{"code": "3100209507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.64, "discounted_cash": 486.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT DELIVERY SYST", "code_information": [{"code": "3100209885", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1046.76, "discounted_cash": 1570.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT DELIVERY SYST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT GUN B", "code_information": [{"code": "3100100374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 277.04, "discounted_cash": 415.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT INJECTOR POWE", "code_information": [{"code": "3100100375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7002.0, "discounted_cash": 10503.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT INJECTOR POWE", "code_information": [{"code": "3100102604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8710.0, "discounted_cash": 13065.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT INJECTOR*5069", "code_information": [{"code": "3100204743", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1530.0, "discounted_cash": 2295.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT MIXER ZIM*414", "code_information": [{"code": "3100207650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.8, "discounted_cash": 571.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT PLUG 12 CLEAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 201.6, "maximum": 279.36, "gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT PLUG CLEARCUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR", "code_information": [{"code": "3100100377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 664.0, "discounted_cash": 996.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR*32", "code_information": [{"code": "3100204744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR*EB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.0, "maximum": 644.36, "gross_charge": 664.29, "discounted_cash": 996.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 564.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 644.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 564.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 531.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT RESTRICTOR*EB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.0, "maximum": 644.36, "gross_charge": 664.29, "discounted_cash": 996.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 564.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 644.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 564.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 531.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT SIMPLEX HV*61", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 154.0, "maximum": 213.4, "gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT SPEED SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT TOTAL COBALT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 609.0, "maximum": 843.9, "gross_charge": 870.0, "discounted_cash": 1305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEMENT TOTAL COBALT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 154.0, "maximum": 213.4, "gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTER SCREW 6.5X28*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 326.64, "maximum": 452.64, "gross_charge": 466.64, "discounted_cash": 699.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 396.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 349.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 326.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 452.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 326.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 349.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 396.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 373.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTER SCREW 6.5X32*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 247.82, "maximum": 343.41, "gross_charge": 354.04, "discounted_cash": 531.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 343.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 283.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTERPIECE 13MM*436", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8400.0, "maximum": 11640.0, "gross_charge": 12000.0, "discounted_cash": 18000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11640.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTERPIECE 13MM*436", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8400.0, "maximum": 11640.0, "gross_charge": 12000.0, "discounted_cash": 18000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11640.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTERPIECE 9X23X29*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8508.5, "maximum": 11790.35, "gross_charge": 12155.0, "discounted_cash": 18232.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10331.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8508.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11790.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8508.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9116.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10331.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTRAL LINE*CDC-457", "code_information": [{"code": "3100207761", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.72, "discounted_cash": 817.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRAL POST 20MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1556.1, "maximum": 2156.31, "gross_charge": 2223.0, "discounted_cash": 3334.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1889.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1667.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1556.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2156.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1556.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1667.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1889.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1778.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTRAL POST 30MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1556.1, "maximum": 2156.31, "gross_charge": 2223.0, "discounted_cash": 3334.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1889.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1667.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1556.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2156.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1556.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1667.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1889.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1778.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTRAL POST 35MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1490.53, "maximum": 2065.45, "gross_charge": 2129.34, "discounted_cash": 3194.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1809.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1597.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1490.53, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2065.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1490.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1597.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1809.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1703.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTRAL VENOUS CATH*", "code_information": [{"code": "3100205536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 601.44, "discounted_cash": 902.16, "setting": "both", "billing_class": "facility"}]}, {"description": "CENTRALIZER DISTAL Z", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CENTRUROIDES IMMUNE F(AB)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0716", "type": "HCPCS"}], "standard_charges": [{"minimum": 2848.75, "maximum": 2848.75, "discounted_cash": 7820.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2848.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CEP72 NUDT15&TPMT GENE ALYS", "code_information": [{"code": "286U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 215.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CEPHALIN FLOCULATION TEST", "code_information": [{"code": "P2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 7.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CEPHALOTHIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1890", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CEPHAPIRIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0710", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.08, "maximum": 2.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERAMIC HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERAMIC HEAD 28MM*65", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1472.1, "maximum": 2039.91, "gross_charge": 2103.0, "discounted_cash": 3154.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1787.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1577.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1472.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2039.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1472.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1577.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1787.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1682.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERAMIC HEAD 36MM*65", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERCLAGE CERVIX IN P", "code_information": [{"code": "59320", "type": "CPT"}, {"code": "3340102302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4668.61, "gross_charge": 4813.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4091.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3609.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3369.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4668.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3369.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3609.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4091.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3850.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERCLAGE PASSER LG*A", "code_information": [{"code": "3100207318", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CERCLAGE PASSER MD*A", "code_information": [{"code": "3100207317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CERCLAGE PASSER SM*A", "code_information": [{"code": "3100207319", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CERCLAGE PIN 3.5*298", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 440.32, "maximum": 610.16, "gross_charge": 629.04, "discounted_cash": 943.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 534.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 471.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 440.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 610.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 440.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 471.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 534.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 503.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERCLAGE TENSIONER*A", "code_information": [{"code": "3100207320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CEREBROSPINAL FLUID SCAN", "code_information": [{"code": "78630", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERTOLIZUMAB PEGOL INJ 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0717", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.62, "maximum": 4.62, "discounted_cash": 7.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERULOPLASMIN", "code_information": [{"code": "82390", "type": "CPT"}, {"code": "3440100877", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.74, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101212", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101212", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101212", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2038.4, "maximum": 2824.64, "gross_charge": 2912.0, "discounted_cash": 4368.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2038.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2824.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2038.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2329.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV INTER 7*6101213", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER 11X14X8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER 13X16X10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER 13X16X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER 13X16X7*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER 13X16X8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER 13X16X9*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERV SPACER11X14X9*X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL COLLAR MULT", "code_information": [{"code": "L0200", "type": "HCPCS"}, {"code": "3100100382", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 954.8, "maximum": 1323.08, "gross_charge": 1364.0, "discounted_cash": 2046.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1159.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1023.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 954.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1323.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 954.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1023.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1091.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL CUP VCARE M", "code_information": [{"code": "3100100383", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CERVICAL DISC 5 X 12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8477.56, "maximum": 11747.47, "gross_charge": 12110.8, "discounted_cash": 18166.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10294.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9083.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8477.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11747.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8477.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9083.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10294.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9688.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 5 X 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 5 X 16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 6 X 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 6 X 16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 6 X 18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 7 X 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 7 X 16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6279.0, "maximum": 8700.9, "gross_charge": 8970.0, "discounted_cash": 13455.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7624.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6727.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6279.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8700.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6279.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6727.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7624.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL DISC 7 X 18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL LAMINOPLSTY 2/> SEG", "code_information": [{"code": "63050", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL LYMPHADENEC", "code_information": [{"code": "38724", "type": "CPT"}, {"code": "3480101897", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2597.7, "maximum": 3599.67, "gross_charge": 3711.0, "discounted_cash": 5566.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3154.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2783.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2597.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3599.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2597.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2783.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3154.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2968.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [{"code": "472", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14724.66, "maximum": 14724.66, "discounted_cash": 32995.76, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14724.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [{"code": "471", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25080.31, "maximum": 25080.31, "discounted_cash": 54918.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25080.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CERVICAL SPINAL FUSION WITHOUT CC/MCC", "code_information": [{"code": "473", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11476.49, "maximum": 11476.49, "discounted_cash": 27471.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11476.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN BIRTH CLASS", "code_information": [{"code": "S9438", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59510", "type": "CPT"}], "standard_charges": [{"minimum": 3961.84, "maximum": 3961.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3961.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY", "code_information": [{"code": "59515", "type": "CPT"}], "standard_charges": [{"minimum": 3961.84, "maximum": 3961.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3961.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN DELIVERY ONLY", "code_information": [{"code": "59514", "type": "CPT"}], "standard_charges": [{"minimum": 3961.84, "maximum": 3961.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3961.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [{"code": "784", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5677.38, "maximum": 5677.38, "discounted_cash": 11433.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5677.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [{"code": "783", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7097.64, "maximum": 7097.64, "discounted_cash": 19781.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7097.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "785", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5033.65, "maximum": 5033.65, "discounted_cash": 9671.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5033.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [{"code": "787", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5998.32, "maximum": 5998.32, "discounted_cash": 11735.07, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5998.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [{"code": "786", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6998.66, "maximum": 6998.66, "discounted_cash": 19532.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6998.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC", "code_information": [{"code": "788", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5343.52, "maximum": 5343.52, "discounted_cash": 9545.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5343.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CESSJ THERAPY CATH REMOVAL", "code_information": [{"code": "37214", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CETUXIMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.49, "maximum": 73.49, "discounted_cash": 118.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 73.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CFTR GENE COM VARIANTS", "code_information": [{"code": "81220", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 556.6, "discounted_cash": 894.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 556.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CFTR GENE DUP/DELET VARIANTS", "code_information": [{"code": "81222", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 435.07, "discounted_cash": 698.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 435.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CFTR GENE FULL SEQUENCE", "code_information": [{"code": "81223", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 499.0, "discounted_cash": 801.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 499.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CFTR GENE INTRON POLY T", "code_information": [{"code": "81224", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 168.75, "discounted_cash": 271.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CFTR GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81221", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 97.22, "discounted_cash": 156.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 97.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CGH TEST DEVELOPMENTAL DELAY", "code_information": [{"code": "S3870", "type": "HCPCS"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHAIRBACK", "code_information": [{"code": "3100102139", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHAMBER MAINTAINER*A", "code_information": [{"code": "3100210262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.8, "discounted_cash": 64.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANGE G-TUBE TO G-J PERC", "code_information": [{"code": "49446", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE GASTRIC PORT OPEN", "code_information": [{"code": "43888", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 8334.85, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TU", "code_information": [{"code": "51710", "type": "CPT"}, {"code": "3480103288", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2293.08, "gross_charge": 2364.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2009.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1773.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1654.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2293.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1654.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1773.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2009.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1891.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF CYSTOSTOMY", "code_information": [{"code": "51705", "type": "CPT"}, {"code": "3480102018", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 518.95, "gross_charge": 535.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 454.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 374.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 518.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 374.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 454.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 428.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF CYSTOSTOMY", "code_information": [{"code": "51705", "type": "CPT"}, {"code": "3480103222", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 902.1, "gross_charge": 930.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 902.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF CYSTOTOMY", "code_information": [{"code": "51705", "type": "CPT"}, {"code": "3480103337", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 978.73, "gross_charge": 1009.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 756.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 706.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 978.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 706.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 756.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 857.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 807.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": "50688", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE OF WINDPIPE AIRWAY", "code_information": [{"code": "31502", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], "standard_charges": [{"minimum": 1571.3, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHARGER KIT*66000", "code_information": [{"code": "3100209569", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGER*16000", "code_information": [{"code": "3100209568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM MEDT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100100384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3915.1, "maximum": 5425.21, "gross_charge": 5593.0, "discounted_cash": 8389.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4754.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4194.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3915.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5425.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3915.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4194.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4754.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4474.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM MEDT", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100102605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM ST J", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100100385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM*1401", "code_information": [{"code": "3100205340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2394.0, "discounted_cash": 3591.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM*DB-6", "code_information": [{"code": "3100208808", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2352.0, "discounted_cash": 3528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHARGING SYSTEM*RS62", "code_information": [{"code": "3100207636", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHCT FOR MAL HYPERTHERMIA", "code_information": [{"code": "89049", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 259.65, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 259.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHECKPOINT 3.5*11165", "code_information": [{"code": "3100208041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 456.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHEM CAUT OF GRANLTJ TISSUE", "code_information": [{"code": "17250", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMDNRV MUS LRNX UN", "code_information": [{"code": "64617", "type": "CPT"}, {"code": "3430100768", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 355.6, "maximum": 839.76, "gross_charge": 508.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 431.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 381.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 355.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 492.76, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 355.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 381.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 431.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 406.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMDNRV MUS/NECK UN", "code_information": [{"code": "64616", "type": "CPT"}, {"code": "3430102296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 216.3, "maximum": 448.56, "gross_charge": 309.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 231.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 216.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 299.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 216.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 231.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 247.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE DERMAL", "code_information": [{"code": "15789", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL FACE EPIDERM", "code_information": [{"code": "15788", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15793", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASS", "code_information": [{"code": "82397", "type": "CPT"}, {"code": "3440100878", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.12, "maximum": 148.41, "gross_charge": 153.0, "discounted_cash": 22.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 148.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO ANTI-NEOPL SQ/IM", "code_information": [{"code": "96401", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO BY BOTH INFUSION AND O", "code_information": [{"code": "Q0085", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO BY OTHER THAN INFUSION", "code_information": [{"code": "Q0083", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO EXTEND IV INFUS W/PUMP", "code_information": [{"code": "G0498", "type": "HCPCS"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO HORMON ANTINEOPL SQ/IM", "code_information": [{"code": "96402", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSE EACH ADDL HR", "code_information": [{"code": "96423", "type": "CPT"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IA PUSH TECNIQUE", "code_information": [{"code": "96420", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 328.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION 1 HR", "code_information": [{"code": "96413", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUSION ADDL HR", "code_information": [{"code": "96415", "type": "CPT"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH ADDL DRUG", "code_information": [{"code": "96411", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> EA", "code_information": [{"code": "64645", "type": "CPT"}], "standard_charges": [{"minimum": 1385.29, "maximum": 1385.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 5/> MUS", "code_information": [{"code": "64644", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ADDUCT VOCAL", "code_information": [{"code": "S2341", "type": "HCPCS"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64650", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION ANAL MUSC", "code_information": [{"code": "46505", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION EXT", "code_information": [{"code": "64646", "type": "CPT"}, {"code": "3480102181", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 448.56, "maximum": 1020.44, "gross_charge": 1052.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1020.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 841.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION EXT", "code_information": [{"code": "64646", "type": "CPT"}, {"code": "3480102182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 448.56, "maximum": 1020.44, "gross_charge": 1052.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1020.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 841.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ABDUCTOR", "code_information": [{"code": "S2340", "type": "HCPCS"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTAXIS ASSAY", "code_information": [{"code": "86155", "type": "CPT"}], "standard_charges": [{"minimum": 15.99, "maximum": 30.26, "discounted_cash": 25.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY BY INFUSION", "code_information": [{"code": "Q0084", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INFUSION METHOD", "code_information": [{"code": "96425", "type": "CPT"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INJECTION", "code_information": [{"code": "96542", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY INTO CNS", "code_information": [{"code": "96450", "type": "CPT"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "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": 18904.92, "maximum": 18904.92, "discounted_cash": 53105.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18904.92, "methodology": "fee schedule"}], "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": 7499.75, "maximum": 7499.75, "discounted_cash": 21797.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7499.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "839", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5746.24, "maximum": 5746.24, "discounted_cash": 14548.55, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5746.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [{"code": "847", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6765.02, "maximum": 6765.02, "discounted_cash": 13538.15, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6765.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [{"code": "846", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6844.33, "maximum": 6844.33, "discounted_cash": 27286.2, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6844.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC", "code_information": [{"code": "848", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5624.5, "maximum": 5624.5, "discounted_cash": 8479.49, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5624.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMOTX ADMN PERTL CAV IMPL", "code_information": [{"code": "96446", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEST PAIN", "code_information": [{"code": "313", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3143.03, "maximum": 3143.03, "discounted_cash": 8078.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3143.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEST PRECUS PHYSIOT", "code_information": [{"code": "94667", "type": "CPT"}, {"code": "3310100283", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 224.07, "gross_charge": 231.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHEST PRECUS PHYSIOT", "code_information": [{"code": "94668", "type": "CPT"}, {"code": "3310100284", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 224.07, "gross_charge": 231.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHI IMPLANT 10MM*MCH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5435.88, "maximum": 7532.58, "gross_charge": 7765.55, "discounted_cash": 11648.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7532.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6212.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHI IMPLANT 11MM*MCH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5435.88, "maximum": 7532.58, "gross_charge": 7765.55, "discounted_cash": 11648.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7532.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6212.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHI IMPLANT 13MM*MCH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5435.88, "maximum": 7532.58, "gross_charge": 7765.55, "discounted_cash": 11648.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7532.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6212.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIBA BIOPSY NEEDLE*", "code_information": [{"code": "3100205498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.4, "discounted_cash": 90.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CHIBA NEEDLE*CNM-220", "code_information": [{"code": "3100204590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.32, "discounted_cash": 57.48, "setting": "both", "billing_class": "facility"}]}, {"description": "CHIBA NEEDLE*DCHN-22", "code_information": [{"code": "3100203128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHILDBIRTH REFRESHER CLASS", "code_information": [{"code": "S9437", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [{"code": "18", "type": "MS-DRG"}], "standard_charges": [{"minimum": 229570.41, "maximum": 229570.41, "discounted_cash": 411332.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 229570.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHIMERISM ANAL NO CELL SELEC", "code_information": [{"code": "81267", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.46, "discounted_cash": 333.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIMERISM ANAL W/CELL SELECT", "code_information": [{"code": "81268", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 260.79, "discounted_cash": 418.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 260.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 1-2 REGIONS", "code_information": [{"code": "98940", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ 3-4 REGIONS", "code_information": [{"code": "98941", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIROPRACT MANJ XTRSPINL 1/>", "code_information": [{"code": "98943", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHIROPRACTIC MANJ 5 REGIONS", "code_information": [{"code": "98942", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA AB", "code_information": [{"code": "86631", "type": "CPT"}, {"code": "3440101097", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.82, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 18.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA IGM AB", "code_information": [{"code": "86632", "type": "CPT"}, {"code": "3440101098", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.68, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 20.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLAMYDIA TRACHOMATIS AG IF", "code_information": [{"code": "87270", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA AMP PROBE", "code_information": [{"code": "87486", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA DIR PROBE", "code_information": [{"code": "87485", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD PNEUM DNA QUANT", "code_information": [{"code": "87487", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH AG IA", "code_information": [{"code": "87320", "type": "CPT"}], "standard_charges": [{"minimum": 15.0, "maximum": 24.03, "discounted_cash": 24.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH ASSAY W/OPTIC", "code_information": [{"code": "87810", "type": "CPT"}], "standard_charges": [{"minimum": 35.29, "maximum": 41.83, "discounted_cash": 56.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH DNA DIR PROBE", "code_information": [{"code": "87490", "type": "CPT"}], "standard_charges": [{"minimum": 22.75, "maximum": 24.03, "discounted_cash": 36.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLMYD TRACH DNA QUANT", "code_information": [{"code": "87492", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 53.47, "discounted_cash": 85.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 53.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLORAMPHENICOL SODIUM INJEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0720", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.26, "maximum": 50.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORAPREP", "code_information": [{"code": "3100102140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.8, "discounted_cash": 34.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CHLORAPREP", "code_information": [{"code": "3100103674", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CHLORDIAZEPOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1990", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.41, "maximum": 15.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORHEX GL/ISOPROP", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300311", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 26.9, "discounted_cash": 40.35, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "CHLORIDE BLOOD", "code_information": [{"code": "82435", "type": "CPT"}, {"code": "3440100879", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.6, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 7.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLORIDE BLOOD (POC)", "code_information": [{"code": "82435", "type": "CPT"}, {"code": "3440100880", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.6, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 7.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLORIDE URINE", "code_information": [{"code": "82436", "type": "CPT"}, {"code": "3440100881", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.75, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 9.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHLOROPROCAINE (CLOROTEKAL)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2402", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOROPROCAINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2401", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "discounted_cash": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLOROPROCAINE OPHT GEL, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2403", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.66, "maximum": 0.66, "discounted_cash": 1.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLOROQUINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0390", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLOROTHIAZIDE SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1205", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.76, "maximum": 87.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 87.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHLORPROMAZINE HCL 5MG ORAL", "code_information": [{"code": "Q0161", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CHLORPROMAZINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3230", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.94, "maximum": 27.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHMDENERV 1 EX 1-4 E", "code_information": [{"code": "64643", "type": "CPT"}, {"code": "3430100780", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 165.9, "maximum": 1385.29, "gross_charge": 237.0, "discounted_cash": 355.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 201.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 177.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 165.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 229.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 165.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 177.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 201.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 189.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHMDENERV 1 EX 1-4 M", "code_information": [{"code": "64642", "type": "CPT"}, {"code": "3430100779", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 253.4, "maximum": 839.76, "gross_charge": 362.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 307.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 351.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 307.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 289.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHMOTX ADMN PLRL CAV THRCNTS", "code_information": [{"code": "96440", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLANGIOGRAPHY SET", "code_information": [{"code": "3100100386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 387.2, "discounted_cash": 580.8, "setting": "both", "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [{"code": "415", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11076.85, "maximum": 11076.85, "discounted_cash": 22058.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11076.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "414", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13667.14, "maximum": 13667.14, "discounted_cash": 39357.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13667.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "416", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10609.58, "maximum": 10609.58, "discounted_cash": 14951.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10609.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [{"code": "412", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13995.47, "maximum": 13995.47, "discounted_cash": 22837.11, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13995.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [{"code": "411", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23077.18, "maximum": 23077.18, "discounted_cash": 32159.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23077.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "413", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10179.81, "maximum": 10179.81, "discounted_cash": 16854.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10179.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHOLERA VACCINE LIVE ORAL", "code_information": [{"code": "90625", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLESTEROL HDL DIRE", "code_information": [{"code": "83718", "type": "CPT"}, {"code": "3440100947", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.19, "maximum": 69.84, "gross_charge": 72.0, "discounted_cash": 13.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 69.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLESTEROL LDL DIRE", "code_information": [{"code": "83721", "type": "CPT"}, {"code": "3440100948", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.5, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 16.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLESTEROL SERUM BL", "code_information": [{"code": "82465", "type": "CPT"}, {"code": "3440100882", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.35, "maximum": 37.83, "gross_charge": 39.0, "discounted_cash": 6.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 37.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHOLINESTERASE CHALLENGE", "code_information": [{"code": "95857", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHORION BIOPSY", "code_information": [{"code": "59015", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2169.82, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHORNC GONADOTROPIN HCG IA", "code_information": [{"code": "167U", "type": "CPT"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "discounted_cash": 12.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRMSM ANALY ADDL KA", "code_information": [{"code": "88280", "type": "CPT"}, {"code": "3440101224", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 33.47, "maximum": 218.25, "gross_charge": 225.0, "discounted_cash": 53.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 218.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.85, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 35.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 35.85, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRMSM ANALYZE 20-25", "code_information": [{"code": "88264", "type": "CPT"}, {"code": "3440101220", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 1087.37, "gross_charge": 1121.0, "discounted_cash": 232.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 952.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 160.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 840.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1087.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 157.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 840.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 154.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 184.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 952.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 154.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 896.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 144.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 154.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 157.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRMSM CNT 15-20 CLL", "code_information": [{"code": "88262", "type": "CPT"}, {"code": "3440101219", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 79.66, "maximum": 1087.37, "gross_charge": 1121.0, "discounted_cash": 201.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 952.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 840.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1087.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 840.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 159.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 952.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 896.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 125.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99491", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99437", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAF EA ADDL", "code_information": [{"code": "99439", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRNC CARE MGMT STAFF 1ST 20", "code_information": [{"code": "99490", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMA QUAN CLMN 1 A", "code_information": [{"code": "82491", "type": "CPT"}, {"code": "3440100883", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 137.2, "maximum": 190.12, "gross_charge": 196.0, "discounted_cash": 294.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROME STEM*6478-6-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1566.33, "maximum": 2170.49, "gross_charge": 2237.62, "discounted_cash": 3356.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1901.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1678.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1566.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2170.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1566.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1678.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1901.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1790.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROME STEM*6478-6-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1566.33, "maximum": 2170.49, "gross_charge": 2237.62, "discounted_cash": 3356.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1901.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1678.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1566.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2170.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1566.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1678.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1901.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1790.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHROMOGENIC SUBSTRAT", "code_information": [{"code": "85130", "type": "CPT"}, {"code": "3440103023", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.89, "maximum": 62.08, "gross_charge": 64.0, "discounted_cash": 19.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 62.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS AMNIOTIC", "code_information": [{"code": "88269", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 173.66, "discounted_cash": 278.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 173.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYS PLACENTA", "code_information": [{"code": "88267", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 188.57, "discounted_cash": 302.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 188.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS", "code_information": [{"code": "88262", "type": "CPT"}, {"code": "3440103032", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 79.66, "maximum": 1055.36, "gross_charge": 1088.0, "discounted_cash": 201.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 924.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1055.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 159.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 924.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 870.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 125.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 100", "code_information": [{"code": "88249", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 173.17, "discounted_cash": 278.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 173.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 20-25", "code_information": [{"code": "88245", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 173.17, "discounted_cash": 278.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 173.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 45", "code_information": [{"code": "88263", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 150.29, "discounted_cash": 241.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 5", "code_information": [{"code": "88261", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 264.34, "discounted_cash": 424.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 264.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME ANALYSIS 50-100", "code_information": [{"code": "88248", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 173.17, "discounted_cash": 278.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 173.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME BANDING STUDY", "code_information": [{"code": "88283", "type": "CPT"}], "standard_charges": [{"minimum": 68.6, "maximum": 79.66, "discounted_cash": 110.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME COUNT ADDITIONAL", "code_information": [{"code": "88285", "type": "CPT"}], "standard_charges": [{"minimum": 26.91, "maximum": 79.66, "discounted_cash": 43.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHROMOSOME STUDY ADDITIONAL", "code_information": [{"code": "88289", "type": "CPT"}], "standard_charges": [{"minimum": 34.43, "maximum": 79.66, "discounted_cash": 55.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [{"code": "191", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4967.86, "maximum": 4967.86, "discounted_cash": 9478.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4967.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [{"code": "190", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6008.16, "maximum": 6008.16, "discounted_cash": 12303.35, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6008.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC", "code_information": [{"code": "192", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3918.95, "maximum": 3918.95, "discounted_cash": 7165.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3918.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIDOFOVIR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0740", "type": "HCPCS"}], "standard_charges": [{"minimum": 581.06, "maximum": 581.06, "discounted_cash": 890.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 581.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CILIARY TRANSSLERAL THERAPY", "code_information": [{"code": "66710", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CILTACABTAGENE CAR-POS T", "code_information": [{"code": "Q2056", "type": "HCPCS"}], "standard_charges": [{"minimum": 507495.55, "maximum": 507495.55, "discounted_cash": 814810.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 507495.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINACALCET, ESRD ON DIALYSIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0604", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.52, "maximum": 0.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINCH ANCHOR*1194", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS", "code_information": [{"code": "76120", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CINE/VIDEO X-RAYS ADD-ON", "code_information": [{"code": "76125", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN LACTAT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0744", "type": "HCPCS"}, {"code": "3400300117", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.86, "maximum": 6.49, "gross_charge": 6.7, "discounted_cash": 10.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIPROFLOXACIN/DEXAME", "code_information": [{"code": "3400300030", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 318.0, "discounted_cash": 477.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT", "code_information": [{"code": "3100100387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT", "code_information": [{"code": "3100102606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT", "code_information": [{"code": "3100102607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT PEDS FLEX2*H", "code_information": [{"code": "3100206695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.6, "discounted_cash": 42.9, "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": 11354.14, "maximum": 11354.14, "discounted_cash": 24066.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11354.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "287", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5999.55, "maximum": 5999.55, "discounted_cash": 12075.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5999.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION NEONATE", "code_information": [{"code": "54160", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2109.3, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION W/REGIO", "code_information": [{"code": "54150", "type": "CPT"}, {"code": "3480102051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION, SURGIC", "code_information": [{"code": "54161", "type": "CPT"}, {"code": "3480102052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRCUMCISION, SURGIC", "code_information": [{"code": "54161", "type": "CPT"}, {"code": "3480103259", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "433", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6166.79, "maximum": 6166.79, "discounted_cash": 11510.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6166.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "432", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9520.7, "maximum": 9520.7, "discounted_cash": 21391.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9520.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "434", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3923.26, "maximum": 3923.26, "discounted_cash": 7474.68, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3923.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CISPLATIN 10 MG INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9060", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.27, "maximum": 3.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CITRATE", "code_information": [{"code": "82507", "type": "CPT"}, {"code": "3440100884", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.8, "maximum": 53.85, "gross_charge": 49.0, "discounted_cash": 44.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 35.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CL MULT VSD W/REM PUL BAND", "code_information": [{"code": "33677", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLAMP BULLDOG", "code_information": [{"code": "3100100388", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.64, "discounted_cash": 125.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP HEMOSTAT", "code_information": [{"code": "3100104695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP HIP POSITIONER", "code_information": [{"code": "3100100389", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2634.0, "discounted_cash": 3951.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP LG COMB*AR-896", "code_information": [{"code": "3100208455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1562.4, "discounted_cash": 2343.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP LG COMBINATION", "code_information": [{"code": "3100104105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2129.0, "discounted_cash": 3193.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP LG EX-FIX *390", "code_information": [{"code": "3100206260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1688.58, "discounted_cash": 2532.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP LG MULTI*AR896", "code_information": [{"code": "3100208456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP LG OPEN ADJUST", "code_information": [{"code": "3100104106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1764.0, "discounted_cash": 2646.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP MULTI-PIN ROD", "code_information": [{"code": "3100100390", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1555.0, "discounted_cash": 2332.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP MUTI PIN SYNTH", "code_information": [{"code": "3100100391", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2127.0, "discounted_cash": 3190.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLAMP, MRI EXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1544.2, "maximum": 2139.82, "gross_charge": 2206.0, "discounted_cash": 3309.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1875.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1654.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1544.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2139.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1544.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1654.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1875.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLARIFIX DEVICE*CFX-", "code_information": [{"code": "3100204502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLARIX 1K*CR-10-4030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2684.5, "maximum": 3719.95, "gross_charge": 3835.0, "discounted_cash": 5752.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3259.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2876.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2684.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3719.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2684.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2876.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3259.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3068.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLDS HUMERUS FX W/MA", "code_information": [{"code": "24535", "type": "CPT"}, {"code": "3480101573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 1675.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1423.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1256.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1172.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1624.75, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1172.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1256.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1423.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN & INSPECT REM DENT MAN", "code_information": [{"code": "D9933", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN & INSPECT REM DENT MAX", "code_information": [{"code": "D9932", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN OUT MASTOID CA", "code_information": [{"code": "69222", "type": "CPT"}, {"code": "3480102227", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "gross_charge": 1745.0, "discounted_cash": 842.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 580.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1692.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 578.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1396.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN REM PART DENTURE MAND", "code_information": [{"code": "D9935", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAN REM PART DENTURE MAX", "code_information": [{"code": "D9934", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69200", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 277.43, "discounted_cash": 326.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLEAT MINI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 451.5, "maximum": 625.65, "gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 625.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLINDAMYCIN PHOSPHAT", "code_information": [{"code": "3400300012", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.5, "discounted_cash": 9.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP APPLIER LIGACLI", "code_information": [{"code": "3100100392", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.92, "discounted_cash": 607.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP APPLIER LIGACLI", "code_information": [{"code": "3100207532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.68, "discounted_cash": 244.02, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ECG ALLIGATOR", "code_information": [{"code": "3100104665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ELECTRODE", "code_information": [{"code": "3100100393", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP HEMOLOK L*54424", "code_information": [{"code": "3100208980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.64, "discounted_cash": 189.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP HEMOLOK M/L*544", "code_information": [{"code": "3100208979", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.28, "discounted_cash": 175.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SMALL*", "code_information": [{"code": "3100208981", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.48, "discounted_cash": 44.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LOCK RIA", "code_information": [{"code": "3100100394", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 466.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPPER ENDO II", "code_information": [{"code": "3100100395", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS", "code_information": [{"code": "3100100396", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS TUBAL LIGATION", "code_information": [{"code": "3100100397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.8, "discounted_cash": 784.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOFARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9027", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.04, "maximum": 18.04, "discounted_cash": 34.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLONIDINE HCL", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300162", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 73.4, "discounted_cash": 110.1, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "CLONIDINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0735", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.02, "maximum": 17.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSD RDUCTN SPLINT ALVEOLUS", "code_information": [{"code": "D7670", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", "code_information": [{"code": "32815", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2713.61, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR SYSTEM FISTULA", "code_information": [{"code": "68770", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TMP MANIPULATION", "code_information": [{"code": "D7820", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF", "code_information": [{"code": "26725", "type": "CPT"}, {"code": "3480101648", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 561.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 544.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF", "code_information": [{"code": "27752", "type": "CPT"}, {"code": "3480101729", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3403.73, "gross_charge": 3509.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2982.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2631.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2456.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3403.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2456.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2631.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2982.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2807.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF", "code_information": [{"code": "27788", "type": "CPT"}, {"code": "3480101732", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 468.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TREATMENT OF", "code_information": [{"code": "27825", "type": "CPT"}, {"code": "3480101736", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2836.28, "gross_charge": 2924.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2485.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2836.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2485.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2339.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX NOSE/JAW FX", "code_information": [{"code": "21345", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1463.16, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX OF NOSE FR", "code_information": [{"code": "21320", "type": "CPT"}, {"code": "3480101466", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/MANIPULJ", "code_information": [{"code": "21401", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1463.16, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX ORBIT W/O MANIPULJ", "code_information": [{"code": "21400", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1463.16, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX SEPTAL&NOSE FX", "code_information": [{"code": "21337", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1463.16, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSED TX VERT FX W/O MANJ", "code_information": [{"code": "22310", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSEURE CARTER", "code_information": [{"code": "3100104379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.92, "discounted_cash": 427.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM DIFFICIL", "code_information": [{"code": "87493", "type": "CPT"}, {"code": "3480103045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 37.27, "maximum": 208.55, "gross_charge": 215.0, "discounted_cash": 59.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 182.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 161.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 150.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 208.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 150.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 161.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 47.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 182.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 172.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 39.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSTRIDIUM TOXIN A W/OPTIC", "code_information": [{"code": "87803", "type": "CPT"}], "standard_charges": [{"minimum": 16.0, "maximum": 24.03, "discounted_cash": 25.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF ENTEROSTO", "code_information": [{"code": "44625", "type": "CPT"}, {"code": "3480101965", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1767.5, "maximum": 2458.18, "gross_charge": 2525.0, "discounted_cash": 3787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2146.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1893.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1767.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2449.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1767.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1893.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2146.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2020.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF EYELID BY SUTURE", "code_information": [{"code": "67875", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "42600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SALIVARY FISTULA", "code_information": [{"code": "D7983", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF SPLIT WOU", "code_information": [{"code": "12020", "type": "CPT"}, {"code": "3480103302", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1900.23, "gross_charge": 1959.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1665.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1469.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1371.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1900.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1371.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1469.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1665.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1567.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF URETHROST", "code_information": [{"code": "53520", "type": "CPT"}, {"code": "3480102044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8056.82, "gross_charge": 8306.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7060.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6229.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5814.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8056.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5814.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6229.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7060.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6644.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VAGINA", "code_information": [{"code": "57120", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33600", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF VALVE", "code_information": [{"code": "33602", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3345.07, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE RECTOVAGI FI", "code_information": [{"code": "57300", "type": "CPT"}, {"code": "3480102093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8960.86, "gross_charge": 9238.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8960.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7390.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/BOWEL FISTULA", "code_information": [{"code": "50930", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOSURE URETER/SKIN FISTULA", "code_information": [{"code": "50920", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR FLETCHER FACT", "code_information": [{"code": "85292", "type": "CPT"}], "standard_charges": [{"minimum": 18.93, "maximum": 20.47, "discounted_cash": 30.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR IX PTC/CHRSTMAS", "code_information": [{"code": "85250", "type": "CPT"}], "standard_charges": [{"minimum": 19.04, "maximum": 59.63, "discounted_cash": 30.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VII PROCONVERTIN", "code_information": [{"code": "85230", "type": "CPT"}], "standard_charges": [{"minimum": 17.9, "maximum": 20.47, "discounted_cash": 28.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII MULTIMETRIC", "code_information": [{"code": "85247", "type": "CPT"}], "standard_charges": [{"minimum": 22.94, "maximum": 59.63, "discounted_cash": 36.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII RELTD ANTGN", "code_information": [{"code": "85244", "type": "CPT"}], "standard_charges": [{"minimum": 20.42, "maximum": 59.63, "discounted_cash": 32.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR VIII VW RISTOCTN", "code_information": [{"code": "85245", "type": "CPT"}], "standard_charges": [{"minimum": 22.94, "maximum": 59.63, "discounted_cash": 36.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR WGHT KININOGEN", "code_information": [{"code": "85293", "type": "CPT"}], "standard_charges": [{"minimum": 18.93, "maximum": 20.47, "discounted_cash": 30.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR X STUART-POWER", "code_information": [{"code": "85260", "type": "CPT"}], "standard_charges": [{"minimum": 17.9, "maximum": 20.47, "discounted_cash": 28.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XII HAGEMAN", "code_information": [{"code": "85280", "type": "CPT"}], "standard_charges": [{"minimum": 19.35, "maximum": 59.63, "discounted_cash": 31.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN SCRN", "code_information": [{"code": "85291", "type": "CPT"}], "standard_charges": [{"minimum": 9.11, "maximum": 20.47, "discounted_cash": 14.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR XIII FIBRIN STAB", "code_information": [{"code": "85290", "type": "CPT"}], "standard_charges": [{"minimum": 16.34, "maximum": 20.47, "discounted_cash": 26.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT C ANTIGEN", "code_information": [{"code": "85302", "type": "CPT"}], "standard_charges": [{"minimum": 12.01, "maximum": 20.47, "discounted_cash": 19.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT INHIBIT PROT S FREE", "code_information": [{"code": "85306", "type": "CPT"}], "standard_charges": [{"minimum": 15.32, "maximum": 20.47, "discounted_cash": 24.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTEST RAPID DIAGNO", "code_information": [{"code": "3100102141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOTTING ASSAY WHOLE BLOOD", "code_information": [{"code": "85396", "type": "CPT"}], "standard_charges": [{"minimum": 20.94, "maximum": 59.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING FACTOR VIII", "code_information": [{"code": "85240", "type": "CPT"}, {"code": "3440103074", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.9, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 28.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING FACTOR VIII", "code_information": [{"code": "85246", "type": "CPT"}, {"code": "3440103112", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 22.94, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 36.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 29.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 24.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING FACTR II PR", "code_information": [{"code": "85210", "type": "CPT"}, {"code": "3440101037", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 12.98, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING FACTR V LAB", "code_information": [{"code": "85220", "type": "CPT"}, {"code": "3440101038", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 17.65, "maximum": 153.26, "gross_charge": 158.0, "discounted_cash": 28.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 153.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING FACTR XI P", "code_information": [{"code": "85270", "type": "CPT"}, {"code": "3440101039", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 17.9, "maximum": 156.17, "gross_charge": 161.0, "discounted_cash": 28.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 156.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.17, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING FUNCT ACTIVITY", "code_information": [{"code": "85397", "type": "CPT"}], "standard_charges": [{"minimum": 30.86, "maximum": 59.63, "discounted_cash": 49.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING INHIB ANTIT", "code_information": [{"code": "85300", "type": "CPT"}, {"code": "3440100836", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 11.85, "maximum": 104.76, "gross_charge": 108.0, "discounted_cash": 19.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 104.76, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.69, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING INHIB PROTE", "code_information": [{"code": "85303", "type": "CPT"}, {"code": "3440101041", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 13.84, "maximum": 119.31, "gross_charge": 123.0, "discounted_cash": 22.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 119.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOTTING INHIB PROTE", "code_information": [{"code": "85305", "type": "CPT"}, {"code": "3440101042", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 11.61, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 18.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOVER ROUND HOLE (T", "code_information": [{"code": "3100100399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 874.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOZAPINE", "code_information": [{"code": "80159", "type": "CPT"}, {"code": "3440100810", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.15, "maximum": 161.02, "gross_charge": 166.0, "discounted_cash": 32.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 25.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 21.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD CARPAL FX W/MAN", "code_information": [{"code": "25635", "type": "CPT"}, {"code": "3480101613", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 561.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 544.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD RED COMP MALAR/ZYGMA FX", "code_information": [{"code": "D7760", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD RED SIMP MALAR/ZYGOM FX", "code_information": [{"code": "D7660", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD RED SIMPL MANDIBLE FX", "code_information": [{"code": "D7640", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD REDUCT COMPD MANDBLE FX", "code_information": [{"code": "D7740", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD REDUCT COMPD MAXILLA FX", "code_information": [{"code": "D7720", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD REDUCT SIMPL MAXILLA FX", "code_information": [{"code": "D7620", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX NSL FX MNPJ WO STBLJ", "code_information": [{"code": "21315", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27197", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLSRE/SCAR REV SCND", "code_information": [{"code": "27884", "type": "CPT"}, {"code": "3340102338", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5564.89, "gross_charge": 5737.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC W/MNPJ", "code_information": [{"code": "23545", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX ACROMCLAV DISLC WO MNPJ", "code_information": [{"code": "23540", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/O MNPJ", "code_information": [{"code": "23500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX W/MNPJ", "code_information": [{"code": "23625", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX MED ANKLE FX W/MNPJ", "code_information": [{"code": "27762", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX W/MNPJ", "code_information": [{"code": "27768", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX PRX HMRL FX MNPJ+-TRACT", "code_information": [{"code": "23605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC FX GR HMRL TBR", "code_information": [{"code": "23665", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DSLC W/MNPJ WO ANES", "code_information": [{"code": "23650", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/MNPJ", "code_information": [{"code": "23525", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX W/MNPJ", "code_information": [{"code": "27268", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLYDESDALE PTC12X50X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMBN ANT PST COLPRHY", "code_information": [{"code": "57260", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4354.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMBN AP COLPRHY W/NTRCL RPR", "code_information": [{"code": "57265", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2670.89, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX CLOS TRNK 2.6-", "code_information": [{"code": "13101", "type": "CPT"}, {"code": "3480101354", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 1602.44, "gross_charge": 1652.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1404.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1239.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1156.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1602.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1156.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1239.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1404.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1321.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX CLOS TRNK EA A", "code_information": [{"code": "13102", "type": "CPT"}, {"code": "3480101355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1024.32, "gross_charge": 1056.0, "discounted_cash": 1584.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX EYE/NOSE/LIP 2", "code_information": [{"code": "13152", "type": "CPT"}, {"code": "3480101361", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1335.69, "gross_charge": 1377.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1335.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX EYE/NOSE/LIPS", "code_information": [{"code": "13150", "type": "CPT"}, {"code": "3480101359", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1335.69, "gross_charge": 1377.0, "discounted_cash": 2065.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1335.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMPLX FACE/OTHER 2.6", "code_information": [{"code": "13132", "type": "CPT"}, {"code": "3480101358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 1335.69, "gross_charge": 1377.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1335.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR E/N/E/L ADDL 5CM/<", "code_information": [{"code": "13153", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR S/A/L 1.1-2.5 CM", "code_information": [{"code": "13120", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX RPR TRUNK 1.1-2.5 CM", "code_information": [{"code": "13100", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPLX SCLP ARM/LEG 2", "code_information": [{"code": "13121", "type": "CPT"}, {"code": "3480101356", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1024.32, "gross_charge": 1056.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPRTV DNA ALYS MLT SNPS", "code_information": [{"code": "79U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH DX IMG ANT SEGMT", "code_information": [{"code": "92132", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMPTR OPHTH IMG OPTIC NERVE", "code_information": [{"code": "92133", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CMV IG IV", "code_information": [{"code": "90291", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CNBP GENE DETC ABNOR ALLELE", "code_information": [{"code": "81187", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CNS DNA AMP PROBE TYPE 12-25", "code_information": [{"code": "87483", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 416.78, "discounted_cash": 669.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CO GNOTYP AQP1 EXON 1", "code_information": [{"code": "181U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CO/MEMBANE DIFFUSE CAPACITY", "code_information": [{"code": "94729", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CO57 CYANO", "code_information": [{"code": "A9559", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CO57/58", "code_information": [{"code": "A9546", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COAGUCHEK", "code_information": [{"code": "3100102142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 611.0, "discounted_cash": 916.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COAGULATION DISORDERS", "code_information": [{"code": "813", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5874.74, "maximum": 5874.74, "discounted_cash": 17416.73, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5874.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME ACTIVATED", "code_information": [{"code": "85347", "type": "CPT"}], "standard_charges": [{"minimum": 4.28, "maximum": 20.47, "discounted_cash": 6.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME LEE & WHITE", "code_information": [{"code": "85345", "type": "CPT"}], "standard_charges": [{"minimum": 4.69, "maximum": 20.47, "discounted_cash": 7.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COAGULATION TIME OTR METHOD", "code_information": [{"code": "85348", "type": "CPT"}], "standard_charges": [{"minimum": 4.49, "maximum": 20.47, "discounted_cash": 7.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COAGULATOR", "code_information": [{"code": "3100103961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COCAINE HCL", "code_information": [{"code": "3400300161", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 273.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COCCIDIOIDES AB", "code_information": [{"code": "86635", "type": "CPT"}, {"code": "3440101099", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.47, "maximum": 98.94, "gross_charge": 102.0, "discounted_cash": 18.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COCCIDIOIDOMYCOSIS SKIN TEST", "code_information": [{"code": "86490", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 70.87, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COCCYGECTOMY, PRIMAR", "code_information": [{"code": "27080", "type": "CPT"}, {"code": "3480101664", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM 7/>", "code_information": [{"code": "92603", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COCHLEAR IMPLT F/UP EXAM <7", "code_information": [{"code": "92601", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COCM BY RHC/FQHC 60 MIN MO", "code_information": [{"code": "G0512", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COCOON MEMBRANE, PER SQ CM", "code_information": [{"code": "Q4264", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COGENEX AMNIO MEMB PER SQ CM", "code_information": [{"code": "Q4229", "type": "HCPCS"}], "standard_charges": [{"minimum": 106.02, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 106.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COGENEX FLOW AMNION 0.5 CC", "code_information": [{"code": "Q4230", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COGNITIVE TEST BY HC PRO", "code_information": [{"code": "96125", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ SCREEN", "code_information": [{"code": "86156", "type": "CPT"}], "standard_charges": [{"minimum": 8.07, "maximum": 30.26, "discounted_cash": 12.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLD AGGLUTININ TITER", "code_information": [{"code": "86157", "type": "CPT"}], "standard_charges": [{"minimum": 8.06, "maximum": 30.26, "discounted_cash": 12.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLD KNIVE ST ELITE*", "code_information": [{"code": "3100203826", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 430.08, "discounted_cash": 645.12, "setting": "both", "billing_class": "facility"}]}, {"description": "COLECTOMY W/ILEOANAL ANAST", "code_information": [{"code": "44157", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLECTOMY W/NEO-RECTUM POUCH", "code_information": [{"code": "44158", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLECTOMY- PARTIAL", "code_information": [{"code": "44140", "type": "CPT"}, {"code": "3480101952", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2304.4, "maximum": 3193.24, "gross_charge": 3292.0, "discounted_cash": 4938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2798.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2469.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2304.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3193.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2304.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2469.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2798.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2633.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLGN CRS-LINK CRN&PACHYMTRY", "code_information": [{"code": "402T", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLISTIMETHATE SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0770", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.84, "maximum": 12.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLL-E-DERM 1 SQ CM", "code_information": [{"code": "Q4193", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLAGEN CROSSLINKS", "code_information": [{"code": "82523", "type": "CPT"}], "standard_charges": [{"minimum": 18.68, "maximum": 40.05, "discounted_cash": 30.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLAGEN MENISCUS IMPLANT", "code_information": [{"code": "G0428", "type": "HCPCS"}], "standard_charges": [{"minimum": 4111.8, "maximum": 4111.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLAGEN POWDER CELL", "code_information": [{"code": "3100100400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 788.0, "discounted_cash": 1182.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAGENASE, CLOST HIST INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0775", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.97, "maximum": 68.97, "discounted_cash": 106.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL", "code_information": [{"code": "3100102379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 769.0, "discounted_cash": 1153.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLAR CERVICAL", "code_information": [{"code": "3100103909", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLECT & APPL BLOOD PRODUCT", "code_information": [{"code": "D7921", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECT & PREP GENETIC SAMP", "code_information": [{"code": "D0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECT & PREP SALIVA SAMPLE", "code_information": [{"code": "D0417", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECT BLOOD FROM PICC", "code_information": [{"code": "36592", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 300.38, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECT SWEAT FOR TEST", "code_information": [{"code": "89230", "type": "CPT"}], "standard_charges": [{"minimum": 4.46, "maximum": 43.61, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECTION OF MICROORGANISMS", "code_information": [{"code": "D0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLECTOR BONEDUST", "code_information": [{"code": "3100100401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLET", "code_information": [{"code": "3100100402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 118.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLINS KNIFE*27040B", "code_information": [{"code": "3100209820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1036.8, "discounted_cash": 1555.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COLLJ & INTERPJ DATA EA 30 D", "code_information": [{"code": "99091", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLLJ CAPILLARY BLOOD SPEC", "code_information": [{"code": "36416", "type": "CPT"}], "standard_charges": [{"minimum": 4.44, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON CA SCREEN;BARIUM ENEMA", "code_information": [{"code": "G0106", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN; BARIUM ENEMA", "code_information": [{"code": "G0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON CA SCRN;BLD-BSD BIOMRK", "code_information": [{"code": "G0327", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLON MOTILITY 6 HR STUDY", "code_information": [{"code": "91117", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOP FLX DX W/", "code_information": [{"code": "45378", "type": "CPT"}, {"code": "3390100659", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOP W/BX SING", "code_information": [{"code": "45380", "type": "CPT"}, {"code": "3390100665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY & POLYPECTOMY", "code_information": [{"code": "44392", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR BLEEDING", "code_information": [{"code": "44391", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY FOR FOREIGN BODY", "code_information": [{"code": "44390", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY THROUGH", "code_information": [{"code": "44388", "type": "CPT"}, {"code": "3480101963", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY THROUGH", "code_information": [{"code": "44394", "type": "CPT"}, {"code": "3480101964", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ABLATION", "code_information": [{"code": "45388", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/BAND LIGATION", "code_information": [{"code": "45398", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "44408", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/DECOMPRESSION", "code_information": [{"code": "45393", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ENDOSCOPE US", "code_information": [{"code": "45391", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECT", "code_information": [{"code": "44405", "type": "CPT"}, {"code": "3390103017", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1204.19, "maximum": 2682.05, "gross_charge": 2765.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2350.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2073.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1935.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2682.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1935.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2073.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2350.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2212.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/INJECTION", "code_information": [{"code": "44404", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/NDL ASPIR/BX", "code_information": [{"code": "44407", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "44403", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/RESECTION", "code_information": [{"code": "45390", "type": "CPT"}], "standard_charges": [{"minimum": 2076.37, "maximum": 2076.37, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "44402", "type": "CPT"}], "standard_charges": [{"minimum": 2076.37, "maximum": 2076.37, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/STENT PLCMT", "code_information": [{"code": "45389", "type": "CPT"}], "standard_charges": [{"minimum": 2076.37, "maximum": 2076.37, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY W/ULTRASOUND", "code_information": [{"code": "44406", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH ABLATION", "code_information": [{"code": "44401", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY WITH BIOPSY", "code_information": [{"code": "44389", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY, FLEXIBL", "code_information": [{"code": "45384", "type": "CPT"}, {"code": "3390100667", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONOSCOPY/CONTROL", "code_information": [{"code": "45382", "type": "CPT"}, {"code": "3340102388", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2501.63, "gross_charge": 2579.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2192.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1934.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1805.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2501.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1805.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1934.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2192.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2063.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONSCPY CA SCRN NO", "code_information": [{"code": "G0121", "type": "HCPCS"}, {"code": "3390100679", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 932.64, "maximum": 2076.77, "gross_charge": 2141.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1819.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1605.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1498.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2076.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1498.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1605.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1819.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLONSCPY SCREEN HI", "code_information": [{"code": "G0105", "type": "HCPCS"}, {"code": "3390100678", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 932.64, "maximum": 2076.77, "gross_charge": 2141.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1819.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1605.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1498.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2076.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1498.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1605.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1819.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLORECTAL CANCER SC", "code_information": [{"code": "G0104", "type": "HCPCS"}, {"code": "3340102448", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 932.64, "maximum": 1705.24, "gross_charge": 1662.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1412.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1246.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1163.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1612.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1163.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1246.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1412.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1329.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY", "code_information": [{"code": "44320", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLOSTOMY WITH BIOPSIES", "code_information": [{"code": "44322", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY EXTRAPERITONEAL", "code_information": [{"code": "57282", "type": "CPT"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY INTRAPERITONEAL", "code_information": [{"code": "57283", "type": "CPT"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPOPEXY, MIN/INV, EX-PERIT", "code_information": [{"code": "C9778", "type": "HCPCS"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLPORRHAPHY", "code_information": [{"code": "57250", "type": "CPT"}, {"code": "3480102090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8960.86, "gross_charge": 9238.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8960.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7390.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLSC FLX PROX SPL", "code_information": [{"code": "45381", "type": "CPT"}, {"code": "3390100666", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLSC FLX PRX SPLEN", "code_information": [{"code": "45379", "type": "CPT"}, {"code": "3390100636", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLSC FLX PRX SPLEN", "code_information": [{"code": "45392", "type": "CPT"}, {"code": "3390100670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLSC FLX PRX SPLN F", "code_information": [{"code": "45385", "type": "CPT"}, {"code": "3390103015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLSC FLX PRX SPLN F", "code_information": [{"code": "45386", "type": "CPT"}, {"code": "3390103016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COLSC RGD/FLX TABDL", "code_information": [{"code": "45355", "type": "CPT"}, {"code": "3390102290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1694.0, "maximum": 2347.4, "gross_charge": 2420.0, "discounted_cash": 3630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2347.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1694.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1815.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2057.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COLUMN CHROMOTOGRAPH", "code_information": [{"code": "82542", "type": "CPT"}, {"code": "3440103048", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.09, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 38.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 30.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 25.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMM BH CLINIC SVC PER DIEM", "code_information": [{"code": "T1040", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMM PSY SUP TX PGM PER DIEM", "code_information": [{"code": "H0037", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMM SVCS BY RHC/FQHC 5 MIN", "code_information": [{"code": "G0071", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMMISSURE SPLINT", "code_information": [{"code": "D5987", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMMUNITY/WORK REINTEGRATION", "code_information": [{"code": "97537", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP ASSES CARE PLAN CCM SVC", "code_information": [{"code": "G0506", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP AST NAVIG ORTH", "code_information": [{"code": "55T", "type": "CPT"}, {"code": "3480101286", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 72.1, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMP CONT LENS EVAL", "code_information": [{"code": "S0592", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP GENET TEST HYP CARDIOMY", "code_information": [{"code": "S3865", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP GERIATR ASSMT TEAM", "code_information": [{"code": "S0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP MGMT CARE COORD ADV ILL", "code_information": [{"code": "S0311", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP MULTIDISIPLN EVALUATION", "code_information": [{"code": "H2000", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP PERIODONTAL EVALUATION", "code_information": [{"code": "D0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMP PLATE 8MM 6HOLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 690.9, "maximum": 957.39, "gross_charge": 987.0, "discounted_cash": 1480.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 957.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPACT MIXING SYS", "code_information": [{"code": "3100104727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPACT MIXING SYSTE", "code_information": [{"code": "3100100403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.0, "discounted_cash": 622.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COMPATBLTY EA UNIT E", "code_information": [{"code": "86923", "type": "CPT"}, {"code": "3440101151", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 70.2, "maximum": 207.41, "gross_charge": 117.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPATIBILITY TEST INCUBATE", "code_information": [{"code": "86921", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPL GIFT CASE RATE", "code_information": [{"code": "S4013", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPL ZIFT CASE RATE", "code_information": [{"code": "S4014", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT ANTIGEN E", "code_information": [{"code": "86160", "type": "CPT"}, {"code": "3440101068", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.0, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 19.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.85, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT FIXATION EACH", "code_information": [{"code": "86171", "type": "CPT"}], "standard_charges": [{"minimum": 10.01, "maximum": 30.26, "discounted_cash": 16.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT TOTAL HEM", "code_information": [{"code": "86162", "type": "CPT"}, {"code": "3440101069", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 20.32, "maximum": 177.51, "gross_charge": 183.0, "discounted_cash": 32.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 25.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEMENT/FUNCTION ACTIVITY", "code_information": [{"code": "86161", "type": "CPT"}], "standard_charges": [{"minimum": 12.0, "maximum": 30.26, "discounted_cash": 19.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLETE AA, PER SQ CM", "code_information": [{"code": "Q4303", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE ACA, PER SQ CM", "code_information": [{"code": "Q4302", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETE FT PER SQ CM", "code_information": [{"code": "Q4271", "type": "HCPCS"}], "standard_charges": [{"minimum": 1749.0, "maximum": 1749.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1749.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLETE IVF NOS CASE RATE", "code_information": [{"code": "S4015", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLETE OCCLUSAL ADJUSTMENT", "code_information": [{"code": "D9952", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLETE REMOVAL OF VULVA", "code_information": [{"code": "56625", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7423.94, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLETE SL PER SQ CM", "code_information": [{"code": "Q4270", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COMPLETION PNEUMONECTOMY", "code_information": [{"code": "32488", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEX CYSTOMETROGRAM", "code_information": [{"code": "51726", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEX LYMPHEDEMA THERAPY,", "code_information": [{"code": "S8950", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLEX REPAIR", "code_information": [{"code": "13131", "type": "CPT"}, {"code": "3340102375", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 676.09, "gross_charge": 697.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 592.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 487.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 676.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 487.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 592.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 557.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [{"code": "381", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4878.71, "maximum": 4878.71, "discounted_cash": 11979.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4878.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "380", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8885.58, "maximum": 8885.58, "discounted_cash": 21754.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8885.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATED PEPTIC ULCER WITHOUT CC/MCC", "code_information": [{"code": "382", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4421.89, "maximum": 4421.89, "discounted_cash": 8452.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4421.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [{"code": "920", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6042.59, "maximum": 6042.59, "discounted_cash": 11541.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6042.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [{"code": "919", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7789.33, "maximum": 7789.33, "discounted_cash": 20371.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7789.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLICATIONS OF TREATMENT WITHOUT CC/MCC", "code_information": [{"code": "921", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2924.15, "maximum": 2924.15, "discounted_cash": 7790.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2924.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPLX EYE/NOSE/LIP", "code_information": [{"code": "13151", "type": "CPT"}, {"code": "3480101360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1335.69, "gross_charge": 1377.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1335.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 963.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1170.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPONENT TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 2 VEINS", "code_information": [{"code": "35682", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT 3/> SEGMT", "code_information": [{"code": "35683", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOSITE BYP GRFT PROS&VEIN", "code_information": [{"code": "35681", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOSITE SKIN GRAFT", "code_information": [{"code": "15760", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPOUNDED DRUG, NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7999", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.88, "maximum": 4.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COMPRE AUDIOMETRY EVALUATION", "code_information": [{"code": "212T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE DENTAL TX ADOLESCENT", "code_information": [{"code": "D8080", "type": "HCPCS"}], "standard_charges": [{"minimum": 573.16, "maximum": 573.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 573.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE DENTAL TX ADULT", "code_information": [{"code": "D8090", "type": "HCPCS"}], "standard_charges": [{"minimum": 573.16, "maximum": 573.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 573.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE DENTAL TX TRANSITION", "code_information": [{"code": "D8070", "type": "HCPCS"}], "standard_charges": [{"minimum": 573.16, "maximum": 573.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 573.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL ABLTJ ATR FIB", "code_information": [{"code": "93656", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 36353.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX SVT", "code_information": [{"code": "93653", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 36353.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE EP EVAL TX VT", "code_information": [{"code": "93654", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 36353.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPRE FUL BDY 3D MTN ALYS", "code_information": [{"code": "693T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 563.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE HEARING TEST", "code_information": [{"code": "92557", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE MED SVC 15 MIN", "code_information": [{"code": "H2010", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPREHENSIVE METABO", "code_information": [{"code": "80053", "type": "CPT"}, {"code": "3440100795", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.56, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 16.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.31, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.31, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPREHENSVE ORAL EVALUATION", "code_information": [{"code": "D0150", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMPUTED TOMOGRAPHIC", "code_information": [{"code": "74174", "type": "CPT"}, {"code": "3290100245", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 513.98, "maximum": 513.98, "gross_charge": 2035.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COMT GENE", "code_information": [{"code": "32U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCENTRIC CONE LG*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7069.44, "maximum": 9796.22, "gross_charge": 10099.2, "discounted_cash": 15148.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8584.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7574.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7069.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9796.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7069.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7574.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8584.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8079.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCENTRIC CONE MED*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7069.44, "maximum": 9796.22, "gross_charge": 10099.2, "discounted_cash": 15148.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8584.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7574.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7069.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9796.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7069.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7574.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8584.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8079.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCENTRTN INFECTIOU", "code_information": [{"code": "87015", "type": "CPT"}, {"code": "3440101159", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.68, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 10.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONCORD 9X10X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH CC", "code_information": [{"code": "89", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5519.36, "maximum": 5519.36, "discounted_cash": 12838.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5519.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITH MCC", "code_information": [{"code": "88", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8974.73, "maximum": 8974.73, "discounted_cash": 17124.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8974.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONCUSSION WITHOUT CC/MCC", "code_information": [{"code": "90", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3144.88, "maximum": 3144.88, "discounted_cash": 10436.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3144.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONDITIONING PLAY AUDIOMETRY", "code_information": [{"code": "92582", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONDYLAR MANDIBLE PR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2160.9, "maximum": 2994.39, "gross_charge": 3087.0, "discounted_cash": 4630.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2623.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2315.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2160.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2994.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2160.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2315.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2623.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2469.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT BOTH JAWS", "code_information": [{"code": "D0383", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT & INTERP", "code_information": [{"code": "D0364", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT MANDIBLE", "code_information": [{"code": "D0381", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPT MAXILLA", "code_information": [{"code": "D0382", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPTURE LIMITED", "code_information": [{"code": "D0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT CAPTURE TMJ", "code_information": [{"code": "D0384", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERP BOTH JAW", "code_information": [{"code": "D0367", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE MAN", "code_information": [{"code": "D0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE MAX", "code_information": [{"code": "D0366", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONE BEAM CT INTERPRETE TMJ", "code_information": [{"code": "D0368", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONEXTIONS GUN*FA000", "code_information": [{"code": "3100209494", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONEXTIONS IMPLANT*F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONFORMITY EVALUATION", "code_information": [{"code": "V5020", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONGO RED BLOOD TEST", "code_information": [{"code": "P2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 7.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57520", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONIZATION OF CERVIX", "code_information": [{"code": "57522", "type": "CPT"}, {"code": "3480102094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONN LAT ILIAC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1799.0, "maximum": 2492.9, "gross_charge": 2570.0, "discounted_cash": 3855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2492.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONN OFFSET ARSEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONN OFFSET ARSEN 30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONN OFFSET OP 45MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT ARMADA OFFSE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1490.3, "maximum": 2065.13, "gross_charge": 2129.0, "discounted_cash": 3193.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1809.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1596.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1490.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2065.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1490.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1596.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1809.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1703.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT ARMADA OFFSE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2071.3, "maximum": 2870.23, "gross_charge": 2959.0, "discounted_cash": 4438.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2515.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2219.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2071.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2870.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2071.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2219.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2515.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2367.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT ARMADA OFFSE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2839.2, "maximum": 3934.32, "gross_charge": 4056.0, "discounted_cash": 6084.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3447.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3042.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2839.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3934.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2839.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3042.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3447.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3244.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT AX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT AXIA 5.5X30*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT POLY MAC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1932.0, "maximum": 2677.2, "gross_charge": 2760.0, "discounted_cash": 4140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2346.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2677.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2346.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT POLY MAC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2054.5, "maximum": 2846.95, "gross_charge": 2935.0, "discounted_cash": 4402.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2494.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2846.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2054.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2494.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2348.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT REV LONG STR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1953.0, "maximum": 2706.3, "gross_charge": 2790.0, "discounted_cash": 4185.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2371.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2092.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2706.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2092.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2371.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT ROD 5.5X5.5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECT UNIV ALIGN K", "code_information": [{"code": "3100100410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 85.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTION BOLT*03.3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 46.95, "maximum": 65.06, "gross_charge": 67.08, "discounted_cash": 100.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 57.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 50.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 65.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 50.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 57.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 53.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTION OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1747.9, "maximum": 2422.09, "gross_charge": 2497.0, "discounted_cash": 3745.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2122.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1872.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1747.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2422.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1747.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1872.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2122.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1997.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "546", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7464.08, "maximum": 7464.08, "discounted_cash": 13389.66, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7464.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [{"code": "545", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10482.3, "maximum": 10482.3, "discounted_cash": 27835.49, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10482.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "547", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4924.21, "maximum": 4924.21, "discounted_cash": 9081.26, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4924.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 10MM*18403", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 15MM LT*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 15MM RT*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 25MM*18403", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 28-38*1531", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 3 MULTI AX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2367.4, "maximum": 3280.54, "gross_charge": 3382.0, "discounted_cash": 5073.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2874.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2536.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2367.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3280.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2367.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2536.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2874.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2705.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 3.5X3.5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 5.5X 6.35*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR 7MMX7.5DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ALPHATEC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR AXIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1497.3, "maximum": 2074.83, "gross_charge": 2139.0, "discounted_cash": 3208.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1818.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1604.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1497.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2074.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1497.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1604.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1818.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1711.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR AXIAL*4855", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR AXIAL*5501", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR CABLE*MN11", "code_information": [{"code": "3100203424", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONNECTOR CROSS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1958.6, "maximum": 2714.06, "gross_charge": 2798.0, "discounted_cash": 4197.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2378.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2098.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1958.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2714.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1958.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2098.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2378.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2238.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR END/END*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR FIXED LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1519.0, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 3255.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LAT 25MM*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LAT 5.5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1276.8, "maximum": 1769.28, "gross_charge": 1824.0, "discounted_cash": 2736.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1550.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1276.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1769.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1276.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1550.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1459.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LAT 70MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1262.94, "maximum": 1750.07, "gross_charge": 1804.2, "discounted_cash": 2706.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1533.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1353.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1262.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1750.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1262.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1353.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1533.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1443.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LAT*593210", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LATERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1291.5, "maximum": 1789.65, "gross_charge": 1845.0, "discounted_cash": 2767.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1568.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1383.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1789.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1383.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1568.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1476.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LATERAL 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LATERAL 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LATERAL 30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LP ISSY AX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR LUERLOK W/", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 319.2, "maximum": 442.32, "gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 442.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR NAR*5501-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFF 35MM*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 960.4, "maximum": 1330.84, "gross_charge": 1372.0, "discounted_cash": 2058.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1166.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 960.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1330.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 960.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1166.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1097.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET 12M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET 15*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET 30*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET ISS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET ISS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET LON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1052.1, "maximum": 1457.91, "gross_charge": 1503.0, "discounted_cash": 2254.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1277.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1127.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1052.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1457.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1052.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1127.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1277.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1202.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR OFFSET XIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1453.64, "maximum": 2014.33, "gross_charge": 2076.63, "discounted_cash": 3114.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1765.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1557.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1453.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2014.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1453.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1557.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1765.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1661.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD AXIAL*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD OPEN*R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD/ROD AX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 1493.8, "gross_charge": 1540.0, "discounted_cash": 2310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1309.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1078.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1493.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1078.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1309.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD/ROD LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1411.9, "maximum": 1956.49, "gross_charge": 2017.0, "discounted_cash": 3025.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1714.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1512.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1411.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1956.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1411.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1512.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1714.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1613.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD/ROD SI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1078.0, "maximum": 1493.8, "gross_charge": 1540.0, "discounted_cash": 2310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1309.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1078.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1493.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1078.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1309.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD/ROD SI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1784.3, "maximum": 2472.53, "gross_charge": 2549.0, "discounted_cash": 3823.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2166.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1911.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1784.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2472.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1784.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1911.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2166.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2039.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR ROD/ROD SI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR SADDLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.3, "maximum": 2123.33, "gross_charge": 2189.0, "discounted_cash": 3283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR SCREW OCC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.1, "maximum": 1312.41, "gross_charge": 1353.0, "discounted_cash": 2029.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1014.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1312.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1014.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR SCREW SET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR SIDE*1797-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1769.88, "maximum": 2452.54, "gross_charge": 2528.4, "discounted_cash": 3792.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2149.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1769.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2452.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1769.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2149.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2022.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR SYNTHES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1769.6, "maximum": 2452.16, "gross_charge": 2528.0, "discounted_cash": 3792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2148.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1896.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1769.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2452.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1769.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1896.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2148.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2022.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1799.0, "maximum": 2492.9, "gross_charge": 2570.0, "discounted_cash": 3855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2492.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR TOP*G55930", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNECTOR WIDE*5501-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONNNECTOR ACCU-FLO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 233.01, "maximum": 322.89, "gross_charge": 332.88, "discounted_cash": 499.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 233.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 233.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 266.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONQUEST PTA BALLOON", "code_information": [{"code": "3100104599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONSTRUCT BLADDER OPENING", "code_information": [{"code": "51980", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50820", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT BOWEL BLADDER", "code_information": [{"code": "50825", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT THUMB REPLACEMENT", "code_information": [{"code": "26550", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCT VAGINA WITH GRAFT", "code_information": [{"code": "57292", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46730", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46735", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF ABSENT ANUS", "code_information": [{"code": "46740", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSTRUCTION OF VAGINA", "code_information": [{"code": "57291", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7423.94, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT & REPORT REF", "code_information": [{"code": "88321", "type": "CPT"}, {"code": "3440103083", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 40.92, "maximum": 178.48, "gross_charge": 184.0, "discounted_cash": 61.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 156.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 178.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 138.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 156.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 147.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT & RPRT MAT R", "code_information": [{"code": "88323", "type": "CPT"}, {"code": "3440101238", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 55.3, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT & RPRT REV R", "code_information": [{"code": "88325", "type": "CPT"}, {"code": "3440101239", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 60.52, "maximum": 386.06, "gross_charge": 398.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 338.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 298.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 278.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 386.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 278.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 298.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 338.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 318.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 105.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT INC PREP OF SLIDES", "code_information": [{"code": "D0485", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.52, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULT SLIDES PREP ELSEWHER", "code_information": [{"code": "D0484", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.52, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULTATION WITH FAMILY", "code_information": [{"code": "90887", "type": "CPT"}], "standard_charges": [{"minimum": 138.84, "maximum": 138.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONSULTATN & RPRT RE", "code_information": [{"code": "88321", "type": "CPT"}, {"code": "3440101237", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 40.92, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 61.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR ANALYSIS I&R", "code_information": [{"code": "95251", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PHYS/QHP EQP", "code_information": [{"code": "95250", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONT GLUC MNTR PT PROV EQP", "code_information": [{"code": "95249", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTACT LASER VAPORI", "code_information": [{"code": "52648", "type": "CPT"}, {"code": "3480102038", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5280.12, "maximum": 11071.58, "gross_charge": 11414.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9701.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8560.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7989.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11071.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7989.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8560.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9701.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9131.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA 1", "code_information": [{"code": "92311", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITG APHAKIA OU", "code_information": [{"code": "92312", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING FOR TX", "code_information": [{"code": "92071", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTACT LENS FITTING OU", "code_information": [{"code": "92310", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTIN INHL TX INIT", "code_information": [{"code": "94645", "type": "CPT"}, {"code": "3310100278", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 317.19, "gross_charge": 327.0, "discounted_cash": 490.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 245.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 228.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 317.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 228.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 245.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 261.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTIN INHL TX INIT1", "code_information": [{"code": "94644", "type": "CPT"}, {"code": "3310100277", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 317.19, "gross_charge": 327.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 245.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 228.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 317.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 228.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 245.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 261.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTOUR 5-4-3 TIP*M0", "code_information": [{"code": "3100203684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTOUR CRANIAL BONE LESION", "code_information": [{"code": "21181", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRACEPTIVE HORMONE PATCH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7304", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.76, "maximum": 15.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRACEPTIVE PILLS FOR BC", "code_information": [{"code": "S4993", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM ABDOMINL AORTA", "code_information": [{"code": "75625", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75600", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75605", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY GALLBLADDER", "code_information": [{"code": "74290", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ANKLE", "code_information": [{"code": "73615", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70010", "type": "CPT"}], "standard_charges": [{"minimum": 871.76, "maximum": 871.76, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF BRAIN", "code_information": [{"code": "70015", "type": "CPT"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF ELBOW", "code_information": [{"code": "73085", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF KNEE JOINT", "code_information": [{"code": "73580", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF SHOULDER", "code_information": [{"code": "73040", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTRAST X-RAY OF WRIST", "code_information": [{"code": "73115", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL LEVEL", "code_information": [{"code": "3100104681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL NASAL HEMORR", "code_information": [{"code": "30905", "type": "CPT"}, {"code": "3480101839", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 318.16, "gross_charge": 328.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 278.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 318.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 278.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 262.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NASOPHARY", "code_information": [{"code": "42970", "type": "CPT"}, {"code": "3480101939", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 191.1, "maximum": 296.61, "gross_charge": 273.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 264.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30903", "type": "CPT"}, {"code": "3480101838", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 277.43, "gross_charge": 273.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 264.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OROPHARYNGEA", "code_information": [{"code": "42960", "type": "CPT"}, {"code": "3480101937", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 229.6, "maximum": 1869.0, "gross_charge": 328.0, "discounted_cash": 842.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 278.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 580.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 318.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 578.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 278.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 262.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL OROPHARYNGEA", "code_information": [{"code": "42962", "type": "CPT"}, {"code": "3480101938", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7332.23, "gross_charge": 7559.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7332.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6047.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROL THROAT BLEEDING", "code_information": [{"code": "42961", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONTROLLER*97745NT", "code_information": [{"code": "3100208977", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.0, "discounted_cash": 2506.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CONVERSION EXT BIL DRG CATH", "code_information": [{"code": "47535", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONVERT NEPHROSTOMY CATHETER", "code_information": [{"code": "50434", "type": "CPT"}], "standard_charges": [{"minimum": 1571.3, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONVRSN PRVS HIP TO", "code_information": [{"code": "27132", "type": "CPT"}, {"code": "3480101669", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2935.8, "maximum": 14671.65, "gross_charge": 4194.0, "discounted_cash": 6291.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3564.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2935.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4068.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2935.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3145.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3564.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3355.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CONZ OF CERVIX W/SCOPE LEEP", "code_information": [{"code": "57461", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COOL QUANT SENSORY TEST", "code_information": [{"code": "108T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COOLSEAL*CSL-RV105-1", "code_information": [{"code": "3100209177", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPING", "code_information": [{"code": "D2975", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COPPER", "code_information": [{"code": "82525", "type": "CPT"}, {"code": "3440100885", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.41, "maximum": 129.98, "gross_charge": 134.0, "discounted_cash": 19.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 100.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 129.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 100.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 107.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COPPER CU 64 DOTATATE DIAG", "code_information": [{"code": "A9592", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "COPY FEE", "code_information": [{"code": "S9981", "type": "HCPCS"}, {"code": "3100102116", "type": "CDM"}, {"code": "999", "type": "RC"}], "standard_charges": [{"minimum": 28.0, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COPY NUMBER SEQUENCE ALYS", "code_information": [{"code": "156U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2795.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1050.0, "discounted_cash": 1686.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX MTAR OSTEOT", "code_information": [{"code": "28295", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR HLX VLGS PRX PHLX OSTEOT", "code_information": [{"code": "28298", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COR SCREW 2.4X18MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 279.32, "maximum": 387.06, "gross_charge": 399.04, "discounted_cash": 598.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 339.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 279.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 387.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 279.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 339.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 319.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR SCREW 2.4X20MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 279.32, "maximum": 387.06, "gross_charge": 399.04, "discounted_cash": 598.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 339.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 279.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 387.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 279.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 339.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 319.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR SCREW 2.4X26MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 279.32, "maximum": 387.06, "gross_charge": 399.04, "discounted_cash": 598.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 339.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 279.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 387.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 279.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 339.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 319.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD HARVESTING", "code_information": [{"code": "S2140", "type": "HCPCS"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORD BLOOD-DERIVED STEM-CELL", "code_information": [{"code": "S2142", "type": "HCPCS"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORD MONOPOLAR DAVIN", "code_information": [{"code": "3100100426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD STABILIZER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4804.8, "maximum": 6658.08, "gross_charge": 6864.0, "discounted_cash": 10296.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5834.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5148.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4804.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6658.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4804.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5148.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5834.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5491.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORE BIOPSY INST 18X", "code_information": [{"code": "3100203082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE BIOPSY INST 18X", "code_information": [{"code": "3100203083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.04, "discounted_cash": 291.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE BIOPSY INST 18X", "code_information": [{"code": "3100203084", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE BUILD-UP INCL ANY PINS", "code_information": [{"code": "D2950", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORE IRRIGATION CASS", "code_information": [{"code": "3100100427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED", "code_information": [{"code": "32408", "type": "CPT"}, {"code": "3480103317", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1282.05, "maximum": 3729.65, "gross_charge": 3845.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3268.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2691.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3729.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2691.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3268.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORECYTE TOPICAL ONLY 0.5 CC", "code_information": [{"code": "Q4240", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORENT XL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8577.1, "maximum": 11885.41, "gross_charge": 12253.0, "discounted_cash": 18379.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10415.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9189.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8577.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11885.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8577.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9189.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10415.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9802.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORETEXT OR PROTEXT, PER CC", "code_information": [{"code": "Q4246", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2968.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2968.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORF RELATED SERV 15 MINS EA", "code_information": [{"code": "G0409", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORF SKILLED NURSING SERVICE", "code_information": [{"code": "G0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORKSCREW 4.5X14 BC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1124.55, "maximum": 1558.3, "gross_charge": 1606.5, "discounted_cash": 2409.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1365.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1204.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1124.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1558.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1124.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1204.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1365.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW DISP 4.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW FBR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 974.85, "gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW NANO FT*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW PEEK 3.9*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 808.5, "maximum": 1120.35, "gross_charge": 1155.0, "discounted_cash": 1732.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 981.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1120.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 981.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW PEEK FT W/", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW PUNCH", "code_information": [{"code": "3100100430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORKSCREW TGRTAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 724.5, "maximum": 1003.95, "gross_charge": 1035.0, "discounted_cash": 1552.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 776.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1003.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 776.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 714.0, "maximum": 989.4, "gross_charge": 1020.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORKSCREW WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL PROTECTOR", "code_information": [{"code": "3100100433", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE PROCESSING", "code_information": [{"code": "V2785", "type": "HCPCS"}], "standard_charges": [{"minimum": 3873.73, "maximum": 3873.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3873.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65710", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65730", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65750", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRANSPLANT", "code_information": [{"code": "65755", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNEAL TRNSPL ENDOTHELIAL", "code_information": [{"code": "65756", "type": "CPT"}], "standard_charges": [{"minimum": 6993.18, "maximum": 6993.18, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORNERSTONE 2X8X8*60", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 866.25, "maximum": 1200.37, "gross_charge": 1237.5, "discounted_cash": 1856.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1051.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 928.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1200.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 928.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1051.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNERSTONE INSTRUME", "code_information": [{"code": "3100104325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1767.0, "discounted_cash": 2650.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE INSTRUME", "code_information": [{"code": "3100104339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.0, "discounted_cash": 1579.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE LORD", "code_information": [{"code": "3100104332", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1329.0, "discounted_cash": 1993.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE LRDTC SP", "code_information": [{"code": "3100100435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1767.0, "discounted_cash": 2650.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE LRDTC SP", "code_information": [{"code": "3100104326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1761.0, "discounted_cash": 2641.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE RASP", "code_information": [{"code": "3100104322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNERSTONE SR ALLOG", "code_information": [{"code": "3100100436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1386.0, "discounted_cash": 2079.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COROENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5758.2, "maximum": 7979.22, "gross_charge": 8226.0, "discounted_cash": 12339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6992.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6169.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5758.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7979.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5758.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6169.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6992.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6580.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8578.5, "maximum": 11887.35, "gross_charge": 12255.0, "discounted_cash": 18382.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10416.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9191.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8578.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11887.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8578.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9191.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10416.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8578.5, "maximum": 11887.35, "gross_charge": 12255.0, "discounted_cash": 18382.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10416.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9191.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8578.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11887.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8578.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9191.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10416.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7061.6, "maximum": 9785.36, "gross_charge": 10088.0, "discounted_cash": 15132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9785.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7901.6, "maximum": 10949.36, "gross_charge": 11288.0, "discounted_cash": 16932.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9594.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8466.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7901.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10949.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7901.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8466.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9594.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9030.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12283.6, "maximum": 17021.56, "gross_charge": 17548.0, "discounted_cash": 26322.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14915.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13161.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12283.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17021.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12283.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13161.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14915.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14038.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL WIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7061.6, "maximum": 9785.36, "gross_charge": 10088.0, "discounted_cash": 15132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9785.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL XWIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10432.8, "maximum": 14456.88, "gross_charge": 14904.0, "discounted_cash": 22356.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12668.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11178.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10432.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14456.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10432.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11178.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12668.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11923.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL XWIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8682.8, "maximum": 12031.88, "gross_charge": 12404.0, "discounted_cash": 18606.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10543.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9303.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8682.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12031.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8682.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9303.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10543.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9923.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COROENT XL XWIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10115.0, "maximum": 14016.5, "gross_charge": 14450.0, "discounted_cash": 21675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12282.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10115.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14016.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10115.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12282.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ART/GRFT ANGIO S&I", "code_information": [{"code": "93455", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY ANGIO S&I", "code_information": [{"code": "93454", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY BYPASS/REOP", "code_information": [{"code": "33530", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY CORRECTION", "code_information": [{"code": "33502", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33503", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY ARTERY GRAFT", "code_information": [{"code": "33504", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [{"code": "233", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33268.05, "maximum": 33268.05, "discounted_cash": 87079.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33268.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [{"code": "234", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29286.39, "maximum": 29286.39, "discounted_cash": 58032.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29286.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [{"code": "231", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39111.44, "maximum": 39111.44, "discounted_cash": 90602.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39111.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [{"code": "232", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38117.25, "maximum": 38117.25, "discounted_cash": 66413.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38117.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [{"code": "235", "type": "MS-DRG"}], "standard_charges": [{"minimum": 27500.91, "maximum": 27500.91, "discounted_cash": 65654.34, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27500.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [{"code": "236", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22729.18, "maximum": 22729.18, "discounted_cash": 45118.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22729.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONECTOMY", "code_information": [{"code": "D7251", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORPLEX P, PER CC", "code_information": [{"code": "Q4231", "type": "HCPCS"}], "standard_charges": [{"minimum": 1528.7, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1528.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORPLEX, PER SQ CM", "code_information": [{"code": "Q4232", "type": "HCPCS"}], "standard_charges": [{"minimum": 150.81, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT FINGER DEFOR", "code_information": [{"code": "26567", "type": "CPT"}, {"code": "3340102361", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7372.97, "gross_charge": 7601.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6460.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5320.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7372.97, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5320.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5700.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6460.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6080.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT INVERTED NIPPLE(S)", "code_information": [{"code": "19355", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4656.04, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT LID RETRACTI", "code_information": [{"code": "67911", "type": "CPT"}, {"code": "3340102316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4922.75, "gross_charge": 5075.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4922.75, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4060.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT MALROTATION OF BOWEL", "code_information": [{"code": "44055", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT METACARPAL FLAW", "code_information": [{"code": "26565", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45540", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR 6.0 CM/<", "code_information": [{"code": "11920", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKIN COLOR EA 20.0CM", "code_information": [{"code": "11922", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECT SKN COLOR 6.1-20.0CM", "code_information": [{"code": "11921", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65772", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 708.89, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 708.89, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"minimum": 7264.63, "maximum": 7264.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7264.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BUNION", "code_information": [{"code": "28299", "type": "CPT"}, {"code": "3340102362", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8874.53, "gross_charge": 9149.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7776.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6861.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6404.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8874.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6404.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6861.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7776.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION, HALLUX V", "code_information": [{"code": "28292", "type": "CPT"}, {"code": "3480101765", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8336.18, "gross_charge": 8594.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7304.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6015.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8336.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6015.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6445.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7304.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6875.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION, HALLUX V", "code_information": [{"code": "28296", "type": "CPT"}, {"code": "3480101766", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10003.61, "gross_charge": 10313.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8766.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7734.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7219.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10003.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7219.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7734.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8766.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8250.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION, HALLUX V", "code_information": [{"code": "28297", "type": "CPT"}, {"code": "3480101767", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10003.61, "gross_charge": 10313.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8766.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7734.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7219.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10003.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7219.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7734.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8766.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8250.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRECTION, HAMMERTO", "code_information": [{"code": "28285", "type": "CPT"}, {"code": "3480101762", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRJ HALUX RIGDUS W/IMPLT", "code_information": [{"code": "28291", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORRJ LAGOPHTHALMOS", "code_information": [{"code": "67912", "type": "CPT"}, {"code": "3480102212", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORT SCREW 3.0X55MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.57, "maximum": 449.76, "gross_charge": 463.68, "discounted_cash": 695.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 347.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 449.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 347.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 370.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTICAL FIBER 10CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTICO CANN ASF SPA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2864.4, "maximum": 3969.24, "gross_charge": 4092.0, "discounted_cash": 6138.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3478.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3069.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2864.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3969.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2864.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3069.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3478.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3273.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTICORELIN OVINE TRIFLUTAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0795", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.62, "maximum": 9.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTICOTOMY, 1-3 TEETH", "code_information": [{"code": "D7296", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORTICOTOMY, 4 OR MORE TEETH", "code_information": [{"code": "D7297", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORTISOL FREE", "code_information": [{"code": "82530", "type": "CPT"}, {"code": "3440100886", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.71, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 26.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORTISOL TOTAL", "code_information": [{"code": "82533", "type": "CPT"}, {"code": "3440100887", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.3, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 26.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CORTIVA DERMIS 16X20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10124.08, "maximum": 14029.09, "gross_charge": 14462.98, "discounted_cash": 21694.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12293.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10847.23, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10124.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14029.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10124.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10847.23, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12293.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11570.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUNS FOR HIGH RISK SUB USE", "code_information": [{"code": "D1321", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COUNTERSINK 1.2/AO*6", "code_information": [{"code": "3100204257", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.66, "discounted_cash": 675.99, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 1.2/STRY", "code_information": [{"code": "3100204258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.66, "discounted_cash": 675.99, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 2.4MM*AR", "code_information": [{"code": "3100205912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 3.5MM*AR", "code_information": [{"code": "3100210121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK 4.0MM*AR", "code_information": [{"code": "3100210122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANN 2.8", "code_information": [{"code": "3100203766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 751.29, "discounted_cash": 1126.94, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANN 3.8", "code_information": [{"code": "3100203064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 698.16, "discounted_cash": 1047.24, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FOR SCRE", "code_information": [{"code": "3100100443", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.0, "discounted_cash": 790.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FOR SCRE", "code_information": [{"code": "3100102620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 739.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK FOR SCRE", "code_information": [{"code": "3100102621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 727.0, "discounted_cash": 1090.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK*907-1003", "code_information": [{"code": "3100202709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 778.47, "discounted_cash": 1167.71, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK*HSINK-1.", "code_information": [{"code": "3100206857", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK*HSINK-2.", "code_information": [{"code": "3100206737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK*HSINK-3.", "code_information": [{"code": "3100206465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK/DENTL SH", "code_information": [{"code": "3100202312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.6, "discounted_cash": 786.9, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING TO ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1544.2, "maximum": 2139.82, "gross_charge": 2206.0, "discounted_cash": 3309.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1875.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1654.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1544.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2139.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1544.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1654.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1875.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COUPLING TO ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COV-19 FLU A/B RSV C", "code_information": [{"code": "3440103098", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 861.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COV-19 HIGH THROUGHP", "code_information": [{"code": "U0005", "type": "HCPCS"}, {"code": "3440103097", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.03, "maximum": 94.09, "gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 94.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COV19 ANTIGEN DIR OP", "code_information": [{"code": "87811", "type": "CPT"}, {"code": "3440103108", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.03, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 66.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 52.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 44.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVER COLOUR BLONDE*", "code_information": [{"code": "3100203840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER CONTAINMENT*DY", "code_information": [{"code": "3100206467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.48, "discounted_cash": 68.22, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE SUTURE", "code_information": [{"code": "65779", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "COVER PLATE LG*AX01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER SLOT HOLE", "code_information": [{"code": "3100100444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 874.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SLOT HOLE", "code_information": [{"code": "3100102622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 648.0, "discounted_cash": 972.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COVEREDGE", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100104522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVEREDGE 32 50CM*SC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVID-19 LAB TEST NO", "code_information": [{"code": "U0002", "type": "HCPCS"}, {"code": "3440103093", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.03, "maximum": 196.91, "gross_charge": 203.0, "discounted_cash": 82.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 172.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 142.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 196.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 142.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 152.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 172.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 54.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPAP/BIPAP INITIAL T", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "3310100279", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 217.61, "maximum": 645.05, "gross_charge": 665.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 645.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPAP/BIPAP SUBSEQ TX", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "3310100280", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 217.61, "maximum": 645.05, "gross_charge": 665.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 645.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE 1ST 60 MIN", "code_information": [{"code": "99487", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE EA ADDL 30", "code_information": [{"code": "99489", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPR FACILITY", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "3300100259", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 1138.31, "gross_charge": 1059.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 847.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1138.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPR FACILITY (RT)", "code_information": [{"code": "92950", "type": "CPT"}, {"code": "3310100266", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 1138.31, "gross_charge": 1059.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 847.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1138.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CPTR-ASST DIR MS PX", "code_information": [{"code": "20985", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CR51 CHROMATE", "code_information": [{"code": "A9553", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [{"code": "73", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9682.41, "maximum": 9682.41, "discounted_cash": 16891.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9682.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [{"code": "74", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6106.53, "maximum": 6106.53, "discounted_cash": 11457.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6106.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIAL PROSTHESIS", "code_information": [{"code": "D5924", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61581", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61582", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61583", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "26", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16930.07, "maximum": 16930.07, "discounted_cash": 32970.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16930.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "25", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23163.87, "maximum": 23163.87, "discounted_cash": 49302.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23163.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "27", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12571.51, "maximum": 12571.51, "discounted_cash": 27162.27, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12571.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "955", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34190.92, "maximum": 34190.92, "discounted_cash": 67994.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34190.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [{"code": "23", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33015.97, "maximum": 33015.97, "discounted_cash": 63289.68, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33015.97, "methodology": "fee schedule"}], "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": 21069.13, "maximum": 21069.13, "discounted_cash": 42300.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21069.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRD CERAMIDES LIQ CHROM PLSM", "code_information": [{"code": "119U", "type": "CPT"}], "standard_charges": [{"minimum": 181.56, "maximum": 181.56, "discounted_cash": 134.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRD HRT TRNSPL MRNA 1283 GEN", "code_information": [{"code": "87U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5075.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE NEW TUBAL OPENING", "code_information": [{"code": "58770", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE PASSAGE TO KIDNEY", "code_information": [{"code": "52334", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68745", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR DUCT DRAIN", "code_information": [{"code": "68750", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATE TEAR SAC DRAIN", "code_information": [{"code": "68720", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE", "code_information": [{"code": "82540", "type": "CPT"}, {"code": "3440100888", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.64, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 7.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE ISOFORMS", "code_information": [{"code": "82554", "type": "CPT"}], "standard_charges": [{"minimum": 11.87, "maximum": 40.05, "discounted_cash": 19.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE ISOE", "code_information": [{"code": "82552", "type": "CPT"}, {"code": "3440100890", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.39, "maximum": 115.43, "gross_charge": 119.0, "discounted_cash": 21.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 115.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE MB F", "code_information": [{"code": "82553", "type": "CPT"}, {"code": "3440100891", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.55, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 18.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.37, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATINE KINASE TOTA", "code_information": [{"code": "82550", "type": "CPT"}, {"code": "3440100889", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.51, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.97, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATININE BLOOD", "code_information": [{"code": "82565", "type": "CPT"}, {"code": "3440100892", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.12, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 8.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATININE BLOOD (PO", "code_information": [{"code": "82565", "type": "CPT"}, {"code": "3440100893", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.12, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 8.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.48, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATININE CLEARANCE", "code_information": [{"code": "82575", "type": "CPT"}, {"code": "3440100895", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.46, "maximum": 80.51, "gross_charge": 83.0, "discounted_cash": 15.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 62.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 80.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 62.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 66.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CREATININE URINE", "code_information": [{"code": "82570", "type": "CPT"}, {"code": "3440100894", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRH STIMULATION PANEL", "code_information": [{"code": "80412", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 801.62, "discounted_cash": 1287.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 801.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRICOTRACHEAL RESECTION", "code_information": [{"code": "31592", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVEN SVC, 15 MIN", "code_information": [{"code": "H2011", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVENTION MENTAL H", "code_information": [{"code": "S9485", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRISIS INTERVENTION PER HOUR", "code_information": [{"code": "S9484", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE PT ADD", "code_information": [{"code": "99292", "type": "CPT"}, {"code": "3500102280", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 721.0, "maximum": 999.1, "gross_charge": 1030.0, "discounted_cash": 1545.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE PT INI", "code_information": [{"code": "95941", "type": "CPT"}, {"code": "3480102244", "type": "CDM"}, {"code": "740", "type": "RC"}], "standard_charges": [{"minimum": 91.7, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRITICAL CARE PT INI", "code_information": [{"code": "99291", "type": "CPT"}, {"code": "3500102279", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 721.0, "maximum": 1077.56, "gross_charge": 1030.0, "discounted_cash": 1358.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 936.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 923.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 905.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1077.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 905.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 824.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 905.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 923.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT<5 CM DIAM", "code_information": [{"code": "62140", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRNOP SKULL DEFECT>5 CM DIAM", "code_information": [{"code": "62141", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT<5 CM DIAM", "code_information": [{"code": "62146", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRNOP W/AUTOGRAFT>5 CM DIAM", "code_information": [{"code": "62147", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROM GNOTYP CD55 EXONS 1-10", "code_information": [{"code": "182U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 484.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7632", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CROMOLYN SODIUM NONCOMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7631", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.93, "maximum": 0.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS CONNECT 20MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS CONNECT 35-45*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS CONNECT 53-73*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS CONNECT 70-99*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.54, "maximum": 1313.02, "gross_charge": 1353.63, "discounted_cash": 2030.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS-OVER VEIN GRAFT", "code_information": [{"code": "34520", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROSSLINK 45-57*UCL4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK 57-81*UCL5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK ADJ 27M*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK ADJ 30M*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK ADJ LG*290", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK ADJ MED*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK ADJ XLG*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK ADJUST XLG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK GLOBUS MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1475.6, "maximum": 2044.76, "gross_charge": 2108.0, "discounted_cash": 3162.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1791.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1475.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2044.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1475.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1791.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1686.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK GLOBUS MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1877.4, "maximum": 2601.54, "gross_charge": 2682.0, "discounted_cash": 4023.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2279.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2011.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1877.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1877.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2011.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2279.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2145.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK GLOBUS MED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3446.8, "maximum": 4776.28, "gross_charge": 4924.0, "discounted_cash": 7386.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4185.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3693.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3446.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4776.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3446.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3693.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4185.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3939.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINK SM ADJ*290", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINKED BEARING*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1916.88, "maximum": 2656.24, "gross_charge": 2738.4, "discounted_cash": 4107.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2656.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2190.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSLINKED BEARING*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1813.0, "maximum": 2512.3, "gross_charge": 2590.0, "discounted_cash": 3885.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1942.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1813.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2512.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1813.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1942.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSSMATCH ANTIGLOBU", "code_information": [{"code": "86922", "type": "CPT"}, {"code": "3440101150", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 26.1, "maximum": 207.41, "gross_charge": 165.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROSSMATCH IMMED SPI", "code_information": [{"code": "86920", "type": "CPT"}, {"code": "3440101149", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 30.93, "maximum": 207.41, "gross_charge": 117.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROTALIDAE POLY IMMUNE FAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0840", "type": "HCPCS"}], "standard_charges": [{"minimum": 1979.87, "maximum": 1979.87, "discounted_cash": 3132.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1979.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST BASE METAL", "code_information": [{"code": "D2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST BASED METAL", "code_information": [{"code": "D6781", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST HI NOBLE MET", "code_information": [{"code": "D2780", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST NOBLE METAL", "code_information": [{"code": "D2782", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 CAST NOBLE METAL", "code_information": [{"code": "D6782", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 HIGH NOBLE METAL", "code_information": [{"code": "D6780", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 PORCELAIN/CERAMIC", "code_information": [{"code": "D2783", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 PORCELAIN/CERAMIC", "code_information": [{"code": "D6783", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN 3/4 RESIN-BASED COMPOS", "code_information": [{"code": "D2712", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN FULL BASE METAL CAST", "code_information": [{"code": "D6791", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST BASE METAL", "code_information": [{"code": "D2791", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST HIGH NOBLE M", "code_information": [{"code": "D2790", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN FULL CAST NOBLE METAL", "code_information": [{"code": "D2792", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN FULL HIGH NOBLE METAL", "code_information": [{"code": "D6790", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN FULL NOBLE METAL CAST", "code_information": [{"code": "D6792", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORC FUSED TO TITANIUM", "code_information": [{"code": "D2753", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN BASE METAL", "code_information": [{"code": "D6751", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN FUSED BASE M", "code_information": [{"code": "D2751", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN HIGH NOBLE", "code_information": [{"code": "D6750", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN NOBLE METAL", "code_information": [{"code": "D6752", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN W/ H NOBLE M", "code_information": [{"code": "D2750", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN W/ NOBLE MET", "code_information": [{"code": "D2752", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN/CERAMIC", "code_information": [{"code": "D2740", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN PORCELAIN/CERAMIC", "code_information": [{"code": "D6740", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN REPAIR", "code_information": [{"code": "D2980", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ BASE METAL", "code_information": [{"code": "D2721", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ HIGH NOBLE ME", "code_information": [{"code": "D2720", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/ NOBLE METAL", "code_information": [{"code": "D2722", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/BASE METAL", "code_information": [{"code": "D6721", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN W/NOBLE METAL", "code_information": [{"code": "D6722", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN RESIN-BASED INDIRECT", "code_information": [{"code": "D2710", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN TITANIUM", "code_information": [{"code": "D6794", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN-INDIRECT RESIN BASED", "code_information": [{"code": "D6710", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CROWN-TITANIUM", "code_information": [{"code": "D2794", "type": "HCPCS"}], "standard_charges": [{"minimum": 1513.0, "maximum": 1513.0, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1513.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRRY CUR STAT 0% IMP", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100338", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "CRRY CUR STAT 0% IMP", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100470", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "CRRY CUR STAT 100% I", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100344", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "CRRY CUR STAT 100% I", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100476", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "CRRY CUR STAT 20-39%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100331", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "CRRY CUR STAT 20-39%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100463", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "CRRY CUR STAT 40-59%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100340", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "CRRY CUR STAT 40-59%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100472", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "CRRY CUR STAT 60-79%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100341", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "CRRY CUR STAT 60-79%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100473", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "CRRY CUR STAT 80-99%", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100474", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "CRRY CUR STAT1-19% I", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100339", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "CRRY CUR STAT1-19% I", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3330100471", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "CRRY CUR STAT80-99%I", "code_information": [{"code": "G8984", "type": "HCPCS"}, {"code": "3320100343", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "CRRY D/C STAT 0% IMP", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100352", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "CRRY D/C STAT 0% IMP", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100484", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "CRRY D/C STAT 100% I", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100358", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "CRRY D/C STAT 100% I", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100490", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "CRRY D/C STAT 20-39%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100342", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "CRRY D/C STAT 20-39%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100475", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "CRRY D/C STAT 40-59%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100354", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "CRRY D/C STAT 40-59%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100486", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "CRRY D/C STAT 60-79%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100355", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "CRRY D/C STAT 60-79%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100487", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "CRRY D/C STAT 80-99%", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100488", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "CRRY D/C STAT1-19% I", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100353", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "CRRY D/C STAT1-19% I", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3330100485", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "CRRY D/C STAT80-99%I", "code_information": [{"code": "G8986", "type": "HCPCS"}, {"code": "3320100357", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "CRRY PR STAT 0% IMP/", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100345", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "CRRY PR STAT 0% IMP/", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100477", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "CRRY PR STAT 100% IM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100351", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "CRRY PR STAT 100% IM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100483", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "CRRY PR STAT 20-39%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100347", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "CRRY PR STAT 20-39%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100479", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "CRRY PR STAT 40-59%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100348", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "CRRY PR STAT 40-59%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100480", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "CRRY PR STAT 60-79%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100349", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "CRRY PR STAT 60-79%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100481", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "CRRY PR STAT 80-99%I", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100482", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "CRRY PR STAT1-19% IM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100346", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "CRRY PR STAT1-19% IM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3330100478", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "CRRY PR STAT80-99%IM", "code_information": [{"code": "G8985", "type": "HCPCS"}, {"code": "3320100350", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "CRUCIFORM M/B PAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1494.5, "maximum": 2070.95, "gross_charge": 2135.0, "discounted_cash": 3202.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1814.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1601.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1494.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2070.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1494.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1601.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1814.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYO EMBRYO TRANSF CASE RATE", "code_information": [{"code": "S4037", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYO FIB COMP PATH REDU EACH", "code_information": [{"code": "P9026", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 127.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYO-CORD, PER SQ CM", "code_information": [{"code": "Q4237", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE PROSTATE", "code_information": [{"code": "55873", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOCAUTERY OF CERVIX", "code_information": [{"code": "57511", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOGLOBULIN QUAL/SE", "code_information": [{"code": "82595", "type": "CPT"}, {"code": "3440100896", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.47, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITATE EA U", "code_information": [{"code": "P9012", "type": "HCPCS"}, {"code": "3440103008", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 64.12, "maximum": 424.98, "gross_charge": 332.0, "discounted_cash": 96.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 64.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRECIPITATEREDUCEDPLASMA", "code_information": [{"code": "P9044", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 111.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION EMBRYO(S)", "code_information": [{"code": "89258", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 1316.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION OOCYTE(S)", "code_information": [{"code": "89337", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIBODY", "code_information": [{"code": "86641", "type": "CPT"}], "standard_charges": [{"minimum": 14.41, "maximum": 30.26, "discounted_cash": 23.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IF", "code_information": [{"code": "87272", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CRYSTL ID MICRO ALY", "code_information": [{"code": "89060", "type": "CPT"}, {"code": "3440101223", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.33, "maximum": 63.05, "gross_charge": 65.0, "discounted_cash": 11.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 63.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.85, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSF LEAKAGE IMAGING", "code_information": [{"code": "78650", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT EVALUATION", "code_information": [{"code": "78645", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 277.43, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CST BSE MTL INLAY 2 SURFACES", "code_information": [{"code": "D6604", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CST BSE MTL INLAY >= 3 SURFA", "code_information": [{"code": "D6605", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CST HGH NBLE MTL INLAY 2 SRF", "code_information": [{"code": "D6602", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CST HGH NBLE MTL INLAY >=3SR", "code_information": [{"code": "D6603", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CST NOBLE MTL INLAY >=3 SURF", "code_information": [{"code": "D6607", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSTB FULL GENE ANALYSIS", "code_information": [{"code": "232U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSTB GENE DETC ABNOR ALLELE", "code_information": [{"code": "81188", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSTB GENE FULL GENE SEQUENCE", "code_information": [{"code": "81189", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CSTB GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81190", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT 3D RENDER NOT WOR", "code_information": [{"code": "76376", "type": "CPT"}, {"code": "3290100238", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT 3D RENDER ON WORK", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "3290100239", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 326.9, "maximum": 452.99, "gross_charge": 467.0, "discounted_cash": 700.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 396.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 350.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 326.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 452.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 326.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 350.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 396.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 373.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABD & PELVIS W CO", "code_information": [{"code": "74177", "type": "CPT"}, {"code": "3290100227", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3084.6, "gross_charge": 3180.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2703.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3084.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2703.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2544.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ABD & PELVIS W/WO", "code_information": [{"code": "74178", "type": "CPT"}, {"code": "3290100228", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3084.6, "gross_charge": 3180.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2703.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3084.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2226.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2385.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2703.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2544.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ABD & PELVIS WO C", "code_information": [{"code": "74176", "type": "CPT"}, {"code": "3290100226", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 1955.52, "gross_charge": 2016.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1411.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1955.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1411.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1612.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ABD / RETROPERI P", "code_information": [{"code": "49180", "type": "CPT"}, {"code": "3290100178", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4011.92, "gross_charge": 4136.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3515.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3102.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2895.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4011.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2895.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3102.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3515.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3308.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W CONTRAS", "code_information": [{"code": "74160", "type": "CPT"}, {"code": "3290100223", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/WO CONT", "code_information": [{"code": "74170", "type": "CPT"}, {"code": "3290100224", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2524.91, "gross_charge": 2603.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2212.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1952.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1822.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2524.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1822.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1952.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2212.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2082.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN WO CONTRA", "code_information": [{"code": "74150", "type": "CPT"}, {"code": "3290100222", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BONE DENSITY AXIAL", "code_information": [{"code": "77078", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C+", "code_information": [{"code": "637T", "type": "CPT"}], "standard_charges": [{"minimum": 599.86, "maximum": 599.86, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-", "code_information": [{"code": "636T", "type": "CPT"}], "standard_charges": [{"minimum": 599.86, "maximum": 599.86, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-/C+", "code_information": [{"code": "638T", "type": "CPT"}], "standard_charges": [{"minimum": 599.86, "maximum": 599.86, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C+", "code_information": [{"code": "634T", "type": "CPT"}], "standard_charges": [{"minimum": 227.4, "maximum": 227.4, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-", "code_information": [{"code": "633T", "type": "CPT"}], "standard_charges": [{"minimum": 227.4, "maximum": 227.4, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-/C+", "code_information": [{"code": "635T", "type": "CPT"}], "standard_charges": [{"minimum": 227.4, "maximum": 227.4, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT CHEST W/CONTRAST", "code_information": [{"code": "71260", "type": "CPT"}, {"code": "3290100198", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT CHEST W/WO", "code_information": [{"code": "71270", "type": "CPT"}, {"code": "3290100199", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT CHEST WO", "code_information": [{"code": "71250", "type": "CPT"}, {"code": "3290100197", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT COLNGRPHY DX W PO", "code_information": [{"code": "74261", "type": "CPT"}, {"code": "3290100229", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT COLNGRPHY DX W PO", "code_information": [{"code": "74262", "type": "CPT"}, {"code": "3290100230", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT COLONGRPHY SCREEN", "code_information": [{"code": "74263", "type": "CPT"}, {"code": "3290100231", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 227.4, "maximum": 1917.69, "gross_charge": 1977.0, "discounted_cash": 2965.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1680.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1482.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1383.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1917.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1383.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1482.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1680.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1581.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT CORONARY CALCIUM", "code_information": [{"code": "75571", "type": "CPT"}, {"code": "3290100232", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 92.73, "maximum": 317.19, "gross_charge": 327.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 245.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 228.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 317.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 228.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 245.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 277.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 261.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT GUID FLD CLCT DRA", "code_information": [{"code": "10030", "type": "CPT"}, {"code": "3290100175", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 717.96, "maximum": 3429.92, "gross_charge": 3536.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3429.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2828.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT GUIDE FLD CLT DRN", "code_information": [{"code": "49406", "type": "CPT"}, {"code": "3290100180", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 1083.58, "maximum": 3717.04, "gross_charge": 3832.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3257.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2874.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2682.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3717.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2682.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2874.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3257.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3065.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT GUIDE FOR NDL BX", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "3290100241", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 193.13, "maximum": 1195.04, "gross_charge": 1232.0, "discounted_cash": 1848.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1047.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 862.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1195.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 862.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1047.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 985.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 193.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT GUIDE FOR TISSUE ABLATION", "code_information": [{"code": "77013", "type": "CPT"}], "standard_charges": [{"minimum": 193.13, "maximum": 193.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 193.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT GUIDED FLD CLT DR", "code_information": [{"code": "49406", "type": "CPT"}, {"code": "3290100179", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1083.58, "maximum": 3828.59, "gross_charge": 3947.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3354.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2960.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2762.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3828.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2762.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2960.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3354.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3157.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT GUIDED LIVER BIOP", "code_information": [{"code": "47000", "type": "CPT"}, {"code": "3290100176", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4132.2, "gross_charge": 4260.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3621.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2982.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4132.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2982.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3195.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3621.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT HEAD/BRAIN W CONT", "code_information": [{"code": "70460", "type": "CPT"}, {"code": "3290100183", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT HEAD/BRAIN W W/O", "code_information": [{"code": "70470", "type": "CPT"}, {"code": "3290100184", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT HEAD/BRAIN W/O CO", "code_information": [{"code": "70450", "type": "CPT"}, {"code": "3290100182", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT HEART W CONT & MO", "code_information": [{"code": "75572", "type": "CPT"}, {"code": "3290100233", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1707.2, "gross_charge": 1760.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1496.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1232.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1707.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1232.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1496.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT HRT W CON STRCT&M", "code_information": [{"code": "75573", "type": "CPT"}, {"code": "3290100234", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1196.01, "gross_charge": 1233.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1048.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 924.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 863.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1196.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 863.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 924.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1048.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 986.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREM W CO", "code_information": [{"code": "73701", "type": "CPT"}, {"code": "3290100219", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREM WO", "code_information": [{"code": "73700", "type": "CPT"}, {"code": "3290100218", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREMITY W", "code_information": [{"code": "73702", "type": "CPT"}, {"code": "3290100220", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT LTD/LOCAL FU STUD", "code_information": [{"code": "76380", "type": "CPT"}, {"code": "3290100240", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 92.73, "maximum": 630.5, "gross_charge": 650.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 552.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 487.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 455.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 630.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 455.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 487.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 552.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 520.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT LUNG SCREENING LO", "code_information": [{"code": "G0297", "type": "HCPCS"}, {"code": "3290103014", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 227.4, "maximum": 360.84, "gross_charge": 372.0, "discounted_cash": 558.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 297.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/", "code_information": [{"code": "70487", "type": "CPT"}, {"code": "3290100189", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/W", "code_information": [{"code": "70488", "type": "CPT"}, {"code": "3290100191", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL WO", "code_information": [{"code": "70486", "type": "CPT"}, {"code": "3290100188", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/SELLA/FOSS", "code_information": [{"code": "70480", "type": "CPT"}, {"code": "3290100185", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1329.87, "gross_charge": 1371.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1165.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1028.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 959.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1329.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 959.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1028.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1165.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1096.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/SELLA/FOSS", "code_information": [{"code": "70481", "type": "CPT"}, {"code": "3290100186", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT ORBIT/SELLA/FOSS", "code_information": [{"code": "70482", "type": "CPT"}, {"code": "3290100187", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT PANCREAS PERC NDL", "code_information": [{"code": "48102", "type": "CPT"}, {"code": "3290100177", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4011.92, "gross_charge": 4136.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3515.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3102.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2895.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4011.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2895.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3102.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3515.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3308.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W CONTRAST", "code_information": [{"code": "72193", "type": "CPT"}, {"code": "3290100212", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/WO CONTR", "code_information": [{"code": "72194", "type": "CPT"}, {"code": "3290100213", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT PELVIS WO CONTRAS", "code_information": [{"code": "72192", "type": "CPT"}, {"code": "3290100211", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT PERC DRAIN/ABSC/", "code_information": [{"code": "75989", "type": "CPT"}, {"code": "3290100194", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 601.4, "gross_charge": 620.0, "discounted_cash": 930.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 601.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 496.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT PERFUSION W/CONTRAST CBF", "code_information": [{"code": "42T", "type": "CPT"}], "standard_charges": [{"minimum": 599.86, "maximum": 599.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT RENAL BIOPSY PERC", "code_information": [{"code": "50200", "type": "CPT"}, {"code": "3290100181", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4132.2, "gross_charge": 4260.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3621.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2982.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4132.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2982.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3195.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3621.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SCAN F/BIOMCHN CT ALYS", "code_information": [{"code": "558T", "type": "CPT"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR LOCALIZATION", "code_information": [{"code": "77011", "type": "CPT"}], "standard_charges": [{"minimum": 193.13, "maximum": 193.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 193.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR THERAPY GUIDE", "code_information": [{"code": "77014", "type": "CPT"}], "standard_charges": [{"minimum": 193.13, "maximum": 193.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 193.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SOFT TISSUE NECK", "code_information": [{"code": "70490", "type": "CPT"}, {"code": "3290100192", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SOFT TISSUE NECK", "code_information": [{"code": "70491", "type": "CPT"}, {"code": "3290100193", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SOFT TISSUE NECK", "code_information": [{"code": "70492", "type": "CPT"}, {"code": "3290102284", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE CERVICAL W", "code_information": [{"code": "72126", "type": "CPT"}, {"code": "3290100202", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE CERVICAL W/", "code_information": [{"code": "72127", "type": "CPT"}, {"code": "3290100203", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE CERVICAL WO", "code_information": [{"code": "72125", "type": "CPT"}, {"code": "3290100201", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE LUMBAR W CO", "code_information": [{"code": "72132", "type": "CPT"}, {"code": "3290100208", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE LUMBAR W/WO", "code_information": [{"code": "72133", "type": "CPT"}, {"code": "3290100209", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE LUMBAR WO C", "code_information": [{"code": "72131", "type": "CPT"}, {"code": "3290100207", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE THORACIC W", "code_information": [{"code": "72129", "type": "CPT"}, {"code": "3290100205", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE THORACIC W/", "code_information": [{"code": "72130", "type": "CPT"}, {"code": "3290100206", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT SPINE THORACIC WO", "code_information": [{"code": "72128", "type": "CPT"}, {"code": "3290100204", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT THORAX LUNG CANCE", "code_information": [{"code": "71271", "type": "CPT"}, {"code": "3290103015", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 400.61, "gross_charge": 413.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 351.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 309.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 289.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 400.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 289.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 309.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 351.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXTREM W CO", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "3290100215", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 1898.29, "gross_charge": 1957.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1898.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1369.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1467.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1663.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1565.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXTREM W/WO", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "3290100216", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 599.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CT UPPER EXTREM WO C", "code_information": [{"code": "73200", "type": "CPT"}, {"code": "3290100214", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 1109.68, "gross_charge": 1144.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1109.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 800.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 858.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 972.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 915.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA AAA LWR EXT RUNO", "code_information": [{"code": "75635", "type": "CPT"}, {"code": "3290100236", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA ABD W/WO WHN PER", "code_information": [{"code": "74175", "type": "CPT"}, {"code": "3290100225", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA CHEST W CONT & W", "code_information": [{"code": "71275", "type": "CPT"}, {"code": "3290103012", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA HEAD W CONT WO I", "code_information": [{"code": "70496", "type": "CPT"}, {"code": "3290100195", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA HRT COR ARTS/GRF", "code_information": [{"code": "75574", "type": "CPT"}, {"code": "3290100235", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 1196.01, "gross_charge": 1233.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1048.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 924.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 863.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1196.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 863.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 924.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1048.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 986.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA LOWR EXTRM W/WO", "code_information": [{"code": "73706", "type": "CPT"}, {"code": "3290100221", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA NECK W CONT WO I", "code_information": [{"code": "70498", "type": "CPT"}, {"code": "3290100196", "type": "CDM"}, {"code": "351", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA PELVIS W/WO WHN", "code_information": [{"code": "72191", "type": "CPT"}, {"code": "3290100210", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTA UPPR EXTREM W/WO", "code_information": [{"code": "73206", "type": "CPT"}, {"code": "3290100217", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 2167.95, "gross_charge": 2235.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1676.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CTM BOOST*BT-0100CTM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CTM THICK 2 X 2*TK-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3427.06, "maximum": 4748.92, "gross_charge": 4895.8, "discounted_cash": 7343.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4161.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3671.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3427.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4748.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3427.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3671.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4161.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3916.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUFF F/AMS URINE CON", "code_information": [{"code": "3100104110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13479.18, "discounted_cash": 20218.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CUFF F/AMS URINE CTR", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9435.43, "maximum": 13074.81, "gross_charge": 13479.19, "discounted_cash": 20218.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11457.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10109.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9435.43, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13074.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9435.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10109.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11457.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10783.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUL BACT ANAERB ADDL", "code_information": [{"code": "87076", "type": "CPT"}, {"code": "3440101147", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.08, "maximum": 70.81, "gross_charge": 73.0, "discounted_cash": 12.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 70.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 58.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CUL BACT STL AERB AD", "code_information": [{"code": "87046", "type": "CPT"}, {"code": "3440101162", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.44, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 15.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CUL BACT STL AEROB S", "code_information": [{"code": "87045", "type": "CPT"}, {"code": "3440101161", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.44, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 15.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT EPIDERM GRFT F/N/HFG +%", "code_information": [{"code": "15157", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT ID BLD DNA/RNA", "code_information": [{"code": "87154", "type": "CPT"}, {"code": "3440103117", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 82.77, "maximum": 560.66, "gross_charge": 578.0, "discounted_cash": 350.31, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 491.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 241.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 404.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 560.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 238.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 404.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 233.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 277.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 491.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 233.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 218.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 233.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 238.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT F/N/HF/G", "code_information": [{"code": "15155", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRAFT T/A/L +%", "code_information": [{"code": "15152", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT F/N/HFG ADD", "code_information": [{"code": "15156", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/A/L ADDL", "code_information": [{"code": "15151", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULT SKIN GRFT T/ARM/LEG", "code_information": [{"code": "15150", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR BACTRL AEROB A", "code_information": [{"code": "87077", "type": "CPT"}, {"code": "3440101166", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.08, "maximum": 70.81, "gross_charge": 73.0, "discounted_cash": 12.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 70.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 58.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR BACTRL AEROBC", "code_information": [{"code": "87070", "type": "CPT"}, {"code": "3440101163", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.62, "maximum": 74.69, "gross_charge": 77.0, "discounted_cash": 13.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR BACTRL ANAERBC", "code_information": [{"code": "87075", "type": "CPT"}, {"code": "3440101164", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 9.47, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 15.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR BACTRL BLD AER", "code_information": [{"code": "87040", "type": "CPT"}, {"code": "3440101160", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.32, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 16.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR BACTRL URINE S", "code_information": [{"code": "P7001", "type": "HCPCS"}, {"code": "3440101262", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 24.03, "maximum": 255.11, "gross_charge": 263.0, "discounted_cash": 394.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 255.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89250", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR OOCYTE/EMBRYO <4 DAYS", "code_information": [{"code": "89251", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR TB AFB MYCOBAC", "code_information": [{"code": "87116", "type": "CPT"}, {"code": "3440101174", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.8, "maximum": 94.09, "gross_charge": 97.0, "discounted_cash": 17.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 94.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTR,TYPING,ID BY N", "code_information": [{"code": "87150", "type": "CPT"}, {"code": "3440103045", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 285.18, "gross_charge": 294.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 285.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE AEROBIC QUANT OTHER", "code_information": [{"code": "87071", "type": "CPT"}], "standard_charges": [{"minimum": 9.89, "maximum": 24.03, "discounted_cash": 15.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIA ANAEROBIC", "code_information": [{"code": "87073", "type": "CPT"}], "standard_charges": [{"minimum": 9.66, "maximum": 24.03, "discounted_cash": 15.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTERIAL SC", "code_information": [{"code": "87081", "type": "CPT"}, {"code": "3440101167", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 6.63, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 10.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE BACTRL URINE", "code_information": [{"code": "87088", "type": "CPT"}, {"code": "3440101169", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.09, "maximum": 52.38, "gross_charge": 54.0, "discounted_cash": 12.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE CHLAMYDIA", "code_information": [{"code": "87110", "type": "CPT"}, {"code": "3440101173", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 19.6, "maximum": 170.72, "gross_charge": 176.0, "discounted_cash": 31.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 170.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE FNGS/MOLD/YS", "code_information": [{"code": "87101", "type": "CPT"}, {"code": "3440101170", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.71, "maximum": 68.87, "gross_charge": 71.0, "discounted_cash": 12.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 68.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE FNGS/MOLD/YS", "code_information": [{"code": "87102", "type": "CPT"}, {"code": "3440101171", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.41, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 13.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE FUNGI DEFIN", "code_information": [{"code": "87106", "type": "CPT"}, {"code": "3440101172", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.32, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 16.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE MYCOBACTRL D", "code_information": [{"code": "87118", "type": "CPT"}, {"code": "3440101175", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 14.61, "maximum": 96.03, "gross_charge": 99.0, "discounted_cash": 23.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 84.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 74.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 96.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 74.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 84.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE OF SPECIMEN BY KIT", "code_information": [{"code": "87084", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 27.07, "discounted_cash": 43.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE TYP IMM NON-", "code_information": [{"code": "87147", "type": "CPT"}, {"code": "3440101176", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPE PULSE FIELD GEL", "code_information": [{"code": "87152", "type": "CPT"}], "standard_charges": [{"minimum": 7.74, "maximum": 24.03, "discounted_cash": 12.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING ADDED METHOD", "code_information": [{"code": "87158", "type": "CPT"}], "standard_charges": [{"minimum": 7.74, "maximum": 24.03, "discounted_cash": 12.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING GLC/HPLC", "code_information": [{"code": "87143", "type": "CPT"}], "standard_charges": [{"minimum": 12.52, "maximum": 24.03, "discounted_cash": 20.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE TYPING IMMUN", "code_information": [{"code": "87140", "type": "CPT"}, {"code": "3440103090", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.57, "maximum": 33.95, "gross_charge": 35.0, "discounted_cash": 8.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 33.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.97, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.97, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE URINE QUANT", "code_information": [{"code": "87086", "type": "CPT"}, {"code": "3440101168", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.07, "maximum": 70.81, "gross_charge": 73.0, "discounted_cash": 12.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 70.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 58.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CULTURE,MYCOPLASMA", "code_information": [{"code": "87109", "type": "CPT"}, {"code": "3440103064", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 15.39, "maximum": 122.22, "gross_charge": 126.0, "discounted_cash": 24.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.48, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.48, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CUP ACETABULAR ZIMME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP ACETABULAR ZIMME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP EYE", "code_information": [{"code": "3100100449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUP REMFIT 54MM*6309", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.87, "maximum": 4540.81, "gross_charge": 4681.25, "discounted_cash": 7021.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3979.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4540.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3979.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3745.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REMFIT 56MM*6309", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.87, "maximum": 4540.81, "gross_charge": 4681.25, "discounted_cash": 7021.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3979.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4540.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3979.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3745.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REMFIT 58MM*6309", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.87, "maximum": 4540.81, "gross_charge": 4681.25, "discounted_cash": 7021.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3979.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4540.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3979.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3745.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 36 +2*AR9502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 36 NEUT*AR95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2598.4, "maximum": 3600.64, "gross_charge": 3712.0, "discounted_cash": 5568.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3155.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2784.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2598.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3600.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2598.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2784.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3155.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2969.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 39 +2*AR9502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 39 NEUT*AR95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 42 NEUT*AR95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 42+2*AR9502F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2598.96, "maximum": 3601.41, "gross_charge": 3712.8, "discounted_cash": 5569.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3155.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2598.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3601.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2598.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3155.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV 42+2*AR9502F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV UNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3734.5, "maximum": 5174.95, "gross_charge": 5335.0, "discounted_cash": 8002.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4534.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4001.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3734.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5174.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3734.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4001.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4534.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4268.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3248.7, "maximum": 4501.77, "gross_charge": 4641.0, "discounted_cash": 6961.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3944.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3248.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4501.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3248.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3944.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2599.1, "maximum": 3601.61, "gross_charge": 3713.0, "discounted_cash": 5569.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3156.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2784.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2599.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3601.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2599.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2784.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3156.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2970.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP TM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CUP TM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETE FRONTAL SINUS", "code_information": [{"code": "3100104092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 1242.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE", "code_information": [{"code": "3100100450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE", "code_information": [{"code": "3100100451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE", "code_information": [{"code": "3100104714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1026.0, "discounted_cash": 1539.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE CURVED", "code_information": [{"code": "3100104093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 725.0, "discounted_cash": 1087.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE DOUBLE END", "code_information": [{"code": "3100100452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.0, "discounted_cash": 436.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE ENDOCERV BIO", "code_information": [{"code": "3100100453", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 379.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE EPSTEIN BONE", "code_information": [{"code": "3100100454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 544.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE MOLT SNGLE-E", "code_information": [{"code": "3100103925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 227.0, "discounted_cash": 340.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE REV", "code_information": [{"code": "3100104655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2223.0, "discounted_cash": 3334.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SINUS", "code_information": [{"code": "3100100455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 1044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SINUS", "code_information": [{"code": "3100102628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 636.0, "discounted_cash": 954.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SPINAL", "code_information": [{"code": "3100100456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 717.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SPINAL", "code_information": [{"code": "3100103985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 447.0, "discounted_cash": 670.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SPINAL", "code_information": [{"code": "3100104383", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE SPINAL", "code_information": [{"code": "3100104741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65435", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 708.89, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURETTE/TREAT CORNEA", "code_information": [{"code": "65436", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 708.89, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURRENT PERCEP THRESHOLD TST", "code_information": [{"code": "G0255", "type": "HCPCS"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CURVE SHEATH BIG 22C", "code_information": [{"code": "3100203468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CURVED TORPEDO 4MM*A", "code_information": [{"code": "3100206767", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 606.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUSTOM ABUTMENT", "code_information": [{"code": "D6057", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CUTTER BONE", "code_information": [{"code": "3100100457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER BONE", "code_information": [{"code": "3100100458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER FLIP", "code_information": [{"code": "3100100459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER FLIP II", "code_information": [{"code": "3100100460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER FLIP III*AR12", "code_information": [{"code": "3100205522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1245.0, "discounted_cash": 1867.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER HOT LOOP", "code_information": [{"code": "3100100461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER LINEAR ETHICO", "code_information": [{"code": "3100100462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTER SUTURE ACL", "code_information": [{"code": "3100100463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 711.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTING LOOP*CL-2412", "code_information": [{"code": "3100203040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 252.28, "discounted_cash": 378.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CUTTING RAMUS OPEN W/GRAFT", "code_information": [{"code": "D7943", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CVAC IMG PROC KIT*IM", "code_information": [{"code": "3100209863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12987.0, "discounted_cash": 19480.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CYANOCOBALAMIN VITAM", "code_information": [{"code": "82607", "type": "CPT"}, {"code": "3440100897", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.08, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 24.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYCLESURE", "code_information": [{"code": "3100100464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYCLIC CITRULLINATED", "code_information": [{"code": "86200", "type": "CPT"}, {"code": "3440101040", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.95, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYCLOPENTOLATE HCL", "code_information": [{"code": "3400300220", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYCLOPHOSPHAMIDE ORAL 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8530", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.86, "maximum": 0.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORIN PARENTERAL 250MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.12, "maximum": 50.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORINE", "code_information": [{"code": "80158", "type": "CPT"}, {"code": "3440100809", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.05, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 29.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORINE ORAL 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.3, "maximum": 2.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYCLOSPORINE ORAL 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7515", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.92, "maximum": 0.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS DUAL PER SQ CM", "code_information": [{"code": "Q4282", "type": "HCPCS"}], "standard_charges": [{"minimum": 875.19, "maximum": 875.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 875.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS MATRIX, PER SQ CM", "code_information": [{"code": "Q4199", "type": "HCPCS"}], "standard_charges": [{"minimum": 317.64, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 317.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYGNUS MAX PATCH2X2*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2908.36, "maximum": 4030.15, "gross_charge": 4154.8, "discounted_cash": 6232.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3531.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3116.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2908.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4030.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2908.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3116.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3531.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3323.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS MAX PATCH2X3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2908.36, "maximum": 4030.15, "gross_charge": 4154.8, "discounted_cash": 6232.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3531.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3116.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2908.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4030.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2908.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3116.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3531.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3323.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS MAX PATCH3X4*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3636.36, "maximum": 5038.95, "gross_charge": 5194.8, "discounted_cash": 7792.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4415.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3896.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3636.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5038.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3636.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3896.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4415.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4155.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYGNUS, PER SQ CM", "code_information": [{"code": "Q4170", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.73, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 56.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYLINDER SCROTAL", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15024.8, "maximum": 20820.08, "gross_charge": 21464.0, "discounted_cash": 32196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20820.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDER SCROTAL", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13659.8, "maximum": 18928.58, "gross_charge": 19514.0, "discounted_cash": 29271.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16586.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14635.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13659.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18928.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13659.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14635.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16586.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15611.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDER SCROTAL W/P", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100100465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10087.0, "maximum": 13977.7, "gross_charge": 14410.0, "discounted_cash": 21615.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12248.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10807.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10087.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13977.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10087.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10807.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12248.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11528.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDER SCROTAL W/P", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100102629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10388.0, "maximum": 14394.8, "gross_charge": 14840.0, "discounted_cash": 22260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12614.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11130.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10388.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14394.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10388.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11130.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12614.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11872.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDER SCROTAL W/P", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100102630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11480.0, "maximum": 15908.0, "gross_charge": 16400.0, "discounted_cash": 24600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13940.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11480.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15908.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11480.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13940.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDER SET 0 ANGLE", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDER SIZE 26CM*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9766.12, "maximum": 13533.05, "gross_charge": 13951.6, "discounted_cash": 20927.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11858.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10463.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9766.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13533.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9766.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10463.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11858.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11161.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYLINDERS CO2", "code_information": [{"code": "3100104555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYMETRA INJECTABLE", "code_information": [{"code": "Q4112", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP1A2 GENE", "code_information": [{"code": "31U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2C19 GENE COM VARIANTS", "code_information": [{"code": "81225", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 291.36, "discounted_cash": 468.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 291.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2C9 GENE COM VARIANTS", "code_information": [{"code": "81227", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 174.81, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 3' GENE DUP/MLT", "code_information": [{"code": "76U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 5' GENE DUP/MLT", "code_information": [{"code": "75U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 FULL GENE SEQUENCE", "code_information": [{"code": "71U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 963.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN COM&SLCT RAR VRNT", "code_information": [{"code": "70U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1086.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D6-2D7 HYBRID", "code_information": [{"code": "72U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GEN CYP2D7-2D6 HYBRID", "code_information": [{"code": "73U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 GENE COM VARIANTS", "code_information": [{"code": "81226", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 450.91, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP2D6 NONDUPLICATED GENE", "code_information": [{"code": "74U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP3A4 GENE COMMON VARIANTS", "code_information": [{"code": "81230", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYP3A5 GENE COMMON VARIANTS", "code_information": [{"code": "81231", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSOURTHRSCPY W/4+ T", "code_information": [{"code": "C9740", "type": "HCPCS"}, {"code": "3480103151", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5791.23, "maximum": 16610.28, "gross_charge": 17124.0, "discounted_cash": 14100.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14555.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9720.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12843.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11986.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16610.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9588.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11986.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9682.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12843.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9400.61, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11186.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14555.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9400.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13699.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9400.61, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9588.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTATIN C", "code_information": [{"code": "82610", "type": "CPT"}], "standard_charges": [{"minimum": 18.52, "maximum": 40.05, "discounted_cash": 29.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO", "code_information": [{"code": "52352", "type": "CPT"}, {"code": "3480102034", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7776.49, "gross_charge": 8017.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7776.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6413.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO", "code_information": [{"code": "52352", "type": "CPT"}, {"code": "3480103246", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO LASER TX URETERAL CALC", "code_information": [{"code": "S2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 1767.1, "maximum": 1767.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO MANIP WO REMOV", "code_information": [{"code": "52330", "type": "CPT"}, {"code": "3480103338", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 11310.2, "gross_charge": 11660.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9911.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8745.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8162.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11310.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8162.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8745.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9911.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9328.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W INSERT OF PE", "code_information": [{"code": "52282", "type": "CPT"}, {"code": "3480103282", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 3557.41, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W INSERT OF PE", "code_information": [{"code": "52282", "type": "CPT"}, {"code": "3480103283", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3557.41, "maximum": 8891.02, "gross_charge": 9166.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7791.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6874.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6416.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8891.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6416.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6874.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7791.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7332.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/REMOVAL OF C", "code_information": [{"code": "52320", "type": "CPT"}, {"code": "3480103341", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 1767.1, "gross_charge": 3683.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/RENAL STRICTURE TX", "code_information": [{"code": "52343", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/TEMP PROS IMPLANT", "code_information": [{"code": "C9769", "type": "HCPCS"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO W/UP STRICTURE TX", "code_information": [{"code": "52342", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICT", "code_information": [{"code": "52344", "type": "CPT"}, {"code": "3480103184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICT", "code_information": [{"code": "52344", "type": "CPT"}, {"code": "3480103244", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/BIOP", "code_information": [{"code": "52354", "type": "CPT"}, {"code": "3480103186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11828.18, "gross_charge": 12194.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11828.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/BIOP", "code_information": [{"code": "52354", "type": "CPT"}, {"code": "3480103248", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/LITH", "code_information": [{"code": "52356", "type": "CPT"}, {"code": "3480103187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4758.39, "maximum": 11828.18, "gross_charge": 12194.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11828.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/LITH", "code_information": [{"code": "52356", "type": "CPT"}, {"code": "3480103249", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 4758.39, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO W/UP STRICTURE", "code_information": [{"code": "52345", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4758.39, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/UP", "code_information": [{"code": "51727", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP", "code_information": [{"code": "51728", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOMETROGRAM W/VP&UP", "code_information": [{"code": "51729", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTORRHAPHY, SUTURE", "code_information": [{"code": "51865", "type": "CPT"}, {"code": "3480102020", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4758.39, "gross_charge": 2251.0, "discounted_cash": 3376.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1913.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1688.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2183.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1688.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1913.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPE*CY-M52H", "code_information": [{"code": "3100210055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & DUCT CATHETER", "code_information": [{"code": "52010", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & REVISE URETHRA", "code_information": [{"code": "52270", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52260", "type": "CPT"}, {"code": "3480103179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52260", "type": "CPT"}, {"code": "3480103234", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52276", "type": "CPT"}, {"code": "3480103180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52276", "type": "CPT"}, {"code": "3480103235", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52300", "type": "CPT"}, {"code": "3480103181", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52300", "type": "CPT"}, {"code": "3480103238", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52315", "type": "CPT"}, {"code": "3480103182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & TREATME", "code_information": [{"code": "52315", "type": "CPT"}, {"code": "3480103240", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & URETER", "code_information": [{"code": "52005", "type": "CPT"}, {"code": "3480103178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY & URETER", "code_information": [{"code": "52005", "type": "CPT"}, {"code": "3480103227", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND BIOPSY", "code_information": [{"code": "52007", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREAT", "code_information": [{"code": "52235", "type": "CPT"}, {"code": "3480103343", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4233.32, "gross_charge": 3541.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3009.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2655.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2478.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3434.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2478.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2655.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3009.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2832.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52265", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1767.1, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52277", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52283", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52290", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1767.1, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52305", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4758.39, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL O", "code_information": [{"code": "52001", "type": "CPT"}, {"code": "3340102352", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4233.32, "gross_charge": 4217.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3584.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3162.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2951.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4090.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2951.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3162.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3584.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3373.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL O", "code_information": [{"code": "52001", "type": "CPT"}, {"code": "3480103226", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4758.39, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO & OR PY", "code_information": [{"code": "52351", "type": "CPT"}, {"code": "3480103185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO & OR PY", "code_information": [{"code": "52351", "type": "CPT"}, {"code": "3480103245", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/CONGEN REPR", "code_information": [{"code": "52400", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/EXCISE TUMOR", "code_information": [{"code": "52355", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETERO W/RENAL STRICT", "code_information": [{"code": "52346", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHRO CUT EJACUL DUCT", "code_information": [{"code": "52402", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY", "code_information": [{"code": "52000", "type": "CPT"}, {"code": "3480102021", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2076.77, "gross_charge": 2141.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1819.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1605.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1498.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2076.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1498.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1605.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1819.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY", "code_information": [{"code": "52000", "type": "CPT"}, {"code": "3480103225", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2294.05, "gross_charge": 2365.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2010.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1773.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1655.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2294.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1655.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1773.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2010.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1892.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY (I", "code_information": [{"code": "52327", "type": "CPT"}, {"code": "3480102032", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 9292.6, "gross_charge": 9580.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8143.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7185.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6706.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9292.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6706.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7185.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8143.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7664.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY IN", "code_information": [{"code": "52287", "type": "CPT"}, {"code": "3480102164", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1767.1, "maximum": 3840.23, "gross_charge": 3959.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3365.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2969.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2771.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3840.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2771.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2969.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3365.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3167.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY IN", "code_information": [{"code": "52287", "type": "CPT"}, {"code": "3480103237", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1767.1, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/", "code_information": [{"code": "52353", "type": "CPT"}, {"code": "3480102035", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9292.6, "gross_charge": 9580.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8143.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7185.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6706.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9292.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6706.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7185.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8143.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7664.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY W/", "code_information": [{"code": "52353", "type": "CPT"}, {"code": "3480103247", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52204", "type": "CPT"}, {"code": "3480102022", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52204", "type": "CPT"}, {"code": "3480103228", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52214", "type": "CPT"}, {"code": "3480102023", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52214", "type": "CPT"}, {"code": "3480103229", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52224", "type": "CPT"}, {"code": "3480102024", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52224", "type": "CPT"}, {"code": "3480103230", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52234", "type": "CPT"}, {"code": "3480102025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52234", "type": "CPT"}, {"code": "3480103231", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52235", "type": "CPT"}, {"code": "3480102026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52235", "type": "CPT"}, {"code": "3480103232", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52240", "type": "CPT"}, {"code": "3480102027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52240", "type": "CPT"}, {"code": "3480103233", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52275", "type": "CPT"}, {"code": "3480102028", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52281", "type": "CPT"}, {"code": "3480102029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3840.23, "gross_charge": 3959.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3365.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2969.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2771.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3840.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2771.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2969.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3365.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3167.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52281", "type": "CPT"}, {"code": "3480103236", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52310", "type": "CPT"}, {"code": "3480102031", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3840.23, "gross_charge": 3959.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3365.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2969.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2771.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3840.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2771.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2969.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3365.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3167.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52310", "type": "CPT"}, {"code": "3480103239", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52332", "type": "CPT"}, {"code": "3480102033", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURETHROSCOPY, W", "code_information": [{"code": "52332", "type": "CPT"}, {"code": "3480103243", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURTHRSCPY 1ST I", "code_information": [{"code": "52441", "type": "CPT"}, {"code": "3480103152", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2013.63, "maximum": 4031.32, "gross_charge": 4156.0, "discounted_cash": 6234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3532.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2909.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4031.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2909.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3532.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3324.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURTHRSCPY EA AD", "code_information": [{"code": "52442", "type": "CPT"}, {"code": "3480103153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2909.2, "maximum": 5791.23, "gross_charge": 4156.0, "discounted_cash": 6234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3532.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2909.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4031.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2909.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3532.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3324.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURTHRSCPY W/1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}, {"code": "3480103150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5105.8, "maximum": 7075.18, "gross_charge": 7294.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6199.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5470.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5105.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7075.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5105.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5470.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6199.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5835.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYSTOURTHRSCPY W/TX", "code_information": [{"code": "52341", "type": "CPT"}, {"code": "3480103029", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7281.86, "gross_charge": 7507.08, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6381.01, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5630.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5254.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7281.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5254.95, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5630.31, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6381.01, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6005.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTAL BURN MATRIX", "code_information": [{"code": "Q4120", "type": "HCPCS"}, {"code": "3100104706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTAL, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4166", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.21, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTARABINE HCL 100 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9100", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.92, "maximum": 0.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTARABINE LIPOSOME INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9098", "type": "HCPCS"}], "standard_charges": [{"minimum": 539.51, "maximum": 539.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 539.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR CGH", "code_information": [{"code": "81228", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 900.0, "discounted_cash": 1445.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOG ALYS CHRML ABNR LW-PS", "code_information": [{"code": "81349", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 1160.0, "discounted_cash": 1863.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1160.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOG CONST ALYS INTERROG", "code_information": [{"code": "209U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 1264.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOGEN M ARRAY COPY", "code_information": [{"code": "81229", "type": "CPT"}, {"code": "3440103106", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 493.51, "maximum": 1478.41, "gross_charge": 1268.0, "discounted_cash": 1863.54, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1077.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1284.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 951.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 887.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1229.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1267.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 887.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1279.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 951.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1242.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1478.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1077.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1242.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1014.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1160.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1242.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1267.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 10-30", "code_information": [{"code": "88273", "type": "CPT"}], "standard_charges": [{"minimum": 34.81, "maximum": 79.66, "discounted_cash": 55.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOGENETICS 3-5", "code_information": [{"code": "88272", "type": "CPT"}], "standard_charges": [{"minimum": 40.7, "maximum": 79.66, "discounted_cash": 65.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOGENICS/MOLEC INT", "code_information": [{"code": "88291", "type": "CPT"}, {"code": "3440101225", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 19.26, "maximum": 145.5, "gross_charge": 150.0, "discounted_cash": 225.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOGENOMIC NEO MICRORA ALYS", "code_information": [{"code": "81277", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1160.0, "discounted_cash": 1863.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1160.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA AMP PROBE", "code_information": [{"code": "87496", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA DIR PROBE", "code_information": [{"code": "87495", "type": "CPT"}], "standard_charges": [{"minimum": 30.03, "maximum": 41.83, "discounted_cash": 48.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEG DNA QUANT", "code_information": [{"code": "87497", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS AG IA", "code_information": [{"code": "87332", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS CMV", "code_information": [{"code": "86644", "type": "CPT"}, {"code": "3440101100", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.39, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 23.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS CMV", "code_information": [{"code": "86645", "type": "CPT"}, {"code": "3440101101", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.85, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 27.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS DFA", "code_information": [{"code": "87271", "type": "CPT"}], "standard_charges": [{"minimum": 13.42, "maximum": 24.03, "discounted_cash": 21.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOMEGALOVIRUS IMM IV /VIAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0850", "type": "HCPCS"}], "standard_charges": [{"minimum": 1808.22, "maximum": 1808.22, "discounted_cash": 2904.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1808.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO FLUID REDO", "code_information": [{"code": "88175", "type": "CPT"}], "standard_charges": [{"minimum": 26.61, "maximum": 34.27, "discounted_cash": 42.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO IN FLUID", "code_information": [{"code": "88174", "type": "CPT"}], "standard_charges": [{"minimum": 25.37, "maximum": 34.27, "discounted_cash": 40.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO REDO", "code_information": [{"code": "88152", "type": "CPT"}], "standard_charges": [{"minimum": 27.64, "maximum": 34.27, "discounted_cash": 44.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTO RESCREEN", "code_information": [{"code": "88148", "type": "CPT"}], "standard_charges": [{"minimum": 17.76, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V AUTOMATED", "code_information": [{"code": "88147", "type": "CPT"}], "standard_charges": [{"minimum": 34.27, "maximum": 50.56, "discounted_cash": 81.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V INDEX ADD-ON", "code_information": [{"code": "88155", "type": "CPT"}], "standard_charges": [{"minimum": 14.65, "maximum": 34.27, "discounted_cash": 23.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V INTERPRET", "code_information": [{"code": "88141", "type": "CPT"}], "standard_charges": [{"minimum": 18.18, "maximum": 34.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V MANUAL", "code_information": [{"code": "88150", "type": "CPT"}], "standard_charges": [{"minimum": 17.76, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V REDO", "code_information": [{"code": "88153", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 34.27, "discounted_cash": 38.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V THIN LAYER", "code_information": [{"code": "88142", "type": "CPT"}], "standard_charges": [{"minimum": 20.26, "maximum": 34.27, "discounted_cash": 32.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH C/V THIN LAYER REDO", "code_information": [{"code": "88143", "type": "CPT"}], "standard_charges": [{"minimum": 23.04, "maximum": 34.27, "discounted_cash": 37.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH CELL ENHANC", "code_information": [{"code": "88112", "type": "CPT"}, {"code": "3440101214", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 43.61, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 110.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH FL NONGYN FILTER", "code_information": [{"code": "88106", "type": "CPT"}], "standard_charges": [{"minimum": 36.06, "maximum": 43.61, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR OTHER", "code_information": [{"code": "88161", "type": "CPT"}, {"code": "3440103040", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 30.38, "maximum": 160.05, "gross_charge": 165.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR OTHER SOURCE", "code_information": [{"code": "88160", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 45.16, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 45.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR OTHER SOURCE", "code_information": [{"code": "88162", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 107.38, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 107.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEAR PREP & REPORT", "code_information": [{"code": "D0480", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH SMEARS NON", "code_information": [{"code": "88104", "type": "CPT"}, {"code": "3440103091", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 40.92, "maximum": 129.01, "gross_charge": 133.0, "discounted_cash": 61.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 129.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V AUTO REDO", "code_information": [{"code": "88166", "type": "CPT"}], "standard_charges": [{"minimum": 17.76, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V MANUAL", "code_information": [{"code": "88164", "type": "CPT"}], "standard_charges": [{"minimum": 17.76, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V REDO", "code_information": [{"code": "88165", "type": "CPT"}], "standard_charges": [{"minimum": 34.27, "maximum": 42.22, "discounted_cash": 67.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH TBS C/V SELECT", "code_information": [{"code": "88167", "type": "CPT"}], "standard_charges": [{"minimum": 17.76, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH,CONC TECH", "code_information": [{"code": "88108", "type": "CPT"}, {"code": "3440103071", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 39.8, "maximum": 164.9, "gross_charge": 170.0, "discounted_cash": 61.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 144.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH,INSITU HYBR", "code_information": [{"code": "88120", "type": "CPT"}, {"code": "3440103070", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 112.14, "maximum": 1065.06, "gross_charge": 1098.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 933.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 823.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 768.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1065.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 768.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 823.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 933.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 878.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 543.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOPATH,INSITU HYBR", "code_information": [{"code": "88121", "type": "CPT"}, {"code": "3440103073", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 112.14, "maximum": 1065.06, "gross_charge": 1098.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 933.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 823.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 768.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1065.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 768.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 823.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 933.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 878.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 468.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86807", "type": "CPT"}], "standard_charges": [{"minimum": 78.65, "maximum": 88.56, "discounted_cash": 126.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTOTOXIC ANTIBODY SCREENING", "code_information": [{"code": "86808", "type": "CPT"}], "standard_charges": [{"minimum": 29.68, "maximum": 35.6, "discounted_cash": 47.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTP DX EVAL FNA 1ST EA SITE", "code_information": [{"code": "88172", "type": "CPT"}], "standard_charges": [{"minimum": 50.13, "maximum": 112.14, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CYTP FNA EVAL EA ADDL", "code_information": [{"code": "88177", "type": "CPT"}], "standard_charges": [{"minimum": 31.62, "maximum": 43.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Calcium glucon (fresenius)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0610", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cantharidin top, applicator", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7354", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrest And Shock, Major", "code_information": [{"code": "196.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20264.36, "maximum": 20264.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20264.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrest And Shock, Minor", "code_information": [{"code": "196.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5837.23, "maximum": 5837.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5837.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrest And Shock, Moderate", "code_information": [{"code": "196.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8724.45, "maximum": 8724.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8724.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrest And Shock, Severe", "code_information": [{"code": "196.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 41316.84, "maximum": 41316.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41316.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrhythmia And Conduction Disorders, Major", "code_information": [{"code": "201.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13304.53, "maximum": 13304.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13304.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrhythmia And Conduction Disorders, Minor", "code_information": [{"code": "201.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5611.69, "maximum": 5611.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5611.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrhythmia And Conduction Disorders, Moderate", "code_information": [{"code": "201.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7176.4, "maximum": 7176.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7176.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Arrhythmia And Conduction Disorders, Severe", "code_information": [{"code": "201.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24550.98, "maximum": 24550.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24550.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Coronary Artery Disease, Major", "code_information": [{"code": "191.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13658.23, "maximum": 13658.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13658.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Coronary Artery Disease, Minor", "code_information": [{"code": "191.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4266.11, "maximum": 4266.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4266.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Coronary Artery Disease, Moderate", "code_information": [{"code": "191.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10077.72, "maximum": 10077.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10077.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Coronary Artery Disease, Severe", "code_information": [{"code": "191.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30775.22, "maximum": 30775.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30775.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Other Non-Coronary Conditions, Major", "code_information": [{"code": "192.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20702.63, "maximum": 20702.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20702.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Other Non-Coronary Conditions, Minor", "code_information": [{"code": "192.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4020.07, "maximum": 4020.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4020.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Other Non-Coronary Conditions, Moderate", "code_information": [{"code": "192.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13559.55, "maximum": 13559.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13559.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Catheterization For Other Non-Coronary Conditions, Severe", "code_information": [{"code": "192.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48089.57, "maximum": 48089.57, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48089.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With MCC", "code_information": [{"code": "222", "type": "MS-DRG"}], "standard_charges": [{"minimum": 45748.57, "maximum": 45748.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 45748.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without MCC", "code_information": [{"code": "223", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28547.97, "maximum": 28547.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28547.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With MCC", "code_information": [{"code": "224", "type": "MS-DRG"}], "standard_charges": [{"minimum": 49560.54, "maximum": 49560.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49560.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without MCC", "code_information": [{"code": "225", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31022.68, "maximum": 31022.68, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31022.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant Without Cardiac Catheterization With MCC", "code_information": [{"code": "226", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36755.39, "maximum": 36755.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36755.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Defibrillator Implant Without Cardiac Catheterization Without MCC", "code_information": [{"code": "227", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25409.24, "maximum": 25409.24, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25409.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Cardiac Output Measurements", "code_information": [{"code": "93561", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Pacemaker And Defibrillator Revision Except Device Replacement, Major", "code_information": [{"code": "177.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30820.08, "maximum": 30820.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30820.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Pacemaker And Defibrillator Revision Except Device Replacement, Minor", "code_information": [{"code": "177.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17652.66, "maximum": 17652.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17652.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Pacemaker And Defibrillator Revision Except Device Replacement, Moderate", "code_information": [{"code": "177.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23685.96, "maximum": 23685.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23685.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Pacemaker And Defibrillator Revision Except Device Replacement, Severe", "code_information": [{"code": "177.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53461.62, "maximum": 53461.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53461.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Structural And Valvular Disorders, Major", "code_information": [{"code": "200.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19027.71, "maximum": 19027.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19027.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Structural And Valvular Disorders, Minor", "code_information": [{"code": "200.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6690.71, "maximum": 6690.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6690.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Structural And Valvular Disorders, Moderate", "code_information": [{"code": "200.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9907.28, "maximum": 9907.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9907.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Structural And Valvular Disorders, Severe", "code_information": [{"code": "200.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24158.84, "maximum": 24158.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24158.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis, Major", "code_information": [{"code": "162.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 81172.77, "maximum": 81172.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 81172.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis, Minor", "code_information": [{"code": "162.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 63218.96, "maximum": 63218.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63218.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis, Moderate", "code_information": [{"code": "162.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 64306.95, "maximum": 64306.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 64306.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis, Severe", "code_information": [{"code": "162.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 121067.15, "maximum": 121067.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 121067.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis, Major", "code_information": [{"code": "163.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62464.15, "maximum": 62464.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62464.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis, Minor", "code_information": [{"code": "163.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48557.32, "maximum": 48557.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48557.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis, Moderate", "code_information": [{"code": "163.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 54175.41, "maximum": 54175.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 54175.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis, Severe", "code_information": [{"code": "163.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 88898.94, "maximum": 88898.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88898.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiology, Echocardiology", "code_information": [{"code": "483", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiology, General", "code_information": [{"code": "480", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Cardiomyopathy, Major", "code_information": [{"code": "205.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12677.88, "maximum": 12677.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12677.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiomyopathy, Minor", "code_information": [{"code": "205.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5530.95, "maximum": 5530.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiomyopathy, Moderate", "code_information": [{"code": "205.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6890.63, "maximum": 6890.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6890.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cardiomyopathy, Severe", "code_information": [{"code": "205.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24904.67, "maximum": 24904.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24904.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Care manage serv minimum 20", "code_information": [{"code": "G0507", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Carry current status", "code_information": [{"code": "G8984", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Carry d/c status", "code_information": [{"code": "G8986", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Carry goal status", "code_information": [{"code": "G8985", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Catheter Based Enlargement Of Opening Between Two Upper Heart Chambers", "code_information": [{"code": "92993", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ccm add 20min", "code_information": [{"code": "G2058", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cellulitis And Other Skin Infections, Major", "code_information": [{"code": "383.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15890.6, "maximum": 15890.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15890.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cellulitis And Other Skin Infections, Minor", "code_information": [{"code": "383.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7246.88, "maximum": 7246.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7246.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cellulitis And Other Skin Infections, Moderate", "code_information": [{"code": "383.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9715.05, "maximum": 9715.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9715.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cellulitis And Other Skin Infections, Severe", "code_information": [{"code": "383.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30990.51, "maximum": 30990.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30990.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section With Sterilization, Major", "code_information": [{"code": "539.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16615.93, "maximum": 16615.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16615.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section With Sterilization, Minor", "code_information": [{"code": "539.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8978.19, "maximum": 8978.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8978.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section With Sterilization, Moderate", "code_information": [{"code": "539.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10740.25, "maximum": 10740.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10740.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section With Sterilization, Severe", "code_information": [{"code": "539.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 47370.65, "maximum": 47370.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47370.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section Without Sterilization, Major", "code_information": [{"code": "540.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14838.49, "maximum": 14838.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14838.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section Without Sterilization, Minor", "code_information": [{"code": "540.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9206.3, "maximum": 9206.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9206.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section Without Sterilization, Moderate", "code_information": [{"code": "540.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11452.77, "maximum": 11452.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11452.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cesarean Section Without Sterilization, Severe", "code_information": [{"code": "540.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30663.73, "maximum": 30663.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30663.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chemotherapy For Acute Leukemia, Major", "code_information": [{"code": "695.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26169.51, "maximum": 26169.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26169.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chemotherapy For Acute Leukemia, Minor", "code_information": [{"code": "695.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8463.03, "maximum": 8463.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8463.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chemotherapy For Acute Leukemia, Moderate", "code_information": [{"code": "695.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12453.62, "maximum": 12453.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12453.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chemotherapy For Acute Leukemia, Severe", "code_information": [{"code": "695.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 99759.65, "maximum": 99759.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 99759.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chest Pain, Major", "code_information": [{"code": "203.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9429.28, "maximum": 9429.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9429.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chest Pain, Minor", "code_information": [{"code": "203.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5612.97, "maximum": 5612.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5612.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chest Pain, Moderate", "code_information": [{"code": "203.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7923.51, "maximum": 7923.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7923.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chest Pain, Severe", "code_information": [{"code": "203.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15893.16, "maximum": 15893.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15893.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cholecystectomy, Major", "code_information": [{"code": "263.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18353.64, "maximum": 18353.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18353.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cholecystectomy, Minor", "code_information": [{"code": "263.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13313.5, "maximum": 13313.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13313.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cholecystectomy, Moderate", "code_information": [{"code": "263.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15649.68, "maximum": 15649.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15649.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cholecystectomy, Severe", "code_information": [{"code": "263.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42279.25, "maximum": 42279.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42279.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Kidney Disease, Major", "code_information": [{"code": "470.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15531.78, "maximum": 15531.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15531.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Kidney Disease, Minor", "code_information": [{"code": "470.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7140.52, "maximum": 7140.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7140.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Kidney Disease, Moderate", "code_information": [{"code": "470.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9725.3, "maximum": 9725.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9725.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Kidney Disease, Severe", "code_information": [{"code": "470.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23215.65, "maximum": 23215.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23215.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Obstructive Pulmonary Disease, Major", "code_information": [{"code": "140.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11118.29, "maximum": 11118.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11118.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Obstructive Pulmonary Disease, Minor", "code_information": [{"code": "140.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7705.66, "maximum": 7705.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7705.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Obstructive Pulmonary Disease, Moderate", "code_information": [{"code": "140.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9484.38, "maximum": 9484.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9484.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Chronic Obstructive Pulmonary Disease, Severe", "code_information": [{"code": "140.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18397.21, "maximum": 18397.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18397.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cleft Lip And Palate Repair, Major", "code_information": [{"code": "95.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21380.55, "maximum": 21380.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21380.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cleft Lip And Palate Repair, Minor", "code_information": [{"code": "95.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10696.68, "maximum": 10696.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10696.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cleft Lip And Palate Repair, Moderate", "code_information": [{"code": "95.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14079.84, "maximum": 14079.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14079.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cleft Lip And Palate Repair, Severe", "code_information": [{"code": "95.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32480.9, "maximum": 32480.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32480.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Clin mang h risk dx 30", "code_information": [{"code": "G2065", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Clinic General", "code_information": [{"code": "510", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Clinical Pathology Consultation", "code_information": [{"code": "80500", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Closed Treatment Of Broken Nasal Bone, Without Manipulation", "code_information": [{"code": "21310", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coagulation And Platelet Disorders, Major", "code_information": [{"code": "661.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26741.06, "maximum": 26741.06, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26741.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coagulation And Platelet Disorders, Minor", "code_information": [{"code": "661.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15105.04, "maximum": 15105.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15105.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coagulation And Platelet Disorders, Moderate", "code_information": [{"code": "661.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16424.99, "maximum": 16424.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16424.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coagulation And Platelet Disorders, Severe", "code_information": [{"code": "661.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32856.38, "maximum": 32856.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32856.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cocaine Abuse And Dependence, Major", "code_information": [{"code": "774.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11552.72, "maximum": 11552.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11552.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cocaine Abuse And Dependence, Minor", "code_information": [{"code": "774.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4955.56, "maximum": 4955.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4955.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cocaine Abuse And Dependence, Moderate", "code_information": [{"code": "774.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6007.67, "maximum": 6007.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6007.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cocaine Abuse And Dependence, Severe", "code_information": [{"code": "774.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25289.12, "maximum": 25289.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25289.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cognitive skills development", "code_information": [{"code": "G0515", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion With CC", "code_information": [{"code": "454", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26720.07, "maximum": 26720.07, "discounted_cash": 68285.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26720.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion With MCC", "code_information": [{"code": "453", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39779.14, "maximum": 39779.14, "discounted_cash": 98933.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39779.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Combined Anterior And Posterior Spinal Fusion Without CC/MCC", "code_information": [{"code": "455", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21843.21, "maximum": 21843.21, "discounted_cash": 51419.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21843.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Complete Removal Of Vaginal Wall And Surrounding Tissue With Removal Of Lymph Nodes On Both Sides Of Pelvis And Aortic Lymph Node Biopsy", "code_information": [{"code": "57112", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Complex Motion Imaging Procedure On Both Sides Of Body", "code_information": [{"code": "76102", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Complex Motion Imaging Procedure On One Side Of Body", "code_information": [{"code": "76101", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Comprehensive, Clinical Pathology Consultation", "code_information": [{"code": "80502", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Body Scan", "code_information": [{"code": "352", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, General", "code_information": [{"code": "350", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Computerized Axial Tomography (Cat)Scan, Head Scan", "code_information": [{"code": "351", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma, Major", "code_information": [{"code": "57.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12812.44, "maximum": 12812.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12812.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma, Minor", "code_information": [{"code": "57.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4794.09, "maximum": 4794.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4794.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma, Moderate", "code_information": [{"code": "57.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7544.19, "maximum": 7544.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7544.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Concussion, Closed Skull Fracture Nos, And Uncomplicated Intracranial Injury, Coma < 1 Hour Or No Coma, Severe", "code_information": [{"code": "57.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28746.61, "maximum": 28746.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28746.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Connection Of External Patient-Activated Ekg Event Recorder", "code_information": [{"code": "497T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Connective Tissue Disorders, Major", "code_information": [{"code": "346.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26691.08, "maximum": 26691.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26691.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Connective Tissue Disorders, Minor", "code_information": [{"code": "346.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12257.55, "maximum": 12257.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12257.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Connective Tissue Disorders, Moderate", "code_information": [{"code": "346.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15656.09, "maximum": 15656.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15656.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Connective Tissue Disorders, Severe", "code_information": [{"code": "346.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35468.08, "maximum": 35468.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35468.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Continuous Recording Of Movement Disorder Symptoms For 8-10 Days With Data Upload, Analysis And Initial Report Configuration", "code_information": [{"code": "535T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Continuous Recording Of Movement Disorder Symptoms For 8-10 Days With Download Of Review, Interpretation And Report", "code_information": [{"code": "536T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Continuous Recording Of Movement Disorder Symptoms For 8-10 Days With Set-Up, Patient Training, Configuration Of Monitor", "code_information": [{"code": "534T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Continuous Recording Of Movement Disorder Symptoms For 8-10 Days With Set-Up, Patient Training, Configuration Of Monitor, Upload Of Data , Analysis And Initial Report Configuration, Download Of Review, Interpretation And Report", "code_information": [{"code": "533T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue, Major", "code_information": [{"code": "384.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12800.9, "maximum": 12800.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12800.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue, Minor", "code_information": [{"code": "384.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5930.78, "maximum": 5930.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5930.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue, Moderate", "code_information": [{"code": "384.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8465.59, "maximum": 8465.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8465.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Contusion, Open Wound And Other Trauma To Skin And Subcutaneous Tissue, Severe", "code_information": [{"code": "384.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36297.21, "maximum": 36297.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36297.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass With Ami Or Complex Principal Diagnosis, Major", "code_information": [{"code": "165.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62001.53, "maximum": 62001.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62001.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass With Ami Or Complex Principal Diagnosis, Minor", "code_information": [{"code": "165.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 41473.18, "maximum": 41473.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41473.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass With Ami Or Complex Principal Diagnosis, Moderate", "code_information": [{"code": "165.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50503.92, "maximum": 50503.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50503.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass With Ami Or Complex Principal Diagnosis, Severe", "code_information": [{"code": "165.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 88820.77, "maximum": 88820.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88820.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass Without Ami Or Complex Principal Diagnosis, Major", "code_information": [{"code": "166.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 52019.93, "maximum": 52019.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 52019.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass Without Ami Or Complex Principal Diagnosis, Minor", "code_information": [{"code": "166.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37550.51, "maximum": 37550.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37550.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass Without Ami Or Complex Principal Diagnosis, Moderate", "code_information": [{"code": "166.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42808.51, "maximum": 42808.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42808.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Coronary Bypass Without Ami Or Complex Principal Diagnosis, Severe", "code_information": [{"code": "166.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 69959.65, "maximum": 69959.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69959.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cov-19 test non-cdc hgh thru", "code_information": [{"code": "U0004", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.83, "maximum": 75.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Craniotomy For Multiple Significant Trauma, Major", "code_information": [{"code": "910.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 64897.72, "maximum": 64897.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 64897.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Craniotomy For Multiple Significant Trauma, Minor", "code_information": [{"code": "910.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46281.37, "maximum": 46281.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46281.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Craniotomy For Multiple Significant Trauma, Moderate", "code_information": [{"code": "910.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 52943.89, "maximum": 52943.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 52943.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Craniotomy For Multiple Significant Trauma, Severe", "code_information": [{"code": "910.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 108454.63, "maximum": 108454.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 108454.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cva And Precerebral Occlusion With Infarction, Major", "code_information": [{"code": "45.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16528.79, "maximum": 16528.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16528.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cva And Precerebral Occlusion With Infarction, Minor", "code_information": [{"code": "45.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8298.99, "maximum": 8298.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8298.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cva And Precerebral Occlusion With Infarction, Moderate", "code_information": [{"code": "45.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11047.81, "maximum": 11047.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11047.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cva And Precerebral Occlusion With Infarction, Severe", "code_information": [{"code": "45.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39130.6, "maximum": 39130.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39130.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cystic Fibrosis - Pulmonary Disease, Major", "code_information": [{"code": "131.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27921.32, "maximum": 27921.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27921.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cystic Fibrosis - Pulmonary Disease, Minor", "code_information": [{"code": "131.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9790.66, "maximum": 9790.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9790.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cystic Fibrosis - Pulmonary Disease, Moderate", "code_information": [{"code": "131.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13774.84, "maximum": 13774.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13774.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Cystic Fibrosis - Pulmonary Disease, Severe", "code_information": [{"code": "131.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33230.58, "maximum": 33230.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33230.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D & C AFTER DELIVERY", "code_information": [{"code": "59160", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2385.2, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D&C OF CERVICAL STUMP", "code_information": [{"code": "57558", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC", "code_information": [{"code": "744", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5763.45, "maximum": 5763.45, "discounted_cash": 21016.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5763.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC", "code_information": [{"code": "745", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5763.45, "maximum": 5763.45, "discounted_cash": 11565.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5763.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "D5W INFUSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7070", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.6, "maximum": 3.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DACARBAZINE 100 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9130", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.69, "maximum": 3.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DACLIZUMAB, PARENTERAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.01, "maximum": 5.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DACTINOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9120", "type": "HCPCS"}], "standard_charges": [{"minimum": 547.8, "maximum": 547.8, "discounted_cash": 1074.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 547.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DALTEPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1645", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.6, "maximum": 16.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAPRODUSTAT ORAL 1MG ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0889", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAPTOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0878", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.1, "maximum": 0.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARATUMUMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9144", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.8, "maximum": 48.8, "discounted_cash": 78.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARBEPOETIN ALFA, ESRD USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0882", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.9, "maximum": 2.9, "discounted_cash": 4.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARBEPOETIN ALFA, NON-ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0881", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.9, "maximum": 2.9, "discounted_cash": 4.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87164", "type": "CPT"}], "standard_charges": [{"minimum": 10.74, "maximum": 24.03, "discounted_cash": 17.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DARK FIELD EXAMINATION", "code_information": [{"code": "87166", "type": "CPT"}], "standard_charges": [{"minimum": 11.3, "maximum": 24.03, "discounted_cash": 18.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN CITRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9151", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DAUNORUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9150", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.5, "maximum": 31.5, "discounted_cash": 57.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCHI MESH LG LT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.08, "maximum": 712.36, "gross_charge": 734.4, "discounted_cash": 1101.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCHI MESH LG RT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.08, "maximum": 712.36, "gross_charge": 734.4, "discounted_cash": 1101.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCHI PORT ACCESS", "code_information": [{"code": "3100208992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.64, "discounted_cash": 489.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCHI TUBE SET*AS", "code_information": [{"code": "3100208991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.32, "discounted_cash": 472.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI 12M HASSON C", "code_information": [{"code": "3100209781", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3135.0, "discounted_cash": 4702.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI 5-8 SEAL*470", "code_information": [{"code": "3100209030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.6, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI CANNULA SEAL", "code_information": [{"code": "3100209014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI DRAPE ARM*47", "code_information": [{"code": "3100209019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.4, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI DRAPE COLUMN", "code_information": [{"code": "3100209020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.6, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI MESH MED LT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 891.45, "maximum": 1235.29, "gross_charge": 1273.5, "discounted_cash": 1910.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1082.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 955.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 891.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1235.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 891.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 955.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1082.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1018.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCI MESH MED RT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 891.45, "maximum": 1235.29, "gross_charge": 1273.5, "discounted_cash": 1910.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1082.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 955.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 891.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1235.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 891.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 955.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1082.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1018.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCI MESH XL LT*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1051.89, "maximum": 1457.61, "gross_charge": 1502.7, "discounted_cash": 2254.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1277.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1127.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1051.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1457.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1051.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1127.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1277.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1202.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCI MESH XL RT*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1051.89, "maximum": 1457.61, "gross_charge": 1502.7, "discounted_cash": 2254.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1277.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1127.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1051.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1457.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1051.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1127.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1277.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1202.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DAVINCI OBTURATOR LO", "code_information": [{"code": "3100209009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI OBTURATOR ST", "code_information": [{"code": "3100209008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI PORT 8 ACCE", "code_information": [{"code": "3100209153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.68, "discounted_cash": 460.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI REDUCER*4703", "code_information": [{"code": "3100209010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 2.5 W", "code_information": [{"code": "3100209003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 2.5 W", "code_information": [{"code": "3100209075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 3.5 B", "code_information": [{"code": "3100209004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 3.5 B", "code_information": [{"code": "3100209245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 4.3 G", "code_information": [{"code": "3100209005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 4.3 G", "code_information": [{"code": "3100209246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI RELOAD 5.0 B", "code_information": [{"code": "3100209006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI SCOPE CLEANE", "code_information": [{"code": "3100209158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.68, "discounted_cash": 83.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI STAPLER 45*4", "code_information": [{"code": "3100209074", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1449.0, "discounted_cash": 2173.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI STAPLER 60*4", "code_information": [{"code": "3100209013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1669.5, "discounted_cash": 2504.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI SUCTION*4802", "code_information": [{"code": "3100209290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 835.0, "discounted_cash": 1252.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI SYNCHROSEAL*", "code_information": [{"code": "3100209651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11302.2, "discounted_cash": 16953.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI TIP COVER*40", "code_information": [{"code": "3100209007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI UNIVERSAL SE", "code_information": [{"code": "3100209015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI VESSEL SEAL*", "code_information": [{"code": "3100209012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1968.99, "discounted_cash": 2953.49, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI VUETIP KIT*V", "code_information": [{"code": "3100209241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DAVINCI WAFFLEGRIP P", "code_information": [{"code": "3100209110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DBF GRAFTON 6CC*T503", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM FIBER 10CC*1008-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM FIBER 1CC*1008-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM FIBER 5CC*1008-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM FIBER 5CC*1008-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM GRAFTON PUTTY 0.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 279.3, "maximum": 387.03, "gross_charge": 399.0, "discounted_cash": 598.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 339.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 299.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 279.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 387.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 279.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 299.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 339.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM GRAFTON PUTTY 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1916.49, "maximum": 2655.71, "gross_charge": 2737.85, "discounted_cash": 4106.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2327.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2053.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1916.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2655.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1916.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2053.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2327.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2190.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM GRAFTON PUTTY 1C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM GRAFTON PUTTY 2.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 795.37, "maximum": 1102.16, "gross_charge": 1136.25, "discounted_cash": 1704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 965.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 852.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 795.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1102.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 795.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 852.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 965.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 909.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM GRAFTON PUTTY 5C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1444.27, "maximum": 2001.35, "gross_charge": 2063.25, "discounted_cash": 3094.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1753.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1547.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1444.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2001.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1444.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1547.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1753.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1650.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY 10CC*4104-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY 10CC*45210", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY 10CC*BNEP0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY 1CC*BNEP00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.01, "discounted_cash": 1237.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY 5.0CC*4520", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY 5CC*BNEP00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY*4104-K0025", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 588.0, "maximum": 814.8, "gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 814.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBM PUTTY*4104-K0050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DBRDMT BONE EACH ADDL", "code_information": [{"code": "11047", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT ECZ/INFCT SKN EA ADDL", "code_information": [{"code": "11001", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT OPN WND 1ST 20 CM/<", "code_information": [{"code": "97597", "type": "CPT"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT OPN WND ADDL 20CM/<", "code_information": [{"code": "97598", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT PER", "code_information": [{"code": "11006", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SKIN XTRNL GENT&PER", "code_information": [{"code": "11004", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBRDMT SUBQ TISS EACH ADDL", "code_information": [{"code": "11045", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DBX PUTTY 10CC*06810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1916.88, "maximum": 2656.24, "gross_charge": 2738.4, "discounted_cash": 4107.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2656.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2190.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DCMPRN PX PERQ 1/MLT LUMBAR", "code_information": [{"code": "62287", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRDMT ELB W/REPAIR", "code_information": [{"code": "24359", "type": "CPT"}, {"code": "3480101569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2919.2, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE MASTOID CAVI", "code_information": [{"code": "69220", "type": "CPT"}, {"code": "3340102312", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 284.21, "gross_charge": 293.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 284.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 1-5", "code_information": [{"code": "11720", "type": "CPT"}], "standard_charges": [{"minimum": 226.95, "maximum": 277.43, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NAIL 6 OR MORE", "code_information": [{"code": "11721", "type": "CPT"}], "standard_charges": [{"minimum": 226.95, "maximum": 277.43, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NEG PRES WND", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "3340100591", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 330.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 320.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE NEG PRES WND", "code_information": [{"code": "97606", "type": "CPT"}, {"code": "3340100592", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 345.1, "maximum": 736.48, "gross_charge": 493.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 419.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 369.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 345.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 478.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 345.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 369.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 419.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN (10% SU", "code_information": [{"code": "11000", "type": "CPT"}, {"code": "3480101296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 762.66, "gross_charge": 734.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 711.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN AT FX S", "code_information": [{"code": "11010", "type": "CPT"}, {"code": "3340102440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2175.71, "gross_charge": 2243.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1906.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1682.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1570.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2175.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1570.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1682.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1906.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1794.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE SKIN MUSC AT FX SITE", "code_information": [{"code": "11011", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDE TISSUE/MUSCL", "code_information": [{"code": "11043", "type": "CPT"}, {"code": "3480101301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 854.57, "gross_charge": 881.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 660.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 616.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 854.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 616.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 660.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 748.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 704.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT & CONTOURING", "code_information": [{"code": "D6102", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT MUSCLE", "code_information": [{"code": "11046", "type": "CPT"}, {"code": "3480101303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 513.8, "maximum": 2771.02, "gross_charge": 734.0, "discounted_cash": 1101.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 711.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT OF A PERIIMPLANT", "code_information": [{"code": "D6101", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT SKIN", "code_information": [{"code": "11012", "type": "CPT"}, {"code": "3480101299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3450.49, "gross_charge": 1413.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1370.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1130.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT SKIN/SQ", "code_information": [{"code": "11042", "type": "CPT"}, {"code": "3480101300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "gross_charge": 734.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 711.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEMENT TISSUE", "code_information": [{"code": "11044", "type": "CPT"}, {"code": "3480101302", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2771.02, "gross_charge": 2451.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2377.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEBRIDEOF SKIN ABD W", "code_information": [{"code": "11005", "type": "CPT"}, {"code": "3480101297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1334.2, "maximum": 2771.02, "gross_charge": 1906.0, "discounted_cash": 2859.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1620.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1429.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1334.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1848.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1334.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1429.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1620.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1524.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION PROC", "code_information": [{"code": "88311", "type": "CPT"}, {"code": "3440101232", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 15.87, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECALCIFICATION PROCEDURE", "code_information": [{"code": "D0475", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECITABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0894", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.64, "maximum": 1.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECLOT THROMBOLYTIC", "code_information": [{"code": "36593", "type": "CPT"}, {"code": "3340100568", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 772.12, "gross_charge": 796.0, "discounted_cash": 518.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 676.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 357.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 597.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 557.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 772.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 352.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 557.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 355.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 597.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 676.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 636.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 352.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMP/INTERNAL NEUR", "code_information": [{"code": "64727", "type": "CPT"}, {"code": "3480102192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6624.27, "gross_charge": 5648.0, "discounted_cash": 8472.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5478.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4518.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS DISC RF LUMBAR", "code_information": [{"code": "S2348", "type": "HCPCS"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS EYE SOCKET", "code_information": [{"code": "61330", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26035", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FINGERS/HAND", "code_information": [{"code": "26037", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1", "code_information": [{"code": "25020", "type": "CPT"}, {"code": "3340102356", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 1 SPACE", "code_information": [{"code": "25023", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25024", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS FOREARM 2 SPACES", "code_information": [{"code": "25025", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS OPTIC NERVE", "code_information": [{"code": "67570", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SMALL BOWEL", "code_information": [{"code": "44021", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CO", "code_information": [{"code": "63056", "type": "CPT"}, {"code": "3480102153", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63064", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63057", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINE CORD ADD-ON", "code_information": [{"code": "63066", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF FOREARM", "code_information": [{"code": "24495", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27892", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27893", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LEG", "code_information": [{"code": "27894", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOW", "code_information": [{"code": "27600", "type": "CPT"}, {"code": "3340102467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5564.89, "gross_charge": 5737.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27601", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF LOWER LEG", "code_information": [{"code": "27602", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27496", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27497", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27498", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION OF THIGH/KNEE", "code_information": [{"code": "27499", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSION UNSPEC", "code_information": [{"code": "64722", "type": "CPT"}, {"code": "3480102191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE CRANIOTOMY", "code_information": [{"code": "61322", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOMPRESSIVE LOBECTOMY", "code_information": [{"code": "61323", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DECOR OR SUBMERG ERUPT TOOTH", "code_information": [{"code": "D3921", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP ANEST, 1ST 15 MIN", "code_information": [{"code": "D9222", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC", "code_information": [{"code": "294", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7884.63, "maximum": 7884.63, "discounted_cash": 12210.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7884.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC", "code_information": [{"code": "295", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6033.37, "maximum": 6033.37, "discounted_cash": 7050.42, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6033.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEFEROXAMINE MESYLATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0895", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.02, "maximum": 9.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEFLUX NEEDLE W/BUND", "code_information": [{"code": "3100100466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 321.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEGARELIX INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9155", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.35, "maximum": 4.35, "discounted_cash": 6.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [{"code": "56", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12826.05, "maximum": 12826.05, "discounted_cash": 26727.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12826.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [{"code": "57", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10243.13, "maximum": 10243.13, "discounted_cash": 15219.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10243.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTERONE", "code_information": [{"code": "82626", "type": "CPT"}], "standard_charges": [{"minimum": 25.27, "maximum": 40.05, "discounted_cash": 40.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEHYDROEPIANDROSTRNE", "code_information": [{"code": "82627", "type": "CPT"}, {"code": "3440100898", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 22.23, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 35.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 28.33, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 23.81, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELA FLAP/SEC FLAP F", "code_information": [{"code": "15620", "type": "CPT"}, {"code": "3480101284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5126.45, "gross_charge": 5285.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5126.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP ARMS/LEGS", "code_information": [{"code": "15610", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP EYE/NOS/EAR/LIP", "code_information": [{"code": "15630", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAY FLAP TRUNK", "code_information": [{"code": "15600", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELAYED INSERTION OF", "code_information": [{"code": "19342", "type": "CPT"}, {"code": "3480101409", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15487.99, "gross_charge": 15967.0, "discounted_cash": 14428.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13571.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9946.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11975.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11176.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15487.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9811.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11176.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9907.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11975.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9619.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11446.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13571.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9619.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12773.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9619.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9811.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVER PLACENTA", "code_information": [{"code": "59414", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2385.2, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVERY COMP IMRT", "code_information": [{"code": "G6016", "type": "HCPCS"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DELIVERY SYSTEM 10FR", "code_information": [{"code": "3100203656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEM&/EVL OF NEB / IN", "code_information": [{"code": "94664", "type": "CPT"}, {"code": "3310100282", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 259.0, "gross_charge": 231.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEMIN STRIP 100X10*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4484.48, "maximum": 6214.2, "gross_charge": 6406.4, "discounted_cash": 9609.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5445.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4804.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4484.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6214.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4484.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4804.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5445.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5125.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEMIN STRIP 50X10*10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2103.92, "maximum": 2915.43, "gross_charge": 3005.6, "discounted_cash": 4508.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2554.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2103.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2915.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2103.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2554.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2404.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEMINERALIZ FIBER*41", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEMO-SMOKING CESSATION COUN", "code_information": [{"code": "G9016", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEMONSTRATE USE HOME INR MON", "code_information": [{"code": "G0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENERVATION OF HIP JOINT", "code_information": [{"code": "27035", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 3 DOSE SUBQ", "code_information": [{"code": "90587", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENOSUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0897", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.19, "maximum": 25.19, "discounted_cash": 40.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENT ANESTHESIA W/O SURGERY", "code_information": [{"code": "D9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENT APPL DESENSITIZING MED", "code_information": [{"code": "D9910", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENT CASE MGMT SPECIAL NEEDS", "code_information": [{"code": "D9997", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENT SUTUR RECENT WND TO 5CM", "code_information": [{"code": "D7910", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENT THERAPEUTIC DRUG INJECT", "code_information": [{"code": "D9610", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [{"code": "158", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4734.22, "maximum": 4734.22, "discounted_cash": 10477.95, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4734.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [{"code": "157", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7382.93, "maximum": 7382.93, "discounted_cash": 19057.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7382.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL AND ORAL DISEASES WITHOUT CC/MCC", "code_information": [{"code": "159", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4051.76, "maximum": 4051.76, "discounted_cash": 7538.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4051.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENTAL BITEWING SINGLE IMAGE", "code_information": [{"code": "D0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL BITEWINGS TWO IMAGES", "code_information": [{"code": "D0272", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL BURR TF", "code_information": [{"code": "3100100468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.8, "discounted_cash": 40.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CONDITIONER", "code_information": [{"code": "3100100470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 253.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CONNECTOR BAR", "code_information": [{"code": "D6920", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL CORONOIDECTOMY", "code_information": [{"code": "D7991", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100100471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102632", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102633", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102636", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102638", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102639", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102640", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102642", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 148.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100102644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 193.0, "discounted_cash": 289.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100104430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CROWN", "code_information": [{"code": "3100104463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL CUSPID ADULT*", "code_information": [{"code": "3100204571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.39, "discounted_cash": 51.59, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL ELEVATOR ST", "code_information": [{"code": "3100103959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL EXCAVATOR", "code_information": [{"code": "3100100472", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL FLOURIDE GEL", "code_information": [{"code": "3100100473", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL FLOWABLE A2*1", "code_information": [{"code": "3100205861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL FLOWABLE COMP", "code_information": [{"code": "3100100474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL FRAME RUBBER", "code_information": [{"code": "3100100475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL GOLD FOIL ONE SURFACE", "code_information": [{"code": "D2410", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL GOLD FOIL THREE SURFA", "code_information": [{"code": "D2430", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL GOLD FOIL TWO SURFACE", "code_information": [{"code": "D2420", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY METALIC 1 SURF", "code_information": [{"code": "D2510", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY METALLIC 2 SURF", "code_information": [{"code": "D2520", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY METL 3/MORE SUR", "code_information": [{"code": "D2530", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL INLAY RESIN 3/MRE SUR", "code_information": [{"code": "D2652", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METALLIC 2 SURF", "code_information": [{"code": "D2542", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METALLIC 3 SURF", "code_information": [{"code": "D2543", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY METL 4/MORE SUR", "code_information": [{"code": "D2544", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 3/MORE SUR", "code_information": [{"code": "D2630", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORC 4/MORE SUR", "code_information": [{"code": "D2644", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORCELIN 2 SURF", "code_information": [{"code": "D2642", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY PORCELIN 3 SURF", "code_information": [{"code": "D2643", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 2 SURFACE", "code_information": [{"code": "D2662", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 3 SURFACE", "code_information": [{"code": "D2663", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL ONLAY RESIN 4/MRE SUR", "code_information": [{"code": "D2664", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL PROPHYLAXIS ADULT", "code_information": [{"code": "D1110", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL PROPHYLAXIS CHILD", "code_information": [{"code": "D1120", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL RETAINR CAST METL", "code_information": [{"code": "D6545", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL SALIOGRAPHY", "code_information": [{"code": "D0310", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.78, "maximum": 179.78, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL SEALANT PER TOOTH", "code_information": [{"code": "D1351", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.64, "maximum": 63.64, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL SEALNT PITT", "code_information": [{"code": "3100102149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL SICKLE SCALER", "code_information": [{"code": "3100100476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.0, "discounted_cash": 175.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DENTAL SKIN GRAFT", "code_information": [{"code": "D7920", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL SUTURE WOUND TO 5 CM", "code_information": [{"code": "D7911", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL TMJ ARTHROGRAM INCL I", "code_information": [{"code": "D0320", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.78, "maximum": 179.78, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL TOMOGRAPHIC SURVEY", "code_information": [{"code": "D0322", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTAL UNSPEC RESTORATIVE PR", "code_information": [{"code": "D2999", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM CMPLT MANDBL", "code_information": [{"code": "D5811", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM CMPLT MAXILL", "code_information": [{"code": "D5810", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM PART MANDBL", "code_information": [{"code": "D5821", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE INTERM PART MAXILL", "code_information": [{"code": "D5820", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAND DIR", "code_information": [{"code": "D5731", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAND IND", "code_information": [{"code": "D5751", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAX DIR", "code_information": [{"code": "D5730", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN CMPLT MAX INDIR", "code_information": [{"code": "D5750", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAND DIR", "code_information": [{"code": "D5741", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAND INDIR", "code_information": [{"code": "D5761", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAX DIR", "code_information": [{"code": "D5740", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE RELN PART MAX INDIR", "code_information": [{"code": "D5760", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE TISS CONDITN MAXILL", "code_information": [{"code": "D5850", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURE TISS CONDTIN MANDBL", "code_information": [{"code": "D5851", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST CMPLT MAND", "code_information": [{"code": "D5411", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST CMPLT MAXIL", "code_information": [{"code": "D5410", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST PART MANDBL", "code_information": [{"code": "D5422", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES ADJUST PART MAXILL", "code_information": [{"code": "D5421", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES COMPLETE MANDIBLE", "code_information": [{"code": "D5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES COMPLETE MAXILLARY", "code_information": [{"code": "D5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES IMMEDIAT MANDIBLE", "code_information": [{"code": "D5140", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES IMMEDIAT MAXILLARY", "code_information": [{"code": "D5130", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES MAND PART RESIN", "code_information": [{"code": "D5212", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES MANDIBL PART METAL", "code_information": [{"code": "D5214", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES MAXILL PART METAL", "code_information": [{"code": "D5213", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES MAXILL PART RESIN", "code_information": [{"code": "D5211", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE CMPLT MAND", "code_information": [{"code": "D5711", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE CMPLT MAXIL", "code_information": [{"code": "D5710", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE PART MANDBL", "code_information": [{"code": "D5721", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DENTURES REBASE PART MAXILL", "code_information": [{"code": "D5720", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEOXYCORTISOL", "code_information": [{"code": "82634", "type": "CPT"}], "standard_charges": [{"minimum": 29.28, "maximum": 34.27, "discounted_cash": 47.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEPAKENE", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "3440100812", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.54, "maximum": 117.37, "gross_charge": 121.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEPO-ESTRADIOL CYPIONATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1000", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.75, "maximum": 35.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEPRESSION SCREEN ANNUAL", "code_information": [{"code": "G0444", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEPRESSIVE NEUROSES", "code_information": [{"code": "881", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3554.97, "maximum": 3554.97, "discounted_cash": 10120.68, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3554.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT F/N/HF/G ADD", "code_information": [{"code": "15136", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT FACE/NCK/HF/G", "code_information": [{"code": "15135", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT T/A/L ADD-ON", "code_information": [{"code": "15131", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM AUTOGRAFT TRNK/ARM/LEG", "code_information": [{"code": "15130", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERM-MAXX, PER SQ CM", "code_information": [{"code": "Q4238", "type": "HCPCS"}], "standard_charges": [{"minimum": 1346.79, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1346.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMA FAT FASCIA GRA", "code_information": [{"code": "15770", "type": "CPT"}, {"code": "3340102380", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7674.64, "gross_charge": 7912.0, "discounted_cash": 5491.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3785.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7674.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3770.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4356.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6329.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMA-GIDE, 1 SQ CM", "code_information": [{"code": "Q4203", "type": "HCPCS"}], "standard_charges": [{"minimum": 300.18, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 300.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABIND CH, PER SQ CM", "code_information": [{"code": "Q4288", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABIND SL, PER SQ CM", "code_information": [{"code": "Q4284", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DERMABOND OPTICLOSE*", "code_information": [{"code": "3100210046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 225.2, "discounted_cash": 337.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DERMABOND SKIN CLOSU", "code_information": [{"code": "3100100477", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 437.4, "discounted_cash": 656.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SEGMENTAL FACE", "code_information": [{"code": "15781", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION SUPRFL ANY SITE", "code_information": [{"code": "15783", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMABRASION TOTAL FACE", "code_information": [{"code": "15780", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMACARRIERS SKIN G", "code_information": [{"code": "3100100478", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DERMACELL, AWM, POROUS SQ CM", "code_information": [{"code": "Q4122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMACYTE AMN MEM ALLO SQ CM", "code_information": [{"code": "Q4248", "type": "HCPCS"}], "standard_charges": [{"minimum": 1083.87, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1083.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMAGRAFT", "code_information": [{"code": "Q4106", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.94, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMAL FILLER INJECTION(S)", "code_information": [{"code": "G0429", "type": "HCPCS"}], "standard_charges": [{"minimum": 1988.71, "maximum": 1988.71, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMAPURE 1 SQUARE CM", "code_information": [{"code": "Q4152", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.9, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DERMAVEST, PLURIVEST SQ CM", "code_information": [{"code": "Q4153", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.56, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 125.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DES FLAT WARTS TO 14", "code_information": [{"code": "17110", "type": "CPT"}, {"code": "3480101384", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 175.0, "maximum": 277.43, "gross_charge": 250.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 212.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 242.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 187.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 212.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESFLURANE", "code_information": [{"code": "3400300207", "type": "CDM"}, {"code": "999", "type": "RC"}], "standard_charges": [{"gross_charge": 373.0, "discounted_cash": 559.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DESIGN CUSTOM BREAST IMPLANT", "code_information": [{"code": "19396", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESIGN MLC DEVICE FOR IMRT", "code_information": [{"code": "77338", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESOXYCORTICOSTERONE", "code_information": [{"code": "82633", "type": "CPT"}], "standard_charges": [{"minimum": 30.98, "maximum": 68.09, "discounted_cash": 49.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST BY NEUR AGT INT", "code_information": [{"code": "64620", "type": "CPT"}, {"code": "3430100769", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3718.98, "gross_charge": 3834.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3258.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2875.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2683.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3718.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2683.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2875.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3258.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3067.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST BY NEUR AGT PUD", "code_information": [{"code": "64630", "type": "CPT"}, {"code": "3430100773", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1977.83, "gross_charge": 2039.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1733.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1529.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1427.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1977.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1427.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1529.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1733.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1631.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST BY NEURO AGT PA", "code_information": [{"code": "64622", "type": "CPT"}, {"code": "3430100770", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 2308.6, "maximum": 3199.06, "gross_charge": 3298.0, "discounted_cash": 4947.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2803.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2473.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3199.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2473.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2803.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2638.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEST NER AGT OTH PER", "code_information": [{"code": "64640", "type": "CPT"}, {"code": "3430100778", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST NER AGT PVRT F", "code_information": [{"code": "64633", "type": "CPT"}, {"code": "3430100754", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3718.98, "gross_charge": 3834.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3258.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2875.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2683.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3718.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2683.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2875.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3258.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3067.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST NER AGT PVRT F", "code_information": [{"code": "64634", "type": "CPT"}, {"code": "3430100767", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 886.0, "discounted_cash": 1329.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 753.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 664.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 620.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 859.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 620.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 664.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 753.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST NER AGT PVRT F", "code_information": [{"code": "64635", "type": "CPT"}, {"code": "3430100775", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3718.98, "gross_charge": 3834.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3258.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2875.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2683.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3718.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2683.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2875.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3258.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3067.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST NER AGT PVRT F", "code_information": [{"code": "64636", "type": "CPT"}, {"code": "3430100776", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 800.0, "discounted_cash": 1200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 680.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 560.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 776.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 560.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 680.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 640.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEST NEURO AGT CEV/T", "code_information": [{"code": "64626", "type": "CPT"}, {"code": "3430100772", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 2308.6, "maximum": 3199.06, "gross_charge": 3298.0, "discounted_cash": 4947.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2803.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2473.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3199.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2473.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2803.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2638.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEST NEURO AGT LUM/S", "code_information": [{"code": "64623", "type": "CPT"}, {"code": "3430100771", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1164.8, "maximum": 1614.08, "gross_charge": 1664.0, "discounted_cash": 2496.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1614.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1331.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY INTERNAL HEMORRHOIDS", "code_information": [{"code": "46930", "type": "CPT"}], "standard_charges": [{"minimum": 2670.89, "maximum": 2670.89, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE FACE MUSCLE", "code_information": [{"code": "64612", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY NERVE OF EYE MUSCLE", "code_information": [{"code": "67345", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY PREMAL LESIONS 15/>", "code_information": [{"code": "17004", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTROY VAG LESIONS COMPLEX", "code_information": [{"code": "57065", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESION", "code_information": [{"code": "56501", "type": "CPT"}, {"code": "3480103062", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5130.33, "gross_charge": 5289.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4495.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3966.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3702.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5130.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3702.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3966.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4495.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTROY VULVA LESION/S COMPL", "code_information": [{"code": "56515", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2564.54, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCT LESION 15 OR MORE", "code_information": [{"code": "17111", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LES 2-14", "code_information": [{"code": "17003", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCT PREMALG LESION", "code_information": [{"code": "17000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION ANAL LESION(S)", "code_information": [{"code": "46900", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66700", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66720", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION CILIARY BODY", "code_information": [{"code": "66740", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "46910", "type": "CPT"}, {"code": "3480101984", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5776.35, "gross_charge": 5955.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5776.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "46917", "type": "CPT"}, {"code": "3480101985", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4813.14, "gross_charge": 4962.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4813.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3969.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "46924", "type": "CPT"}, {"code": "3480101986", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5776.35, "gross_charge": 5955.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5776.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "54057", "type": "CPT"}, {"code": "3480102047", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4813.14, "gross_charge": 4962.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4813.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3969.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "54060", "type": "CPT"}, {"code": "3340102487", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6202.18, "gross_charge": 6394.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5434.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4795.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4475.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6202.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4475.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4795.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5434.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5115.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "54060", "type": "CPT"}, {"code": "3480102048", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4813.14, "gross_charge": 4962.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4813.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3969.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF LESIO", "code_information": [{"code": "54065", "type": "CPT"}, {"code": "3480102049", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5776.35, "gross_charge": 5955.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5776.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17106", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17107", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION OF SKIN LESIONS", "code_information": [{"code": "17108", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION PENIS LESION(S)", "code_information": [{"code": "54050", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION RECTAL TUMOR", "code_information": [{"code": "45190", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DESTRUCTION VAG LESI", "code_information": [{"code": "57061", "type": "CPT"}, {"code": "3480102086", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA AMPLI", "code_information": [{"code": "87801", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 70.2, "discounted_cash": 112.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DETECT AGNT MULT DNA DIREC", "code_information": [{"code": "87800", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 43.67, "discounted_cash": 70.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 43.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DETECT TEST AMP PROB", "code_information": [{"code": "87529", "type": "CPT"}, {"code": "3440103110", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DETECT TEST AMP PROB", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "3440103111", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DETERGENT INTERCEPT", "code_information": [{"code": "3100104625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 165.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEV INTERROG REMOTE 1/2/MLT", "code_information": [{"code": "93295", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP 1ST HR", "code_information": [{"code": "96112", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEVEL TST PHYS/QHP EA ADDL", "code_information": [{"code": "96113", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEVELOPMENTAL SCREEN W/SCORE", "code_information": [{"code": "96110", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEVICE AC LOCKDOWN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4959.5, "maximum": 6872.45, "gross_charge": 7085.0, "discounted_cash": 10627.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6022.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5313.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4959.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6872.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4959.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5313.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6022.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEVICE POST TENSION", "code_information": [{"code": "3100100479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TENSIONING AR", "code_information": [{"code": "3100100480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1875.0, "discounted_cash": 2812.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEVLOPMENT TEST INTERPT&REP", "code_information": [{"code": "G0451", "type": "HCPCS"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEXAMETHA OPTH INSERT 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1096", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.87, "maximum": 139.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 139.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7637", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7638", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE INTRA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7312", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.6, "maximum": 205.6, "discounted_cash": 330.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 205.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE PANEL", "code_information": [{"code": "80420", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 161.88, "discounted_cash": 260.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 161.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEXAMETHASONE SODIUM PHOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1100", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.12, "maximum": 0.12, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXMEDETOMIDINE FILM, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1105", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 1.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXRAZOXANE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1190", "type": "HCPCS"}], "standard_charges": [{"minimum": 91.09, "maximum": 91.09, "discounted_cash": 173.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 91.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXTRAN 40 INFUSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7100", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.89, "maximum": 23.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEXTRAN 75 INFUSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7110", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DEXTRANOMER/HYALURONIC ACID", "code_information": [{"code": "L8604", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DEXTROSE 50%/WATER", "code_information": [{"code": "3400300121", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.4, "discounted_cash": 36.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DGP ANTIBODY EACH IG CLASS", "code_information": [{"code": "86258", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DI GNOTYP SLC4A1 EXON 19", "code_information": [{"code": "183U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN  PER INDIV", "code_information": [{"code": "G0108", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAB MANAGE TRN IND/GROUP", "code_information": [{"code": "G0109", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV ONLINE/ELEC", "code_information": [{"code": "488T", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES PREV STANDARD CURR", "code_information": [{"code": "403T", "type": "CPT"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH CC", "code_information": [{"code": "638", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4191.94, "maximum": 4191.94, "discounted_cash": 10041.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4191.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES WITH MCC", "code_information": [{"code": "637", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6850.48, "maximum": 6850.48, "discounted_cash": 16180.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6850.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETES WITHOUT CC/MCC", "code_information": [{"code": "639", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3431.39, "maximum": 3431.39, "discounted_cash": 6949.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3431.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9140", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9141", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9455", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIABETIC MANAGEMENT PROGRAM,", "code_information": [{"code": "S9465", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG BRONCHOSCOPE/CATHETER", "code_information": [{"code": "31643", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1756.42, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAG TST DETECT MUCOS ABNORM", "code_information": [{"code": "D0431", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY", "code_information": [{"code": "46601", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY & BIOPSY", "code_information": [{"code": "46607", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC ANOSCOPY SPX", "code_information": [{"code": "46600", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC CASTS", "code_information": [{"code": "D0470", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSC", "code_information": [{"code": "31505", "type": "CPT"}, {"code": "3340102456", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 510.22, "gross_charge": 526.0, "discounted_cash": 303.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 240.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALATOR 10FR 20CM*G", "code_information": [{"code": "3100206583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.2, "discounted_cash": 81.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR 12FR 20CM*G", "code_information": [{"code": "3100206584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.2, "discounted_cash": 81.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALATOR MEATAL FR.6", "code_information": [{"code": "3100208195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIALYSIS ACU KIDNEY NO ESRD", "code_information": [{"code": "G0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS CIRCUIT EMBOLJ", "code_information": [{"code": "36909", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS ONE EVALUATION", "code_information": [{"code": "90945", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "discounted_cash": 677.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS REPEATED EVAL", "code_information": [{"code": "90947", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING COMPLETE", "code_information": [{"code": "90989", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIALYSIS TRAINING INCOMPL", "code_information": [{"code": "90993", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIATHERMY EG MICROWAVE", "code_information": [{"code": "97024", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3360", "type": "HCPCS"}, {"code": "3400300082", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.32, "maximum": 7.37, "gross_charge": 7.6, "discounted_cash": 11.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZEPAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3360", "type": "HCPCS"}, {"code": "3400300105", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.54, "maximum": 14.84, "gross_charge": 15.3, "discounted_cash": 22.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAZOXIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1730", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DICYCLOMINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0500", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.99, "maximum": 24.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIETHYLSTILBESTROL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9165", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.49, "maximum": 13.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIFELIKEFALIN, ESRD ON DIALY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0879", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIFFICULT INTUBATION", "code_information": [{"code": "31500", "type": "CPT"}, {"code": "3480101861", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 249.25, "maximum": 1138.31, "gross_charge": 563.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 422.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 394.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 546.11, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 394.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 422.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1138.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [{"code": "375", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6583.64, "maximum": 6583.64, "discounted_cash": 13378.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6583.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [{"code": "374", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9921.58, "maximum": 9921.58, "discounted_cash": 23434.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9921.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGESTIVE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "376", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4380.08, "maximum": 4380.08, "discounted_cash": 9952.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4380.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGIT NERVE SURGERY ADD-ON", "code_information": [{"code": "64778", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGIT TRAP", "code_information": [{"code": "3100100481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGIT WIDGET BLUE DE", "code_information": [{"code": "3100100482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIGITAL SUB 2 OR MORE IMAGES", "code_information": [{"code": "D0394", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGOXIN", "code_information": [{"code": "80162", "type": "CPT"}, {"code": "3440100811", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.28, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIGOXIN IMMUNE FAB (OVINE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1162", "type": "HCPCS"}], "standard_charges": [{"minimum": 4777.44, "maximum": 4777.44, "discounted_cash": 7674.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4777.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIGOXIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1160", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.06, "maximum": 9.06, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIHYDROTESTOSTERONE", "code_information": [{"code": "82642", "type": "CPT"}], "standard_charges": [{"minimum": 29.28, "maximum": 34.27, "discounted_cash": 47.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIKE SPILLBLOCKER RO", "code_information": [{"code": "3100100483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 1026.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA DIFF TER", "code_information": [{"code": "61642", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT IC VSPSM EA VSL SM TER", "code_information": [{"code": "61641", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT URETHRAL MALE", "code_information": [{"code": "53601", "type": "CPT"}, {"code": "3340102324", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 277.43, "gross_charge": 277.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 235.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 207.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 193.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 268.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 193.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 207.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 235.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 221.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NDURLGC PX", "code_information": [{"code": "50436", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILAT XST TRC NEW ACCESS RCS", "code_information": [{"code": "50437", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE BILIARY DUCT/AMPULLA", "code_information": [{"code": "47542", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE ESOPHAGUS", "code_information": [{"code": "43453", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE IC VASOSPASM INIT", "code_information": [{"code": "61640", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE TEAR DUCT OPENING", "code_information": [{"code": "68801", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRIC", "code_information": [{"code": "53600", "type": "CPT"}, {"code": "3480103191", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 733.32, "gross_charge": 756.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 733.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRIC", "code_information": [{"code": "53600", "type": "CPT"}, {"code": "3480103254", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 902.1, "gross_charge": 930.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 902.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53605", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 434.32, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53620", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATE URETHRA STRICTURE", "code_information": [{"code": "53621", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION & CURETTAGE", "code_information": [{"code": "58120", "type": "CPT"}, {"code": "3480102095", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5925.73, "gross_charge": 6109.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5192.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4581.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4276.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5925.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4276.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4581.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5192.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4887.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION CERVICAL CA", "code_information": [{"code": "57800", "type": "CPT"}, {"code": "3340102297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4668.61, "gross_charge": 4813.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4091.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3609.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3369.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4668.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3369.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3609.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4091.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3850.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF ESOPHAGU", "code_information": [{"code": "43450", "type": "CPT"}, {"code": "3480101946", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1100.76, "gross_charge": 966.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 676.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 937.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 676.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF ESOPHAGU", "code_information": [{"code": "43458", "type": "CPT"}, {"code": "3480101947", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2270.8, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 4866.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF RECTAL NARROWING", "code_information": [{"code": "45910", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42660", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53661", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53665", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATON OF ANAL SPHI", "code_information": [{"code": "45905", "type": "CPT"}, {"code": "3340102392", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4820.9, "gross_charge": 4970.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4224.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3727.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3479.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4820.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3479.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3727.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4224.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3976.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATOR AMPLTZ SET", "code_information": [{"code": "3100100484", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 800.0, "discounted_cash": 1200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR AQ 8.0FR*G10", "code_information": [{"code": "3100204770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.2, "discounted_cash": 70.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR GRAFTBOLT AR", "code_information": [{"code": "3100100485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HANK UTERINE", "code_information": [{"code": "3100100486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HANK UTERINE", "code_information": [{"code": "3100102645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HANK UTERINE", "code_information": [{"code": "3100102646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.0, "discounted_cash": 244.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HANK UTERINE", "code_information": [{"code": "3100102647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 250.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HANK UTERINE", "code_information": [{"code": "3100104418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.0, "discounted_cash": 238.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR HANK UTERINE", "code_information": [{"code": "3100104419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 235.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR INSUL 8/13*M", "code_information": [{"code": "3100202726", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR LACRIMAL INF", "code_information": [{"code": "3100100487", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR TAP SCREW CA", "code_information": [{"code": "3100100488", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETERAL LNG", "code_information": [{"code": "3100100489", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 130.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETERAL LNG", "code_information": [{"code": "3100102648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.0, "discounted_cash": 208.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETH MEATAL", "code_information": [{"code": "3100202992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.92, "discounted_cash": 43.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETH S CUR*", "code_information": [{"code": "3100202994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.92, "discounted_cash": 781.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL SET", "code_information": [{"code": "3100202993", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.92, "discounted_cash": 880.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR URETHRAL SET", "code_information": [{"code": "3100207451", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 613.14, "discounted_cash": 919.71, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR VAS 12 FR*G0", "code_information": [{"code": "3100205497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.72, "discounted_cash": 53.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORS ESOPHAGEA", "code_information": [{"code": "3100104600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORS ESOPHAGEA", "code_information": [{"code": "3100104601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORS MALONEY", "code_information": [{"code": "3100104609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 658.0, "discounted_cash": 987.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATORY PACK*1100-0", "code_information": [{"code": "3100207030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4506.66, "discounted_cash": 6759.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM HCL", "code_information": [{"code": "3400300217", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.3, "discounted_cash": 9.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DIMECAPROL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0470", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.51, "maximum": 58.51, "discounted_cash": 96.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIMENHYDRINATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1240", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.86, "maximum": 8.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOXIDE 50% 50 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}], "standard_charges": [{"minimum": 680.16, "maximum": 680.16, "discounted_cash": 1093.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 680.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE HCL 50MG", "code_information": [{"code": "Q0163", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.32, "maximum": 0.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE HCL INJECTIO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1200", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.82, "maximum": 0.82, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA AB", "code_information": [{"code": "86648", "type": "CPT"}, {"code": "3440101102", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.21, "maximum": 132.89, "gross_charge": 137.0, "discounted_cash": 24.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTITOXIN", "code_information": [{"code": "90296", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DIPROPYLACETIC ACID FREE", "code_information": [{"code": "80165", "type": "CPT"}], "standard_charges": [{"minimum": 13.54, "maximum": 41.39, "discounted_cash": 21.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIPYRIDAMOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1245", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.74, "maximum": 3.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHO SEC CLSR", "code_information": [{"code": "23921", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISC CARTIFORM 20MM*", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "3100104231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 16490.0, "gross_charge": 17000.0, "discounted_cash": 25500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16490.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13600.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISC MONITORS", "code_information": [{"code": "3100100490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISC MONITORS", "code_information": [{"code": "3100102649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISCECTOMY CERVICAL-", "code_information": [{"code": "63075", "type": "CPT"}, {"code": "3480102154", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISCIS SECONDRY MEMB", "code_information": [{"code": "66820", "type": "CPT"}, {"code": "3410100688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2829.81, "gross_charge": 2320.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1972.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1624.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2250.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1624.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1972.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1856.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISE EVAL SLP DO BRTH FLX DX", "code_information": [{"code": "42975", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISEASE MANAGEMENT PROGRAM", "code_information": [{"code": "S0315", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISEASE MGMT PER DIEM", "code_information": [{"code": "S0317", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2350", "type": "HCPCS"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISKECTOMY, ANTERIOR, WITH D", "code_information": [{"code": "S2351", "type": "HCPCS"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [{"code": "442", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5355.82, "maximum": 5355.82, "discounted_cash": 10623.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5355.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [{"code": "441", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9067.57, "maximum": 9067.57, "discounted_cash": 20411.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9067.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC", "code_information": [{"code": "443", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3609.08, "maximum": 3609.08, "discounted_cash": 7979.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3609.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [{"code": "439", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4825.22, "maximum": 4825.22, "discounted_cash": 9547.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4825.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [{"code": "438", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8353.75, "maximum": 8353.75, "discounted_cash": 18631.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8353.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "440", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4119.39, "maximum": 4119.39, "discounted_cash": 6872.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4119.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [{"code": "883", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3679.78, "maximum": 3679.78, "discounted_cash": 20938.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3679.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [{"code": "445", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6437.31, "maximum": 6437.31, "discounted_cash": 12133.65, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6437.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [{"code": "444", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7417.97, "maximum": 7417.97, "discounted_cash": 18233.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7417.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC", "code_information": [{"code": "446", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4396.06, "maximum": 4396.06, "discounted_cash": 8948.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4396.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL BINAU", "code_information": [{"code": "V5240", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISP FEE CONTRALATERAL MONAU", "code_information": [{"code": "V5200", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISP FILSHIE CLIP*AV", "code_information": [{"code": "3100207812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 859.2, "discounted_cash": 1288.8, "setting": "both", "billing_class": "facility"}]}, {"description": "DISP KIT KNOTLESS*AR", "code_information": [{"code": "3100207346", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISP KIT NANO 2.5X7*", "code_information": [{"code": "3100205469", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISPENSING FEE BINAURAL", "code_information": [{"code": "V5160", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISPENSING FEE, MONAURAL", "code_information": [{"code": "V5241", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISSEC ELEV", "code_information": [{"code": "3100104103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.0, "discounted_cash": 544.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECT BRAIN W/SCOPE", "code_information": [{"code": "62161", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISSECTOR", "code_information": [{"code": "3100100491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR", "code_information": [{"code": "3100102650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR", "code_information": [{"code": "3100102651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR BLUNT", "code_information": [{"code": "3100100492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR BLUNT", "code_information": [{"code": "3100102652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR PENFIELD", "code_information": [{"code": "3100100493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 352.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR PENFIELD", "code_information": [{"code": "3100102653", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.0, "discounted_cash": 400.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR PENFIELD", "code_information": [{"code": "3100102654", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 661.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSECTOR PENFIELD", "code_information": [{"code": "3100103816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 889.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DISSOLVE CLOT HEART VESSEL", "code_information": [{"code": "92975", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIST FEM AUG 10MM*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2307.76, "maximum": 3197.89, "gross_charge": 3296.8, "discounted_cash": 4945.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2802.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2472.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2307.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3197.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2307.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2472.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2802.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2637.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST FEM AUG 65 X10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2825.55, "maximum": 3915.4, "gross_charge": 4036.5, "discounted_cash": 6054.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3431.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3027.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2825.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3915.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2825.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3027.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3431.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3229.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST FEM AUG 65X5*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2770.95, "maximum": 3839.74, "gross_charge": 3958.5, "discounted_cash": 5937.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3839.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST FEM AUG 70 X10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1843.66, "maximum": 2554.78, "gross_charge": 2633.8, "discounted_cash": 3950.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2238.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1975.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2554.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1975.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2238.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2107.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST FEMORAL 65MM*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8726.59, "maximum": 12092.56, "gross_charge": 12466.56, "discounted_cash": 18699.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10596.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9349.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8726.59, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12092.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8726.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9349.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10596.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9973.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST FEMUR SM*6495-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1741.41, "maximum": 2413.1, "gross_charge": 2487.74, "discounted_cash": 3731.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2114.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1865.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1741.41, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2413.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1741.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1865.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2114.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1990.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIST REVAS LIGATION HEMO", "code_information": [{"code": "36838", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIST SPACE MAINT, FIXED UNIL", "code_information": [{"code": "D1575", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1925.0, "maximum": 2667.5, "gross_charge": 2750.0, "discounted_cash": 4125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2337.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2062.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2667.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2062.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2337.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1852.9, "maximum": 2567.59, "gross_charge": 2647.0, "discounted_cash": 3970.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2249.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1852.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1852.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2249.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "401934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1852.9, "maximum": 2567.59, "gross_charge": 2647.0, "discounted_cash": 3970.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2249.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1852.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1852.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2249.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ 3 12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ2.5 4MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ2.5 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ2.5 8MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ3 4MM L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ3 8MM L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ4 4MM L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ4 8MM L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1588.58, "maximum": 2201.31, "gross_charge": 2269.4, "discounted_cash": 3404.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1928.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1588.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2201.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1588.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1928.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1815.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ5 12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1516.2, "maximum": 2101.02, "gross_charge": 2166.0, "discounted_cash": 3249.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1841.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1624.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1516.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2101.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1516.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1624.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1841.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1732.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ5 4MM R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL AUG SZ5 8MM R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL CLAVICLE ASSE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL FINGER*MCP100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2223.58, "maximum": 3081.25, "gross_charge": 3176.55, "discounted_cash": 4764.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2700.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2382.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2223.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3081.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2223.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2382.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2700.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2541.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL FINGER*MCP100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2211.02, "maximum": 3063.85, "gross_charge": 3158.61, "discounted_cash": 4737.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2684.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2368.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2211.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3063.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2211.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2368.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2684.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2526.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL LPS FEM LT*19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12168.8, "maximum": 16862.48, "gross_charge": 17384.0, "discounted_cash": 26076.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14776.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13038.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12168.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16862.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12168.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13038.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14776.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13907.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTAL LPS FEM RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11013.1, "maximum": 15261.01, "gross_charge": 15733.0, "discounted_cash": 23599.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13373.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11799.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11013.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15261.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11013.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11799.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13373.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12586.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DISTRACTOR/TRIAL", "code_information": [{"code": "3100100494", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1923.0, "discounted_cash": 2884.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58600", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIVISION OF FALLOPIAN TUBE", "code_information": [{"code": "58605", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2385.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH 1ST VSL", "code_information": [{"code": "34710", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DLYD PLMT XTN PROSTH EA ADDL", "code_information": [{"code": "34711", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DMD DUP/DELET ANALYSIS", "code_information": [{"code": "81161", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 279.0, "discounted_cash": 448.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4034", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4036", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4081", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4082", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4083", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4087", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4088", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4149", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4150", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4152", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4153", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4154", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4155", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4164", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4168", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4176", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4178", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4180", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4185", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4187", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4189", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4193", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4197", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4199", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4216", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4220", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4222", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B4224", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B5000", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B5100", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B9002", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B9004", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME PEN", "code_information": [{"code": "B9006", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "A4216", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DME POS", "code_information": [{"code": "L8607", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DMPK GENE CHARAC ALLELES", "code_information": [{"code": "81239", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DMPK GENE DETC ABNOR ALLELE", "code_information": [{"code": "81234", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA AB NATIVE/DBLE S", "code_information": [{"code": "86225", "type": "CPT"}, {"code": "3440101071", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.74, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 22.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS APOE ALZHEIMER", "code_information": [{"code": "S3852", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS DEAFNESS", "code_information": [{"code": "S3844", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA ANALYSIS RET-ONCOGENE", "code_information": [{"code": "S3840", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA ANTB 2STRAND HI AVIDITY", "code_information": [{"code": "39U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 22.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA ANTIBODY SINGLE STRAND", "code_information": [{"code": "86226", "type": "CPT"}], "standard_charges": [{"minimum": 12.11, "maximum": 30.26, "discounted_cash": 19.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA Test For Detecting Gene Abnormality Associated With Blood And Lymphatic System Cancer In Blood Or Bone Marrow", "code_information": [{"code": "14U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA/RNA DIRECT PROBE", "code_information": [{"code": "87149", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 25.55, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 25.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 21.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DNA/RNA SEQUENCING", "code_information": [{"code": "87153", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 115.36, "discounted_cash": 185.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 115.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DO GNOTYP ART4 EXON 2", "code_information": [{"code": "184U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOBUTAMINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1250", "type": "HCPCS"}, {"code": "3400300099", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.23, "maximum": 9.26, "gross_charge": 8.9, "discounted_cash": 13.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOBUTAMINE HCL/D5W", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1250", "type": "HCPCS"}, {"code": "3400300100", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 9.26, "maximum": 30.45, "gross_charge": 31.4, "discounted_cash": 47.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 25.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL (INGENUS), 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9172", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DOCETAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9171", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.87, "maximum": 0.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1260", "type": "HCPCS"}, {"code": "3400300045", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 40.01, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOLASETRON MESYLATE ORAL", "code_information": [{"code": "Q0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 113.7, "maximum": 113.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 113.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOMINO 4.75-5.5/6*59", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOMINO VARIABL 5.5/6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN CDVR", "code_information": [{"code": "664T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY OPEN LIV", "code_information": [{"code": "665T", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY RCP UTER", "code_information": [{"code": "667T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONOR LOBECTOMY (LUNG)", "code_information": [{"code": "S2061", "type": "HCPCS"}], "standard_charges": [{"minimum": 19281.41, "maximum": 19281.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19281.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONOR PANCREATECTOMY", "code_information": [{"code": "48550", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 19281.41, "maximum": 19281.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19281.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DONOR SERV IVF CASE RATE", "code_information": [{"code": "S4025", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPAMINE HCL/D5W", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1265", "type": "HCPCS"}, {"code": "3400300073", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.82, "maximum": 27.83, "gross_charge": 28.7, "discounted_cash": 43.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 27.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER COLOR FLOW ADD-ON", "code_information": [{"code": "93325", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93320", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93321", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOPPLER FLOW TESTING", "code_information": [{"code": "93990", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DORIPENEM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1267", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.86, "maximum": 0.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORNASE ALFA NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7639", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.03, "maximum": 52.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DORSAL RASP 12MM*120", "code_information": [{"code": "3100209364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DORSAL RASP 16MM*120", "code_information": [{"code": "3100209210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOSE OPTIMIZATION AUC - 5FU", "code_information": [{"code": "S3722", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.39, "maximum": 41.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOUBLE FIBERTAK*AR-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOUBLE FLEX WIRE*TDO", "code_information": [{"code": "3100203043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.08, "discounted_cash": 102.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DOUBLE TRANSFER TOE-HAND", "code_information": [{"code": "26554", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOWEL CANCELOUS PLUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 603.45, "maximum": 836.21, "gross_charge": 862.08, "discounted_cash": 1293.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL CANCELOUS PLUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 603.45, "maximum": 836.21, "gross_charge": 862.08, "discounted_cash": 1293.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL CANCELOUS PLUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 603.45, "maximum": 836.21, "gross_charge": 862.08, "discounted_cash": 1293.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL CANCELOUS PLUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 603.45, "maximum": 836.21, "gross_charge": 862.08, "discounted_cash": 1293.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL CANCELOUS PLUG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 603.45, "maximum": 836.21, "gross_charge": 862.08, "discounted_cash": 1293.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 603.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 646.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 732.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 689.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 10X26", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1915.9, "maximum": 2654.89, "gross_charge": 2737.0, "discounted_cash": 4105.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2654.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 10X31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2088.45, "maximum": 2893.99, "gross_charge": 2983.5, "discounted_cash": 4475.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2893.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 11X28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1915.9, "maximum": 2654.89, "gross_charge": 2737.0, "discounted_cash": 4105.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2654.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 11X31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2088.45, "maximum": 2893.99, "gross_charge": 2983.5, "discounted_cash": 4475.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2893.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 12X29", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100202351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 12X31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2088.45, "maximum": 2893.99, "gross_charge": 2983.5, "discounted_cash": 4475.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2893.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION 13X32", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100202350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2088.45, "maximum": 2893.99, "gross_charge": 2983.5, "discounted_cash": 4475.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2893.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1915.9, "maximum": 2654.89, "gross_charge": 2737.0, "discounted_cash": 4105.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2654.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2088.45, "maximum": 2893.99, "gross_charge": 2983.5, "discounted_cash": 4475.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2893.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2237.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2535.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOWEL REVISION CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1915.9, "maximum": 2654.89, "gross_charge": 2737.0, "discounted_cash": 4105.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2654.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1915.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2326.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9000", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.65, "maximum": 3.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXORUBICIN INJ 10MG", "code_information": [{"code": "Q2050", "type": "HCPCS"}], "standard_charges": [{"minimum": 114.94, "maximum": 114.94, "discounted_cash": 137.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 114.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOXYCYCLINE HYCLATE", "code_information": [{"code": "3400300270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 46.3, "discounted_cash": 69.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANTS", "code_information": [{"code": "81232", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 174.81, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN 10.2X25*RLC-10", "code_information": [{"code": "3100206619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.28, "discounted_cash": 313.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 10.2X45*RLC40-", "code_information": [{"code": "3100206620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.28, "discounted_cash": 313.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 10X25*H9651054", "code_information": [{"code": "3100206615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 12X25*H9651042", "code_information": [{"code": "3100206618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 14X25*H9651042", "code_information": [{"code": "3100206616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 6X25CM*H965105", "code_information": [{"code": "3100206613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN 8X25*H96510540", "code_information": [{"code": "3100206617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN APPENDIX ABSCESS OPEN", "code_information": [{"code": "44900", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BIFURCATED EXT", "code_information": [{"code": "3100100495", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY NEEDLE", "code_information": [{"code": "51100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLADDER BY TROCAR/CATH", "code_information": [{"code": "51101", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN BLAKE", "code_information": [{"code": "3100100496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 369.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLAKE", "code_information": [{"code": "3100102655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLAKE", "code_information": [{"code": "3100102656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 185.0, "discounted_cash": 277.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLAKE", "code_information": [{"code": "3100102657", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLAKE", "code_information": [{"code": "3100104404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 325.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN BLOOD FROM UNDER NAIL", "code_information": [{"code": "11740", "type": "CPT"}], "standard_charges": [{"minimum": 226.95, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2470.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69005", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN FINGER ABSCESS", "code_information": [{"code": "26011", "type": "CPT"}, {"code": "3340102337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2867.32, "gross_charge": 2956.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2512.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2217.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2069.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2867.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2069.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2217.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2512.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2364.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN HAND TENDON SHEATH", "code_information": [{"code": "26020", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN HEMOVAC KT MED", "code_information": [{"code": "3100207411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100100497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100102658", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100102659", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100104441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100104444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100104445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN JACKSON PRATT", "code_information": [{"code": "3100104486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 93.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG BURSA", "code_information": [{"code": "27604", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN LOWER LEG LESION", "code_information": [{"code": "27603", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN NECK/CHEST LESION", "code_information": [{"code": "21501", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2470.2, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN LUNG LESION", "code_information": [{"code": "32200", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN PANCREATIC PSEUDOCYST", "code_information": [{"code": "48510", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN PENIS LESION", "code_information": [{"code": "54015", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2109.3, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER LESION", "code_information": [{"code": "23030", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN TLS", "code_information": [{"code": "3100102284", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN TLS DRAINS", "code_information": [{"code": "3100100498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JNT/BURSA", "code_information": [{"code": "20600", "type": "CPT"}, {"code": "3480101434", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20604", "type": "CPT"}], "standard_charges": [{"minimum": 720.01, "maximum": 720.01, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20606", "type": "CPT"}], "standard_charges": [{"minimum": 720.01, "maximum": 720.01, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAIN/INJ JOINT/BURSA W/US", "code_information": [{"code": "20611", "type": "CPT"}], "standard_charges": [{"minimum": 720.01, "maximum": 720.01, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE BAG*NDB600", "code_information": [{"code": "3100210043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 384.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAINAGE CATH 10FR*G", "code_information": [{"code": "3100206337", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 295.68, "discounted_cash": 443.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAINAGE CATH 12FR*G", "code_information": [{"code": "3100206336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 295.68, "discounted_cash": 443.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAINAGE CATH 16FX25", "code_information": [{"code": "3100206679", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAINAGE EXTERNAL EA", "code_information": [{"code": "69000", "type": "CPT"}, {"code": "3480102220", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 854.37, "gross_charge": 439.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 373.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 329.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 307.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 425.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 307.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 329.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 373.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 351.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3504.82, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 372.23, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABSCESS,", "code_information": [{"code": "40800", "type": "CPT"}, {"code": "3480101899", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "gross_charge": 527.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 511.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1767.1, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "26992", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "27303", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BURSA OF FOOT", "code_information": [{"code": "28001", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65800", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65810", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYE", "code_information": [{"code": "65815", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF EYELID ABSCESS", "code_information": [{"code": "67700", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FINGER A", "code_information": [{"code": "26010", "type": "CPT"}, {"code": "3340102402", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 542.23, "gross_charge": 559.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 475.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 419.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 542.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 419.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 475.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 447.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM BURSA", "code_information": [{"code": "25031", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM LESION", "code_information": [{"code": "25028", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GLAND AB", "code_information": [{"code": "56420", "type": "CPT"}, {"code": "3340102468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 167.32, "maximum": 429.71, "gross_charge": 443.0, "discounted_cash": 305.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 376.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 332.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 310.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 429.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 310.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 332.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 241.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 376.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 354.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESI", "code_information": [{"code": "41800", "type": "CPT"}, {"code": "3480103141", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 542.23, "gross_charge": 559.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 475.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 419.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 542.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 391.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 419.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 475.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 447.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HIP JOINT", "code_information": [{"code": "27030", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HYDROCELE", "code_information": [{"code": "55000", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF KIDNEY LESION", "code_information": [{"code": "50390", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LE", "code_information": [{"code": "41016", "type": "CPT"}, {"code": "3340102386", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 7111.29, "gross_charge": 6507.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LE", "code_information": [{"code": "41017", "type": "CPT"}, {"code": "3340102385", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4134.14, "gross_charge": 4262.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4134.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3409.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "40801", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41005", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41006", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41007", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41008", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41018", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30000", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58800", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF OVARIAN CYST(S)", "code_information": [{"code": "58805", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSA", "code_information": [{"code": "26025", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PALM BURSAS", "code_information": [{"code": "26030", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "45000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3271.2, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC ABSCESS", "code_information": [{"code": "57010", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIC FLUID", "code_information": [{"code": "57020", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 551.8, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS BURSA", "code_information": [{"code": "26991", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PELVIS LESION", "code_information": [{"code": "26990", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "52700", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2013.63, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55720", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2013.63, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF PROSTATE ABSCESS", "code_information": [{"code": "55725", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2013.63, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45005", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2670.89, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY", "code_information": [{"code": "42409", "type": "CPT"}, {"code": "3340102455", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6311.79, "gross_charge": 6507.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42305", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42310", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SCROTUM ABSCESS", "code_information": [{"code": "55100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1927.74, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63172", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SPINAL CYST", "code_information": [{"code": "63173", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42720", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", "code_information": [{"code": "42725", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF TONSIL ABSCESS", "code_information": [{"code": "42700", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53040", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53080", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URINARY LEAKAGE", "code_information": [{"code": "53085", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRAINAGE PILONIDOL C", "code_information": [{"code": "10080", "type": "CPT"}, {"code": "3480101290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 854.37, "gross_charge": 527.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 511.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100102151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103676", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103677", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103678", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103679", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103687", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.36, "discounted_cash": 87.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100103688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100104447", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100104461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100104462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100104464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100104465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE", "code_information": [{"code": "3100104475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ARTHRO SHEET*5", "code_information": [{"code": "3100206962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.96, "discounted_cash": 146.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE BRACHYTHERAPY*", "code_information": [{"code": "3100203087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARM STERI 64", "code_information": [{"code": "3100207527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.24, "discounted_cash": 31.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-ARMOR*5523", "code_information": [{"code": "3100202659", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.64, "discounted_cash": 212.46, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE C-SECTION*DYNJ", "code_information": [{"code": "3100203129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.96, "discounted_cash": 59.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE EXTREMITY HEAV", "code_information": [{"code": "3100202787", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.16, "discounted_cash": 76.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE FEN*NDAN207105", "code_information": [{"code": "3100203304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.92, "discounted_cash": 1.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE FML ANGI*183-I", "code_information": [{"code": "3100210000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.92, "discounted_cash": 55.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE FULL CNTRL", "code_information": [{"code": "3100102370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 82.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HIP", "code_information": [{"code": "3100102371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE HIP W/POUCH*29", "code_information": [{"code": "3100202283", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.72, "discounted_cash": 448.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE INCISE", "code_information": [{"code": "3100102373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ISO", "code_information": [{"code": "3100102372", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 159.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ISOLATION 125X", "code_information": [{"code": "3100208311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.24, "discounted_cash": 79.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE ISOLATION*DYNJ", "code_information": [{"code": "3100207902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.36, "discounted_cash": 101.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LAP PEDIATRIC*", "code_information": [{"code": "3100209377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.16, "discounted_cash": 31.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LAP W/POUCH*89", "code_information": [{"code": "3100209032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.32, "discounted_cash": 72.48, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LARGE 60-76*89", "code_information": [{"code": "3100203334", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.32, "discounted_cash": 13.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LEVO CERVICAL*", "code_information": [{"code": "3100209497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.32, "discounted_cash": 424.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE LITHOTOMY*3511", "code_information": [{"code": "3100205898", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICRO LONG NEU", "code_information": [{"code": "3100207428", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.96, "discounted_cash": 101.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE MICRO LONG NEU", "code_information": [{"code": "3100208656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE NON FEN*NDAN20", "code_information": [{"code": "3100203303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.84, "discounted_cash": 1.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SYSTEM 32X36*6", "code_information": [{"code": "3100207564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.24, "discounted_cash": 85.86, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE UNIVERSAL DRAP", "code_information": [{"code": "3100203720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 91.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAW BLOOD OFF VENOU", "code_information": [{"code": "36591", "type": "CPT"}, {"code": "3480103100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 300.38, "gross_charge": 283.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 240.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 212.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 198.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 274.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 198.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 212.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 240.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 226.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DREAMTOME 44*M005840", "code_information": [{"code": "3100203680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DREAMWIRE .035 260 *", "code_information": [{"code": "3100203690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DREAMWIRE .035 260*M", "code_information": [{"code": "3100203688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DREAMWIRE .035 450*M", "code_information": [{"code": "3100203689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN M", "code_information": [{"code": "16025", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN S", "code_information": [{"code": "16020", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESSING", "code_information": [{"code": "3100104762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 141.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING", "code_information": [{"code": "3100104763", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING AQUACEL", "code_information": [{"code": "3100100499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.0, "discounted_cash": 133.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BOARDER 4X8", "code_information": [{"code": "3100205353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.8, "discounted_cash": 148.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING BORDER 4X10", "code_information": [{"code": "3100205289", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.4, "discounted_cash": 159.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CAST PADDIN", "code_information": [{"code": "3100100500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CAST PADDIN", "code_information": [{"code": "3100102660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING CHANGE NOT FOR BURN", "code_information": [{"code": "15852", "type": "CPT"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRESSING FLEXNET TUB", "code_information": [{"code": "3100100501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FLEXNET TUB", "code_information": [{"code": "3100102661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 100.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FLEXNET TUB", "code_information": [{"code": "3100102662", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FOAM", "code_information": [{"code": "3100104067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FOAM", "code_information": [{"code": "3100104458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING FOAMKIT*SKT", "code_information": [{"code": "3100203998", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.8, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE", "code_information": [{"code": "3100100502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING GAUZE TUBE", "code_information": [{"code": "3100100503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING HEMOSTATIC*", "code_information": [{"code": "3100202614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING INTELLI-FLO", "code_information": [{"code": "3100100504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING INTERCEED H", "code_information": [{"code": "3100100505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 594.88, "discounted_cash": 892.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING IODOFORM", "code_information": [{"code": "3100100506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING JUMPSTART2X", "code_information": [{"code": "3100204720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MATRIX BGC", "code_information": [{"code": "3100100507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.0, "discounted_cash": 237.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEPILEX 12X", "code_information": [{"code": "3100205828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 190.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEPILEX 4X1", "code_information": [{"code": "3100202265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.48, "discounted_cash": 162.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEPILEX 4X1", "code_information": [{"code": "3100202266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.8, "discounted_cash": 175.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING MEPILEX 4X6", "code_information": [{"code": "3100205827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.72, "discounted_cash": 128.58, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL/SINUS", "code_information": [{"code": "3100100508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 316.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL/SINUS", "code_information": [{"code": "3100100509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 475.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL/SINUS", "code_information": [{"code": "3100102663", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 402.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASAL/SINUS", "code_information": [{"code": "3100202921", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.8, "discounted_cash": 220.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASOPORE", "code_information": [{"code": "3100100510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 566.0, "discounted_cash": 849.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASOPORE", "code_information": [{"code": "3100102664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 638.0, "discounted_cash": 957.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NASOPORE", "code_information": [{"code": "3100102665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 824.73, "discounted_cash": 1237.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING NOSE MEROGE", "code_information": [{"code": "3100203817", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 389.76, "discounted_cash": 584.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING OASIS ULTRA", "code_information": [{"code": "3100100511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1310.0, "discounted_cash": 1965.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING PICC CHANGE", "code_information": [{"code": "3100100512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TOPIFOAM *5", "code_information": [{"code": "3100202501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.32, "discounted_cash": 64.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING TOPIFOAM *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRESSING WEBRIL", "code_information": [{"code": "3100100513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESSING WOUND MATRI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8686.04, "maximum": 12036.37, "gross_charge": 12408.63, "discounted_cash": 18612.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10547.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9306.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8686.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12036.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8686.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9306.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10547.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9926.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRG/EPG HEADER*7032", "code_information": [{"code": "3100204311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.0 X22MM*60-1", "code_information": [{"code": "3100204256", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.36, "discounted_cash": 689.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.1 X 50*01-71", "code_information": [{"code": "3100208910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.5*AR-9938-05", "code_information": [{"code": "3100208577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.6 X 50*46-10", "code_information": [{"code": "3100209053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.7 FIBERTAK*A", "code_information": [{"code": "3100203763", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.7*AR-9938-06", "code_information": [{"code": "3100208578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.8 X 115*46-1", "code_information": [{"code": "3100209052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.8*DRLL-DIP-1", "code_information": [{"code": "3100208972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 1.9*4008-000", "code_information": [{"code": "3100209418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 10MM*AR-9620-1", "code_information": [{"code": "3100205379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1173.0, "discounted_cash": 1759.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0MM", "code_information": [{"code": "3100104112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.0X102MM*45-2", "code_information": [{"code": "3100203753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.72, "discounted_cash": 607.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.1*DRLL-DIP-2", "code_information": [{"code": "3100208932", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.3 X14*8801-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL 2.4*DRILL-2.4/", "code_information": [{"code": "3100208258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.5*58850025", "code_information": [{"code": "3100208198", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.0, "discounted_cash": 624.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.7 W STOP*110", "code_information": [{"code": "3100204454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 508.84, "discounted_cash": 763.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8*4009-100", "code_information": [{"code": "3100208751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.8, "discounted_cash": 691.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8*4009-200", "code_information": [{"code": "3100208250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8*HR-D105", "code_information": [{"code": "3100208623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 231.0, "discounted_cash": 346.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.8MM HBONE*AR", "code_information": [{"code": "3100209789", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 2.9*DRLL-DIP-2", "code_information": [{"code": "3100209704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.0MM*102-0000", "code_information": [{"code": "3100209207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.2 X 250*7505", "code_information": [{"code": "3100208062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.5 X 122MM*70", "code_information": [{"code": "3100209730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 3.9 KNOTLESS*A", "code_information": [{"code": "3100203882", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL 4.5 X 170*310.", "code_information": [{"code": "3100209449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1161.9, "discounted_cash": 1742.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ACUTRAK", "code_information": [{"code": "3100100514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 846.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ACUTRAK", "code_information": [{"code": "3100102666", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 1174.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ACUTRAK", "code_information": [{"code": "3100102667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 1404.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL AND PIN SET", "code_information": [{"code": "3100100515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL AO", "code_information": [{"code": "3100104634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ARTHREX", "code_information": [{"code": "3100102402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL AWL 9MM*663091", "code_information": [{"code": "3100204545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100100516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100100556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1434.0, "discounted_cash": 2151.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 661.0, "discounted_cash": 991.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 555.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102671", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 775.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102673", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 669.0, "discounted_cash": 1003.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102674", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 731.0, "discounted_cash": 1096.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 777.0, "discounted_cash": 1165.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102676", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 877.0, "discounted_cash": 1315.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102729", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.12, "discounted_cash": 486.18, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100102731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 738.0, "discounted_cash": 1107.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104362", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 699.0, "discounted_cash": 1048.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 804.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104398", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.68, "discounted_cash": 437.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 445.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.72, "discounted_cash": 391.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104566", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.8, "discounted_cash": 565.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.0, "discounted_cash": 835.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 506.0, "discounted_cash": 759.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT", "code_information": [{"code": "3100104748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT *6975015", "code_information": [{"code": "3100203954", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT *AR-8737-5", "code_information": [{"code": "3100204949", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT .059*AR-18", "code_information": [{"code": "3100209244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT .079*AR-18", "code_information": [{"code": "3100208695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 0.7*AR-187", "code_information": [{"code": "3100207338", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.0*03.130", "code_information": [{"code": "3100206708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.76, "discounted_cash": 575.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.0MM*03.1", "code_information": [{"code": "3100203209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.1*00-480", "code_information": [{"code": "3100204083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.1*AR-187", "code_information": [{"code": "3100207339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.1X65MM*0", "code_information": [{"code": "3100202273", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.2*AR-187", "code_information": [{"code": "3100207676", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.3MM*03.1", "code_information": [{"code": "3100203210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.4*3911-7", "code_information": [{"code": "3100209463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.4MM*60-1", "code_information": [{"code": "3100204039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.36, "discounted_cash": 689.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5*00-480", "code_information": [{"code": "3100204084", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5*AR-187", "code_information": [{"code": "3100206084", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5MM*03.1", "code_information": [{"code": "3100202534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5X50MM", "code_information": [{"code": "3100104047", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5X74MM*0", "code_information": [{"code": "3100202468", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.5X88MM*0", "code_information": [{"code": "3100202870", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.6 X 115*", "code_information": [{"code": "3100208628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.6 X50*52", "code_information": [{"code": "3100206270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 804.0, "discounted_cash": 1206.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.6*AR-187", "code_information": [{"code": "3100209078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.6*AR-871", "code_information": [{"code": "3100206070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.7 LONG*A", "code_information": [{"code": "3100210015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.7*AR-187", "code_information": [{"code": "3100205545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.7*AR-187", "code_information": [{"code": "3100206987", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.7MM*AR-1", "code_information": [{"code": "3100208534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.7MM*AR-1", "code_information": [{"code": "3100208649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.8 X 50*2", "code_information": [{"code": "3100208627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.8*AR-360", "code_information": [{"code": "3100209970", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.75, "discounted_cash": 685.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.9 X50*25", "code_information": [{"code": "3100206122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 688.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.9*IS1106", "code_information": [{"code": "3100205214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 695.67, "discounted_cash": 1043.51, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.9MM CAN*", "code_information": [{"code": "3100205109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 741.93, "discounted_cash": 1112.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 1.9MM*60-1", "code_information": [{"code": "3100204040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.36, "discounted_cash": 689.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 10.5*CES-3", "code_information": [{"code": "3100206286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 11.5*CES-3", "code_information": [{"code": "3100205852", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 13.0 X 300", "code_information": [{"code": "3100208901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1552.26, "discounted_cash": 2328.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 14MM*05-10", "code_information": [{"code": "3100205181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 16MM*05-10", "code_information": [{"code": "3100208400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 X 125*", "code_information": [{"code": "3100205112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.32, "discounted_cash": 660.48, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0 X 145*", "code_information": [{"code": "3100208869", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.93, "discounted_cash": 1981.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*00-480", "code_information": [{"code": "3100208585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*00-480", "code_information": [{"code": "3100208692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*03.130", "code_information": [{"code": "3100205042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*231220", "code_information": [{"code": "3100206408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*AR-187", "code_information": [{"code": "3100206950", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*AR-188", "code_information": [{"code": "3100208506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*AR-871", "code_information": [{"code": "3100206130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0*AR-896", "code_information": [{"code": "3100208540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM CANN", "code_information": [{"code": "3100203651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 736.86, "discounted_cash": 1105.29, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM*03.1", "code_information": [{"code": "3100202419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 345.0, "discounted_cash": 517.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM*03.1", "code_information": [{"code": "3100205137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 541.62, "discounted_cash": 812.43, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM*03.1", "code_information": [{"code": "3100205669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 509.84, "discounted_cash": 764.76, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM*316-", "code_information": [{"code": "3100205398", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1245.0, "discounted_cash": 1867.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0MM*AR-1", "code_information": [{"code": "3100208068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.0X135MM*", "code_information": [{"code": "3100202875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.4, "discounted_cash": 866.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2*Z400-1", "code_information": [{"code": "3100208780", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.5, "discounted_cash": 1023.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2MM*AR-8", "code_information": [{"code": "3100203336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2X115*50", "code_information": [{"code": "3100202580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.2X70*50-", "code_information": [{"code": "3100202581", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.3MM*80-0", "code_information": [{"code": "3100205580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 981.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.4*AR-292", "code_information": [{"code": "3100209968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.75, "discounted_cash": 685.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.4*TB-100", "code_information": [{"code": "3100206806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.4MM*6956", "code_information": [{"code": "3100203416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 649.5, "discounted_cash": 974.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5 *CS612", "code_information": [{"code": "3100204607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5 130MM*", "code_information": [{"code": "3100208350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5 X 110*", "code_information": [{"code": "3100205370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 319.68, "discounted_cash": 479.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5* DRUJ-", "code_information": [{"code": "3100207300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5*03.133", "code_information": [{"code": "3100207096", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 516.84, "discounted_cash": 775.26, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5*705025", "code_information": [{"code": "3100205467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 779.94, "discounted_cash": 1169.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5*AR-415", "code_information": [{"code": "3100207389", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM*03.1", "code_information": [{"code": "3100205696", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.92, "discounted_cash": 874.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM*AR-8", "code_information": [{"code": "3100205593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.5MM*AR-8", "code_information": [{"code": "3100207419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.6 X 135*", "code_information": [{"code": "3100205106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.6*AR-871", "code_information": [{"code": "3100205816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.6MM*7038", "code_information": [{"code": "3100209731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7 X 145*", "code_information": [{"code": "3100209617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1397.13, "discounted_cash": 2095.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7 X160*0", "code_information": [{"code": "3100205371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1474.62, "discounted_cash": 2211.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7*A070-0", "code_information": [{"code": "3100203067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7*AR-188", "code_information": [{"code": "3100209385", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.7X122MM*", "code_information": [{"code": "3100202876", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.4, "discounted_cash": 866.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8*0237-2", "code_information": [{"code": "3100208345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 709.5, "discounted_cash": 1064.25, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8*03.133", "code_information": [{"code": "3100207362", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 511.53, "discounted_cash": 767.3, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8*03.133", "code_information": [{"code": "3100209095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.56, "discounted_cash": 675.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.8MM*324.", "code_information": [{"code": "3100202246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 2.9*AR-874", "code_information": [{"code": "3100207696", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3 FLUTED S", "code_information": [{"code": "3100100517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 714.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3 FLUTED S", "code_information": [{"code": "3100102677", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3 FLUTED S", "code_information": [{"code": "3100102678", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 547.0, "discounted_cash": 820.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3 FLUTED S", "code_information": [{"code": "3100102679", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 642.3, "discounted_cash": 963.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3 X 170*70", "code_information": [{"code": "3100205381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.69, "discounted_cash": 878.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0*AR-415", "code_information": [{"code": "3100207390", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0*AR-962", "code_information": [{"code": "3100205378", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0*AR-962", "code_information": [{"code": "3100205842", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0*TB-100", "code_information": [{"code": "3100206807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.6, "discounted_cash": 333.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.0MM*AR-8", "code_information": [{"code": "3100203288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2 CANN*0", "code_information": [{"code": "3100204685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1416.0, "discounted_cash": 2124.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2 CANN*A", "code_information": [{"code": "3100205070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2 X 16*7", "code_information": [{"code": "3100204912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 779.94, "discounted_cash": 1169.91, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2*AR-875", "code_information": [{"code": "3100206567", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2*G36003", "code_information": [{"code": "3100208727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2X30MM*3", "code_information": [{"code": "3100202316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 402.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.2X40MM*3", "code_information": [{"code": "3100202689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.3X25MM*7", "code_information": [{"code": "3100203811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.3X25MM*7", "code_information": [{"code": "3100205350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.3X40MM*7", "code_information": [{"code": "3100203812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 266.0, "discounted_cash": 399.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.3X40MM*7", "code_information": [{"code": "3100205342", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5 CANN*7", "code_information": [{"code": "3100209944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 906.0, "discounted_cash": 1359.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5 FLEX*7", "code_information": [{"code": "3100204048", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1072.5, "discounted_cash": 1608.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5 X 135*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 705.6, "maximum": 977.76, "gross_charge": 1008.0, "discounted_cash": 1512.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 856.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 705.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 977.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 705.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 856.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5*03.133", "code_information": [{"code": "3100209094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 267.0, "discounted_cash": 400.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.5MM*L070", "code_information": [{"code": "3100203645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.6*AR-874", "code_information": [{"code": "3100207719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3.7MM*AR89", "code_information": [{"code": "3100205586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 3MM*AR-895", "code_information": [{"code": "3100205475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4 BI-CORTC", "code_information": [{"code": "3100100518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 304.0, "discounted_cash": 456.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4 FLUTE*T0", "code_information": [{"code": "3100204521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0 X25*70", "code_information": [{"code": "3100205323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0 X25*70", "code_information": [{"code": "3100205349", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0 X40*70", "code_information": [{"code": "3100205195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0*DRUJ-C", "code_information": [{"code": "3100207302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0X40*700", "code_information": [{"code": "3100205298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.0X40MM*2", "code_information": [{"code": "3100202251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.2 X 130*", "code_information": [{"code": "3100202951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 516.03, "discounted_cash": 774.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.2 X 180*", "code_information": [{"code": "3100203187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.8, "discounted_cash": 743.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.2 X 180*", "code_information": [{"code": "3100203460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 553.98, "discounted_cash": 830.97, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.2 X 340*", "code_information": [{"code": "3100202950", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 516.03, "discounted_cash": 774.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.3 LONG*0", "code_information": [{"code": "3100208365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.3 X 216*", "code_information": [{"code": "3100204913", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 768.36, "discounted_cash": 1152.54, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.3 X413*0", "code_information": [{"code": "3100205598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1761.75, "discounted_cash": 2642.63, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.4*S7540", "code_information": [{"code": "3100208364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1008.03, "discounted_cash": 1512.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.5*DRUJ-C", "code_information": [{"code": "3100207303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.5MM *AR-", "code_information": [{"code": "3100202925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.5MM*AR-8", "code_information": [{"code": "3100203289", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 4.5MM*AR-8", "code_information": [{"code": "3100209269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.0 CANN*A", "code_information": [{"code": "3100205254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.0 X 230*", "code_information": [{"code": "3100202952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 516.03, "discounted_cash": 774.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.0*03.008", "code_information": [{"code": "3100209102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 654.72, "discounted_cash": 982.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.0*DRUJ-C", "code_information": [{"code": "3100207304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.5 BIO-CK", "code_information": [{"code": "3100202619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.5 LONG*A", "code_information": [{"code": "3100208144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 5.5MM*AR-8", "code_information": [{"code": "3100204496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 7.0*400146", "code_information": [{"code": "3100208045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1263.0, "discounted_cash": 1894.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT 9.5*CES-30", "code_information": [{"code": "3100205853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AESCULAP", "code_information": [{"code": "3100103868", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AO", "code_information": [{"code": "3100100519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 694.0, "discounted_cash": 1041.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AP FITTING", "code_information": [{"code": "3100100520", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX", "code_information": [{"code": "3100102303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX", "code_information": [{"code": "3100103812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX", "code_information": [{"code": "3100103821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 285.6, "discounted_cash": 428.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100100521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX CA", "code_information": [{"code": "3100102687", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX FO", "code_information": [{"code": "3100100522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.8, "discounted_cash": 497.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX FO", "code_information": [{"code": "3100102688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ARTHREX FO", "code_information": [{"code": "3100102689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 399.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ASSY 2MM*S", "code_information": [{"code": "3100206791", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ASSY 3MM*S", "code_information": [{"code": "3100206792", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ASSY 4MM*S", "code_information": [{"code": "3100206793", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ASSY 5MM*S", "code_information": [{"code": "3100206794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ASSY 6MM*S", "code_information": [{"code": "3100206795", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ASSY 7MM*S", "code_information": [{"code": "3100206796", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT AVIATOR", "code_information": [{"code": "3100100523", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1079.0, "discounted_cash": 1618.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT BIO-COMP S", "code_information": [{"code": "3100100524", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT BIO-COMP S", "code_information": [{"code": "3100102691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CALIBRATED", "code_information": [{"code": "3100100525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CALIBRATED", "code_information": [{"code": "3100100526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1770.0, "discounted_cash": 2655.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CAN 3.0*AR", "code_information": [{"code": "3100207553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CAN 4.5*AR", "code_information": [{"code": "3100208312", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CAN 5.5*AR", "code_information": [{"code": "3100208313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANC 25MM", "code_information": [{"code": "3100104064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN", "code_information": [{"code": "3100100527", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2156.0, "discounted_cash": 3234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN", "code_information": [{"code": "3100102301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1323.0, "discounted_cash": 1984.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN", "code_information": [{"code": "3100102692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN", "code_information": [{"code": "3100102693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1223.0, "discounted_cash": 1834.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN", "code_information": [{"code": "3100102694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 2457.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN", "code_information": [{"code": "3100102695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2128.0, "discounted_cash": 3192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 2.0MM", "code_information": [{"code": "3100202946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.5, "discounted_cash": 816.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 3.0*A", "code_information": [{"code": "3100204494", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 3.0*A", "code_information": [{"code": "3100205659", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 3.O*A", "code_information": [{"code": "3100203488", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 4.0*A", "code_information": [{"code": "3100204495", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 4.3*A", "code_information": [{"code": "3100203489", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANN 6MM*A", "code_information": [{"code": "3100204339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100100528", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1514.0, "discounted_cash": 2271.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100100529", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100102696", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1487.0, "discounted_cash": 2230.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100102697", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1496.0, "discounted_cash": 2244.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100102698", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1712.0, "discounted_cash": 2568.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100102699", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CANNULATED", "code_information": [{"code": "3100104331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1190.1, "discounted_cash": 1785.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CARBIDE SY", "code_information": [{"code": "3100100530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT COUPLING", "code_information": [{"code": "3100100531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 1188.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT COUPLING", "code_information": [{"code": "3100102700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT COUPLING", "code_information": [{"code": "3100102701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 957.0, "discounted_cash": 1435.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT CSTOP", "code_information": [{"code": "3100104245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT DEPUY", "code_information": [{"code": "3100103994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT DJO", "code_information": [{"code": "3100100532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT DJO CAL", "code_information": [{"code": "3100100533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ENDOSCOPIC", "code_information": [{"code": "3100100534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.0, "discounted_cash": 781.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ENDOSCOPIC", "code_information": [{"code": "3100102702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 820.0, "discounted_cash": 1230.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT FAST", "code_information": [{"code": "3100104533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.92, "discounted_cash": 562.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT FIXED", "code_information": [{"code": "3100100535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT FLEX", "code_information": [{"code": "3100100536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100100537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100100538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1586.0, "discounted_cash": 2379.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100102703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 804.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100102704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 825.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100102705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 2457.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100102706", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1718.0, "discounted_cash": 2577.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100102707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1801.0, "discounted_cash": 2701.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT HOWMEDICA", "code_information": [{"code": "3100102708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1834.0, "discounted_cash": 2751.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT JUGGERKNOT", "code_information": [{"code": "3100100539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.0, "discounted_cash": 462.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT JUGGERKNOT", "code_information": [{"code": "3100102709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT K-MEDIC RO", "code_information": [{"code": "3100100540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT LINDEMANN", "code_information": [{"code": "3100100541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT LOCKING SC", "code_information": [{"code": "3100100542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT LONG SYNTH", "code_information": [{"code": "3100100543", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 468.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT LONG SYNTH", "code_information": [{"code": "3100102710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT MINI 2.5*2", "code_information": [{"code": "3100207058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT NAV*NAVG36", "code_information": [{"code": "3100204303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1959.0, "discounted_cash": 2938.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT NON-CANNUL", "code_information": [{"code": "3100100544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT OASYS", "code_information": [{"code": "3100100545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT OASYS", "code_information": [{"code": "3100104377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT OSTEOMED", "code_information": [{"code": "3100103851", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT OSTEOMED", "code_information": [{"code": "3100103853", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 735.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT PERIP*5901", "code_information": [{"code": "3100204968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.4, "discounted_cash": 309.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT QUICK RELE", "code_information": [{"code": "3100100546", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT QUICKFIX", "code_information": [{"code": "3100100547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 331.8, "discounted_cash": 497.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT QUICKSET F", "code_information": [{"code": "3100100548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1607.0, "discounted_cash": 2410.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT REGENT 10M", "code_information": [{"code": "3100202278", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT REGENT ACP", "code_information": [{"code": "3100100549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SELF SCREW", "code_information": [{"code": "3100100550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SELF SCREW", "code_information": [{"code": "3100102711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 314.0, "discounted_cash": 471.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SELF SCREW", "code_information": [{"code": "3100102712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOFAMOR", "code_information": [{"code": "3100100551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 912.0, "discounted_cash": 1368.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOFAMOR", "code_information": [{"code": "3100102713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOFAMOR", "code_information": [{"code": "3100102714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SOFAMOR", "code_information": [{"code": "3100104436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STERILE 11", "code_information": [{"code": "3100206310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 501.0, "discounted_cash": 751.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STOP", "code_information": [{"code": "3100100552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 354.0, "discounted_cash": 531.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STOP", "code_information": [{"code": "3100102715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 591.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STOP", "code_information": [{"code": "3100102716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 399.0, "discounted_cash": 598.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STOP", "code_information": [{"code": "3100102717", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STOP", "code_information": [{"code": "3100102718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 886.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STRAIGHT S", "code_information": [{"code": "3100100553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STRAIGHT S", "code_information": [{"code": "3100104420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.0, "discounted_cash": 235.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STRYKER", "code_information": [{"code": "3100100554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 711.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT STYRKER", "code_information": [{"code": "3100103863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 571.0, "discounted_cash": 856.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100100555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 502.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102425", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 639.0, "discounted_cash": 958.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 563.0, "discounted_cash": 844.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 475.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.64, "discounted_cash": 384.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.0, "discounted_cash": 459.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.96, "discounted_cash": 436.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 621.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 804.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100102726", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT SYNTHES", "code_information": [{"code": "3100104183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 574.0, "discounted_cash": 861.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT UCSS*87300", "code_information": [{"code": "3100209701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 1485.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT VARIABLE", "code_information": [{"code": "3100104144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2108.0, "discounted_cash": 3162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT VERTEX SEL", "code_information": [{"code": "3100100557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/ DEPTH M", "code_information": [{"code": "3100100558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 537.64, "discounted_cash": 806.46, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/AO FITTI", "code_information": [{"code": "3100100559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/COLOR MA", "code_information": [{"code": "3100100560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 933.0, "discounted_cash": 1399.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/COLOR MA", "code_information": [{"code": "3100102732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1171.0, "discounted_cash": 1756.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/COLOR MA", "code_information": [{"code": "3100102733", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1203.0, "discounted_cash": 1804.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/COLOR MA", "code_information": [{"code": "3100102734", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1265.0, "discounted_cash": 1897.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/DEPTH", "code_information": [{"code": "3100100561", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 471.0, "discounted_cash": 706.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT W/STOP", "code_information": [{"code": "3100100562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 801.0, "discounted_cash": 1201.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ZIMMER CAN", "code_information": [{"code": "3100100563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2156.0, "discounted_cash": 3234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ZIMMER CAN", "code_information": [{"code": "3100102735", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ZIMMER STA", "code_information": [{"code": "3100100564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT ZIMMER TWI", "code_information": [{"code": "3100100565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT* K100-115", "code_information": [{"code": "3100207497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.5, "discounted_cash": 1023.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*19805-S", "code_information": [{"code": "3100207115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*6975150", "code_information": [{"code": "3100204386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 711.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*8530636", "code_information": [{"code": "3100207406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL 2.0/", "code_information": [{"code": "3100206146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL 2.3/", "code_information": [{"code": "3100206147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-1.6/", "code_information": [{"code": "3100206225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-1.6/", "code_information": [{"code": "3100206511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-1.60", "code_information": [{"code": "3100203138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-1.8/", "code_information": [{"code": "3100206394", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-1.8/", "code_information": [{"code": "3100207709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-2.0/", "code_information": [{"code": "3100206435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-2.3/", "code_information": [{"code": "3100204064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-2.3/", "code_information": [{"code": "3100206223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DRILL-3.0/", "code_information": [{"code": "3100207710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*DWD060", "code_information": [{"code": "3100205304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 1210.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT*G3606010", "code_information": [{"code": "3100204277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BIT1.9X115*50-", "code_information": [{"code": "3100202582", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BITS*2318-20-0", "code_information": [{"code": "3100206676", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 896.0, "discounted_cash": 1344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL BITT", "code_information": [{"code": "3100104542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1679.0, "discounted_cash": 2518.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN", "code_information": [{"code": "3100104254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 2.0*101-0", "code_information": [{"code": "3100209672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 738.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 2.5MM*348", "code_information": [{"code": "3100202764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.25, "discounted_cash": 804.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 2.7*127-0", "code_information": [{"code": "3100209673", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 492.0, "discounted_cash": 738.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 3.5*70525", "code_information": [{"code": "3100208307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 895.59, "discounted_cash": 1343.39, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 3.5MM*348", "code_information": [{"code": "3100202765", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 555.75, "discounted_cash": 833.63, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN 4.0MM*348", "code_information": [{"code": "3100202766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 575.25, "discounted_cash": 862.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN WRIST*8W0", "code_information": [{"code": "3100208472", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANN*Z410-150-", "code_information": [{"code": "3100208163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.5, "discounted_cash": 1023.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CANNULATE ARTH", "code_information": [{"code": "3100103877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CARTRIDGE*7531", "code_information": [{"code": "3100206766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2508.8, "discounted_cash": 3763.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CASPAR DISTRAC", "code_information": [{"code": "3100100566", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CASPAR DISTRAC", "code_information": [{"code": "3100102736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 302.4, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL COCHLEAR", "code_information": [{"code": "3100100567", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL COCHLEAR", "code_information": [{"code": "3100102737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 718.0, "discounted_cash": 1077.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CUT2.5X80*DRLL", "code_information": [{"code": "3100203398", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL CUTT 2.7X70*US", "code_information": [{"code": "3100203397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL DEPTH POWERPIC", "code_information": [{"code": "3100100568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 606.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL DEPUY", "code_information": [{"code": "3100103990", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FLIPCUTTER", "code_information": [{"code": "3100100569", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL FOR SWIVELOCK", "code_information": [{"code": "3100100570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GLENOID *804-0", "code_information": [{"code": "3100210063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2732.6, "discounted_cash": 4098.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GLENOID 2.5MM*", "code_information": [{"code": "3100203306", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GLENOID 3.5*80", "code_information": [{"code": "3100209912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 1854.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GLENOID CANNUL", "code_information": [{"code": "3100100571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE", "code_information": [{"code": "3100100572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE", "code_information": [{"code": "3100102738", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE 3.2*312.", "code_information": [{"code": "3100204307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 783.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE CORACOID", "code_information": [{"code": "3100100574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE HANDLE", "code_information": [{"code": "3100100575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE LOCKING", "code_information": [{"code": "3100100576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE PARALLEL", "code_information": [{"code": "3100100577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE PARALLEL", "code_information": [{"code": "3100100578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE PARALLEL", "code_information": [{"code": "3100102739", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE PIN 2.4*", "code_information": [{"code": "3100204696", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE UNIV", "code_information": [{"code": "3100100579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1345.0, "discounted_cash": 2017.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE UNIV", "code_information": [{"code": "3100102740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1441.0, "discounted_cash": 2161.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE UNIV", "code_information": [{"code": "3100102741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1559.0, "discounted_cash": 2338.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE W/DEPTH", "code_information": [{"code": "3100100573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1388.0, "discounted_cash": 2082.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE W/DEPTH", "code_information": [{"code": "3100100580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1093.0, "discounted_cash": 1639.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE W/DEPTH", "code_information": [{"code": "3100102742", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1866.0, "discounted_cash": 2799.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL GUIDE W/SLEEVE", "code_information": [{"code": "3100100581", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 917.0, "discounted_cash": 1375.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HANDDRILL", "code_information": [{"code": "3100100582", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.0, "discounted_cash": 520.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL HARD BONE 2.4*", "code_information": [{"code": "3100209969", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.75, "discounted_cash": 685.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL INTRACEPT*RLV0", "code_information": [{"code": "3100209155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL JACOBS", "code_information": [{"code": "3100100583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2116.0, "discounted_cash": 3174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL KIT", "code_information": [{"code": "3100103806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 1485.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL KIT SPEED IMPL", "code_information": [{"code": "3100204463", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1277.1, "discounted_cash": 1915.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LONG 3.0 X 30*", "code_information": [{"code": "3100204328", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL LONG 4 X 80*KI", "code_information": [{"code": "3100204330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL MINI / MICRO L", "code_information": [{"code": "3100100584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 903.0, "discounted_cash": 1354.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL MINI / MICRO L", "code_information": [{"code": "3100102743", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 939.0, "discounted_cash": 1408.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ORTHO SOLUTION", "code_information": [{"code": "3100103914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PATELL", "code_information": [{"code": "3100104629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 711.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PILOT OSTEOMED", "code_information": [{"code": "3100103824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 694.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN", "code_information": [{"code": "3100100585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 2565.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN 3.7MM*AR-2", "code_information": [{"code": "3100203559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN ACL TIGHRO", "code_information": [{"code": "3100100586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN BICEP 3.2*", "code_information": [{"code": "3100203715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN DISPOSABLE", "code_information": [{"code": "3100100587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN RETROBUTTO", "code_information": [{"code": "3100100588", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN TIP", "code_information": [{"code": "3100100589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN TIP 3.5*AR", "code_information": [{"code": "3100205245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PIN TRIM-IT", "code_information": [{"code": "3100100590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL POWERPICK", "code_information": [{"code": "3100100591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 606.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PRFL 5.0MM FT*", "code_information": [{"code": "3100204726", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PROFILE 7MM*AR", "code_information": [{"code": "3100210179", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL PROFILE MICRO", "code_information": [{"code": "3100104148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QC", "code_information": [{"code": "3100104180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK 2.8*4027", "code_information": [{"code": "3100208251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK REL", "code_information": [{"code": "3100103968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 618.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK REL", "code_information": [{"code": "3100103969", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 444.52, "discounted_cash": 666.78, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK RELE", "code_information": [{"code": "3100104353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK RELE", "code_information": [{"code": "3100104354", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL QUICK RELE 1.6", "code_information": [{"code": "3100205023", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW CENTRAL", "code_information": [{"code": "3100100592", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 609.0, "discounted_cash": 913.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW PERIPHER", "code_information": [{"code": "3100100593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.23, "discounted_cash": 681.35, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SCREW VARIABLE", "code_information": [{"code": "3100100594", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SHAVER", "code_information": [{"code": "3100104736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SHORT 3 X 30*K", "code_information": [{"code": "3100204329", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SHORT 3X30*KIT", "code_information": [{"code": "3100204482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SHORT 4.8*7107", "code_information": [{"code": "3100209127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1431.0, "discounted_cash": 2146.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR DRAINAGE", "code_information": [{"code": "61108", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRILL SKULL FOR IMPLANTATION", "code_information": [{"code": "61107", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRILL SLEEVE", "code_information": [{"code": "3100100595", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1482.0, "discounted_cash": 2223.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE", "code_information": [{"code": "3100102744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 505.0, "discounted_cash": 757.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE", "code_information": [{"code": "3100102745", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 511.0, "discounted_cash": 766.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE", "code_information": [{"code": "3100102746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1094.0, "discounted_cash": 1641.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE", "code_information": [{"code": "3100102747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1214.0, "discounted_cash": 1821.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE", "code_information": [{"code": "3100102748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1635.0, "discounted_cash": 2452.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE COVER", "code_information": [{"code": "3100102304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE GUIDE", "code_information": [{"code": "3100100596", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SLEEVE RETRO G", "code_information": [{"code": "3100100597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SPEEDGUIDE", "code_information": [{"code": "3100100598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 640.0, "discounted_cash": 960.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEP", "code_information": [{"code": "3100100599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STEP BIT 2.5*A", "code_information": [{"code": "3100205082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL STRYKER", "code_information": [{"code": "3100100600", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1079.0, "discounted_cash": 1618.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SUCTION DEVICE", "code_information": [{"code": "3100100601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2023.0, "discounted_cash": 3034.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL SUTURETAK", "code_information": [{"code": "3100100602", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TALAR PEG 4MM*", "code_information": [{"code": "3100208109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TALAR PEG*IB20", "code_information": [{"code": "3100208158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TIBIAL*3360004", "code_information": [{"code": "3100208157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TIP 2 PIN PASS", "code_information": [{"code": "3100204622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.04, "discounted_cash": 886.56, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TIP GUIDE ACL", "code_information": [{"code": "3100104460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TIP GUIDE PIN", "code_information": [{"code": "3100100603", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.4, "discounted_cash": 233.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100100604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100100605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 681.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 700.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.0, "discounted_cash": 799.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 584.0, "discounted_cash": 876.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.0, "discounted_cash": 753.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102754", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.0, "discounted_cash": 775.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102755", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 530.0, "discounted_cash": 795.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102756", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 533.0, "discounted_cash": 799.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102757", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102758", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 566.0, "discounted_cash": 849.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102759", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 886.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100102761", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100104258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100104341", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100104513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST", "code_information": [{"code": "3100104751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 604.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST 1.1X50MM", "code_information": [{"code": "3100204112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL TWIST KLS", "code_information": [{"code": "3100100606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL VRS 2.7*110028", "code_information": [{"code": "3100207555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 306.0, "discounted_cash": 459.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ZIMMER FEMORAL", "code_information": [{"code": "3100102762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 1188.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ZIMMER FEMORAL", "code_information": [{"code": "3100102763", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ZIMMER FREE HA", "code_information": [{"code": "3100100607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL ZIMMER WITH ST", "code_information": [{"code": "3100100608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL*DRILL-1.6/095C", "code_information": [{"code": "3100206705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL*DRILL-2.1/100C", "code_information": [{"code": "3100207775", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILL*DRILL-2.1/110C", "code_information": [{"code": "3100206464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILLING TEMPLATES*E", "code_information": [{"code": "3100204465", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.4, "discounted_cash": 567.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRILLL BIT 3.2X230MM", "code_information": [{"code": "3100202563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVE HEXAL", "code_information": [{"code": "3100104217", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVE POLYAXIL", "code_information": [{"code": "3100104670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVE SHAFT SEAL RIA", "code_information": [{"code": "3100100610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 2.5*DRVR-HCS-", "code_information": [{"code": "3100208933", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER 3.5*DRVR-HCS-", "code_information": [{"code": "3100209705", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BALL TIP LOCK", "code_information": [{"code": "3100100611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1134.0, "discounted_cash": 1701.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT", "code_information": [{"code": "3100102152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 759.0, "discounted_cash": 1138.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT", "code_information": [{"code": "3100103689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.0, "discounted_cash": 624.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT", "code_information": [{"code": "3100104534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 461.44, "discounted_cash": 692.16, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT 1.3MM*231", "code_information": [{"code": "3100206694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 426.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT 1.3MM*231", "code_information": [{"code": "3100209745", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.92, "discounted_cash": 562.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER BIT 2.0/2.5*2", "code_information": [{"code": "3100206409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 284.0, "discounted_cash": 426.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER EVOLUTION HEX", "code_information": [{"code": "3100100612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1449.0, "discounted_cash": 2173.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HCS", "code_information": [{"code": "3100104181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER HEX CANN", "code_information": [{"code": "3100104338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER LOCK SLEEVE*7", "code_information": [{"code": "3100207517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER MINI", "code_information": [{"code": "3100104574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 714.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER MINI*23121100", "code_information": [{"code": "3100207379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER REDUCT 2.0*DR", "code_information": [{"code": "3100208973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT T10*AR-", "code_information": [{"code": "3100208722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.25, "discounted_cash": 1866.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT T10*AR-", "code_information": [{"code": "3100209222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT T4*AR-1", "code_information": [{"code": "3100208436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.25, "discounted_cash": 1866.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT T6*AR-1", "code_information": [{"code": "3100207235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT T8*AR-1", "code_information": [{"code": "3100208652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.25, "discounted_cash": 1866.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT*7480741", "code_information": [{"code": "3100207516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT*DVHX-2.", "code_information": [{"code": "3100206725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SHAFT*DVHX25/", "code_information": [{"code": "3100206397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SQUARE 1.5*SD", "code_information": [{"code": "3100209649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SQUARE 2.0*SD", "code_information": [{"code": "3100207521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER SWIVEL", "code_information": [{"code": "3100100613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 106.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T10 HEXALOBE*", "code_information": [{"code": "3100208000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER T10*AR-18800-", "code_information": [{"code": "3100209060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.25, "discounted_cash": 1866.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER TIBIA REAMER*", "code_information": [{"code": "3100208110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 733.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER TORX*DVTX-8", "code_information": [{"code": "3100207551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER UNIV CONN*DRV", "code_information": [{"code": "3100202407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 714.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER UNIV T20*DRVR", "code_information": [{"code": "3100203392", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER*DVHX-1.2/055C", "code_information": [{"code": "3100206858", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER*DVHX-1.5/070C", "code_information": [{"code": "3100206228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER*DVHX-1.6/070M", "code_information": [{"code": "3100207711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.0, "discounted_cash": 1116.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER*DVHX-2.0/070C", "code_information": [{"code": "3100206466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRIVER*DVHX-2.4/070M", "code_information": [{"code": "3100207712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 744.0, "discounted_cash": 1116.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRLL BIT 3.2*MWJ126", "code_information": [{"code": "3100206897", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DRONABINOL 2.5MG ORAL", "code_information": [{"code": "Q0167", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.84, "maximum": 0.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DROPERIDOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1790", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.96, "maximum": 22.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DROPERIDOL/FENTANYL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1810", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DRUG ADMIN & HEMODYNMIC MEAS", "code_information": [{"code": "93463", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ACETAMINOPHEN", "code_information": [{"code": "80143", "type": "CPT"}], "standard_charges": [{"minimum": 41.39, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY AMIODARONE", "code_information": [{"code": "80151", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FELBAMATE", "code_information": [{"code": "80167", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY FLECAINIDE", "code_information": [{"code": "80181", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY INFLIXIMAB", "code_information": [{"code": "80230", "type": "CPT"}], "standard_charges": [{"minimum": 38.57, "maximum": 41.39, "discounted_cash": 61.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY ITRACONAZOLE", "code_information": [{"code": "80189", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 41.39, "discounted_cash": 43.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LACOSAMIDE", "code_information": [{"code": "80235", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 41.39, "discounted_cash": 43.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY LEFLUNOMIDE", "code_information": [{"code": "80193", "type": "CPT"}], "standard_charges": [{"minimum": 38.57, "maximum": 41.39, "discounted_cash": 61.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY METHOTREXATE", "code_information": [{"code": "80204", "type": "CPT"}], "standard_charges": [{"minimum": 38.57, "maximum": 41.39, "discounted_cash": 61.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY POSACONAZOLE", "code_information": [{"code": "80187", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 41.39, "discounted_cash": 43.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY RUFINAMIDE", "code_information": [{"code": "80210", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 41.39, "discounted_cash": 43.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY SALICYLATE", "code_information": [{"code": "80179", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY VEDOLIZUMAB", "code_information": [{"code": "80280", "type": "CPT"}], "standard_charges": [{"minimum": 38.57, "maximum": 41.39, "discounted_cash": 61.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASSAY VORICONAZOLE", "code_information": [{"code": "80285", "type": "CPT"}], "standard_charges": [{"minimum": 27.11, "maximum": 41.39, "discounted_cash": 43.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG ASY HYDROXYCHLOROQUINE", "code_information": [{"code": "80220", "type": "CPT"}], "standard_charges": [{"minimum": 18.64, "maximum": 41.39, "discounted_cash": 29.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN AMPHETAMINES 1/2", "code_information": [{"code": "80324", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN CLS A IN", "code_information": [{"code": "G0479", "type": "HCPCS"}, {"code": "3440103056", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 44.95, "maximum": 472.39, "gross_charge": 487.0, "discounted_cash": 730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 365.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 472.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 365.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUAL 1 C", "code_information": [{"code": "80101", "type": "CPT"}, {"code": "3440100802", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 50.4, "maximum": 69.84, "gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 69.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUAL MLT", "code_information": [{"code": "80100", "type": "CPT"}, {"code": "3440100801", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 60.9, "maximum": 84.39, "gross_charge": 87.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 73.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 60.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 60.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 73.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 69.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN QUANT ZONISAMIDE", "code_information": [{"code": "80203", "type": "CPT"}], "standard_charges": [{"minimum": 13.25, "maximum": 41.39, "discounted_cash": 21.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREEN,PRESUMP,", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "3440103066", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 62.14, "maximum": 461.72, "gross_charge": 476.0, "discounted_cash": 99.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 404.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 461.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 79.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 404.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING BARBITURATES", "code_information": [{"code": "80345", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING BUPRENORPHINE", "code_information": [{"code": "80348", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING COCAINE", "code_information": [{"code": "80353", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING FENTANYL", "code_information": [{"code": "80354", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING METHADONE", "code_information": [{"code": "80358", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING OXYCODONE", "code_information": [{"code": "80365", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING PREGABALIN", "code_information": [{"code": "80366", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING PROPOXYPHENE", "code_information": [{"code": "80367", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING TAPENTADOL", "code_information": [{"code": "80372", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCREENING TRAMADOL", "code_information": [{"code": "80373", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN MULT MOD C", "code_information": [{"code": "G0434", "type": "HCPCS"}, {"code": "3440101259", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 91.0, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 195.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG SCRN MULTI HI C", "code_information": [{"code": "G0431", "type": "HCPCS"}, {"code": "3440101256", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 456.4, "maximum": 632.44, "gross_charge": 652.0, "discounted_cash": 978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 554.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 489.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 456.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 632.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 456.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 489.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 554.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 521.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [{"code": "G0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 183.34, "maximum": 198.74, "discounted_cash": 319.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 198.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 22+ CLASSES", "code_information": [{"code": "G0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 183.34, "maximum": 246.92, "discounted_cash": 396.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 246.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 8-14 CLASSES", "code_information": [{"code": "G0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 156.59, "maximum": 183.34, "discounted_cash": 251.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 156.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF SIMPLE ALL CL", "code_information": [{"code": "G0659", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.14, "maximum": 78.77, "discounted_cash": 99.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST PRSMV INSTRMNT", "code_information": [{"code": "80306", "type": "CPT"}], "standard_charges": [{"minimum": 17.14, "maximum": 44.95, "discounted_cash": 27.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST, ALL SOURC", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "3440103109", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 78.77, "maximum": 269.66, "gross_charge": 278.0, "discounted_cash": 183.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 236.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 126.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 208.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 194.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 269.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 194.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 126.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 208.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 145.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 236.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 222.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST,DEF.QUAL O", "code_information": [{"code": "80307", "type": "CPT"}, {"code": "3440103063", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 62.14, "maximum": 680.94, "gross_charge": 702.0, "discounted_cash": 99.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 596.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 526.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 680.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 526.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 79.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 596.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 561.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 66.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST,PRESUMP,AN", "code_information": [{"code": "80305", "type": "CPT"}, {"code": "3440103077", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.6, "maximum": 74.69, "gross_charge": 77.0, "discounted_cash": 20.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 1-3", "code_information": [{"code": "80375", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 4-6", "code_information": [{"code": "80376", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG/SUBSTANCE NOS 7/MORE", "code_information": [{"code": "80377", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUGS ASSAY ADALIMUM", "code_information": [{"code": "80145", "type": "CPT"}, {"code": "3440103103", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 38.57, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 61.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 49.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 41.31, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUGS/MEDS DISP FOR HOME USE", "code_information": [{"code": "D9630", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G .5 /<", "code_information": [{"code": "17270", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ EXTENSIVE RETINOPATHY", "code_information": [{"code": "67227", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 7184.53, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION LID MARGIN <1CM", "code_information": [{"code": "67850", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION PENIS S", "code_information": [{"code": "54055", "type": "CPT"}, {"code": "3480102176", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5776.35, "gross_charge": 5955.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5776.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4168.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4466.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5061.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ LESION PENIS S", "code_information": [{"code": "54055", "type": "CPT"}, {"code": "3480103257", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5961.62, "gross_charge": 6146.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5224.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4609.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4302.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5961.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4302.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4609.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5224.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4916.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "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": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ NULYT AGT GNCL", "code_information": [{"code": "64624", "type": "CPT"}, {"code": "3480103307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1385.29, "maximum": 5836.49, "gross_charge": 6017.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5114.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4512.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4211.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5836.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4211.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4512.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5114.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4813.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DSTRY EYE LESN,FDR VSSL TECH", "code_information": [{"code": "G0186", "type": "HCPCS"}], "standard_charges": [{"minimum": 902.02, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DT VACCINE UNDER 7 YRS IM", "code_information": [{"code": "90702", "type": "CPT"}], "standard_charges": [{"minimum": 23.17, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP VACCINE < 7 YRS IM", "code_information": [{"code": "90700", "type": "CPT"}], "standard_charges": [{"minimum": 30.6, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP-HEP B-IPV VACCINE IM", "code_information": [{"code": "90723", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 86.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV VACCINE 4-6 YRS IM", "code_information": [{"code": "90696", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 59.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 59.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV-HIB-HEPB VACCINE IM", "code_information": [{"code": "90697", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DTAP-IPV/HIB VACCINE IM", "code_information": [{"code": "90698", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 106.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 106.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUAL LAYER IMPAX, PER SQ CM", "code_information": [{"code": "Q4262", "type": "HCPCS"}], "standard_charges": [{"minimum": 631.06, "maximum": 631.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 631.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUAL TIP LIGHT*2762-", "code_information": [{"code": "3100203404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 1314.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUODENAL MOTILITY STUDY", "code_information": [{"code": "91022", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT 7X12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT 7X15*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT 7X18*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT 7X5*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT 7X7*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT 7X9*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT10X12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT10X15*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT10X18*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT10X5*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT10X7*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUODENAL STENT10X9*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUOTOME 550 FIBER*84", "code_information": [{"code": "3100203191", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2304.96, "discounted_cash": 3457.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL BI STD", "code_information": [{"code": "93985", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUP-SCAN HEMO COMPL UNI STD", "code_information": [{"code": "93986", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DUPLOCATH", "code_information": [{"code": "3100100614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DURA HOOK", "code_information": [{"code": "3100100615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.6, "discounted_cash": 41.4, "setting": "both", "billing_class": "facility"}]}, {"description": "DURACLIP 11MM*DC0235", "code_information": [{"code": "3100204097", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DURACLIP 16MM*DC0235", "code_information": [{"code": "3100204098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DURAFORM DURAL GRAFT", "code_information": [{"code": "3100100616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 601.0, "discounted_cash": 901.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DURAFORM DURAL GRAFT", "code_information": [{"code": "3100100617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1329.0, "discounted_cash": 1993.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DURAPREP", "code_information": [{"code": "3100102153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DURASEAL APPLICATOR", "code_information": [{"code": "3100100619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DX BONE MARROW BX & ASPIR", "code_information": [{"code": "38222", "type": "CPT"}], "standard_charges": [{"minimum": 1290.06, "maximum": 1290.06, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1290.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/BRUS", "code_information": [{"code": "31623", "type": "CPT"}, {"code": "3480101871", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2593.78, "gross_charge": 2674.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [{"code": "31624", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1756.42, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DARK ADAPTATION EXAM I&R", "code_information": [{"code": "92284", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPEC", "code_information": [{"code": "43756", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX DUOD INTUB W/ASP SPECS", "code_information": [{"code": "43757", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX GASTR INTUB W/ASP SPECS", "code_information": [{"code": "43755", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD BI", "code_information": [{"code": "77066", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DX MAMMO INCL CAD UNI", "code_information": [{"code": "77065", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY AXIAL", "code_information": [{"code": "77080", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY/PERIPHERAL", "code_information": [{"code": "77081", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYNAMIC CAVERNOSOMETRY", "code_information": [{"code": "54231", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2109.3, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYNAMIC FINE WIRE EMG", "code_information": [{"code": "96003", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 12MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 12MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 12MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 12MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.94, "maximum": 3958.9, "gross_charge": 4081.35, "discounted_cash": 6122.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 14MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 14MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 14MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 14MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.94, "maximum": 3958.9, "gross_charge": 4081.35, "discounted_cash": 6122.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYNANITE PIP 16MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYPHYLLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1180", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3808.9, "maximum": 3808.9, "discounted_cash": 8314.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3808.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DYSPHAGIA SCREENING", "code_information": [{"code": "V5364", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Defibrillator Implants, Major", "code_information": [{"code": "179.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 63160.01, "maximum": 63160.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63160.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Defibrillator Implants, Minor", "code_information": [{"code": "179.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50382.17, "maximum": 50382.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50382.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Defibrillator Implants, Moderate", "code_information": [{"code": "179.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53336.03, "maximum": 53336.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53336.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Defibrillator Implants, Severe", "code_information": [{"code": "179.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 98848.5, "maximum": 98848.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 98848.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Degenerative Nervous System Disorders Except Multiple Sclerosis, Major", "code_information": [{"code": "42.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24254.95, "maximum": 24254.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24254.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Degenerative Nervous System Disorders Except Multiple Sclerosis, Minor", "code_information": [{"code": "42.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10082.84, "maximum": 10082.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10082.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Degenerative Nervous System Disorders Except Multiple Sclerosis, Moderate", "code_information": [{"code": "42.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15886.76, "maximum": 15886.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15886.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Degenerative Nervous System Disorders Except Multiple Sclerosis, Severe", "code_information": [{"code": "42.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40574.85, "maximum": 40574.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40574.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dental Diseases And Disorders, Major", "code_information": [{"code": "114.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13090.52, "maximum": 13090.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13090.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dental Diseases And Disorders, Minor", "code_information": [{"code": "114.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7086.7, "maximum": 7086.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7086.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dental Diseases And Disorders, Moderate", "code_information": [{"code": "114.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8070.89, "maximum": 8070.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8070.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dental Diseases And Disorders, Severe", "code_information": [{"code": "114.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23470.67, "maximum": 23470.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23470.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Depression Except Major Depressive Disorder, Major", "code_information": [{"code": "754.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8172.13, "maximum": 8172.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8172.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Depression Except Major Depressive Disorder, Minor", "code_information": [{"code": "754.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5250.31, "maximum": 5250.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5250.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Depression Except Major Depressive Disorder, Moderate", "code_information": [{"code": "754.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6847.05, "maximum": 6847.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6847.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Depression Except Major Depressive Disorder, Severe", "code_information": [{"code": "754.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21684.26, "maximum": 21684.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21684.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Destruction Of Growths In Uterus With Ultrasound Guidance Using An Endoscope", "code_information": [{"code": "404T", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diabetes, Major", "code_information": [{"code": "420.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12287.02, "maximum": 12287.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12287.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diabetes, Minor", "code_information": [{"code": "420.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4870.98, "maximum": 4870.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4870.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diabetes, Moderate", "code_information": [{"code": "420.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7595.45, "maximum": 7595.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7595.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diabetes, Severe", "code_information": [{"code": "420.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36470.21, "maximum": 36470.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36470.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diagnostic Hearing Loss Test", "code_information": [{"code": "92561", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Digestive Malignancy, Major", "code_information": [{"code": "240.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18393.37, "maximum": 18393.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18393.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Digestive Malignancy, Minor", "code_information": [{"code": "240.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9181.95, "maximum": 9181.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9181.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Digestive Malignancy, Moderate", "code_information": [{"code": "240.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10610.82, "maximum": 10610.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10610.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Digestive Malignancy, Severe", "code_information": [{"code": "240.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36707.29, "maximum": 36707.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36707.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dilation And Curettage For Non-Obstetric Diagnoses, Major", "code_information": [{"code": "517.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25769.68, "maximum": 25769.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25769.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dilation And Curettage For Non-Obstetric Diagnoses, Minor", "code_information": [{"code": "517.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7536.5, "maximum": 7536.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7536.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dilation And Curettage For Non-Obstetric Diagnoses, Moderate", "code_information": [{"code": "517.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9566.4, "maximum": 9566.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9566.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dilation And Curettage For Non-Obstetric Diagnoses, Severe", "code_information": [{"code": "517.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38197.67, "maximum": 38197.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38197.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Gallbladder And Biliary Tract, Major", "code_information": [{"code": "284.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14092.66, "maximum": 14092.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14092.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Gallbladder And Biliary Tract, Minor", "code_information": [{"code": "284.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8747.52, "maximum": 8747.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8747.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Gallbladder And Biliary Tract, Moderate", "code_information": [{"code": "284.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11674.47, "maximum": 11674.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11674.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Gallbladder And Biliary Tract, Severe", "code_information": [{"code": "284.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24110.14, "maximum": 24110.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24110.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Pancreas Except Malignancy, Major", "code_information": [{"code": "282.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17742.37, "maximum": 17742.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17742.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Pancreas Except Malignancy, Minor", "code_information": [{"code": "282.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7632.61, "maximum": 7632.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7632.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Pancreas Except Malignancy, Moderate", "code_information": [{"code": "282.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9889.34, "maximum": 9889.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9889.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Pancreas Except Malignancy, Severe", "code_information": [{"code": "282.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 47316.82, "maximum": 47316.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47316.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Personality And Impulse Control, Major", "code_information": [{"code": "752.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13937.59, "maximum": 13937.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13937.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Personality And Impulse Control, Minor", "code_information": [{"code": "752.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4777.43, "maximum": 4777.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Personality And Impulse Control, Moderate", "code_information": [{"code": "752.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6730.44, "maximum": 6730.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6730.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Disorders Of Personality And Impulse Control, Severe", "code_information": [{"code": "752.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 56528.25, "maximum": 56528.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56528.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diverticulitis And Diverticulosis, Major", "code_information": [{"code": "244.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13860.7, "maximum": 13860.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13860.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diverticulitis And Diverticulosis, Minor", "code_information": [{"code": "244.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7621.08, "maximum": 7621.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7621.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diverticulitis And Diverticulosis, Moderate", "code_information": [{"code": "244.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9551.02, "maximum": 9551.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9551.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Diverticulitis And Diverticulosis, Severe", "code_information": [{"code": "244.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46990.04, "maximum": 46990.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46990.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back, Major", "code_information": [{"code": "304.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 60891.75, "maximum": 60891.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60891.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back, Minor", "code_information": [{"code": "304.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42445.84, "maximum": 42445.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42445.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back, Moderate", "code_information": [{"code": "304.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 49262.14, "maximum": 49262.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 49262.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back, Severe", "code_information": [{"code": "304.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 95064.23, "maximum": 95064.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95064.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure For Curvature Of Back, Major", "code_information": [{"code": "303.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 93883.97, "maximum": 93883.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93883.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure For Curvature Of Back, Minor", "code_information": [{"code": "303.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 61907.98, "maximum": 61907.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61907.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure For Curvature Of Back, Moderate", "code_information": [{"code": "303.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 69407.32, "maximum": 69407.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69407.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dorsal And Lumbar Fusion Procedure For Curvature Of Back, Severe", "code_information": [{"code": "303.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 127531.04, "maximum": 127531.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 127531.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice, Major", "code_information": [{"code": "770.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9716.33, "maximum": 9716.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9716.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice, Minor", "code_information": [{"code": "770.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4194.35, "maximum": 4194.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4194.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice, Moderate", "code_information": [{"code": "770.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5410.49, "maximum": 5410.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5410.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice, Severe", "code_information": [{"code": "770.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18907.25, "maximum": 18907.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18907.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Drug test presump opt inst", "code_information": [{"code": "G0478", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Drug test presump optical", "code_information": [{"code": "G0477", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dx mammo incl cad bi", "code_information": [{"code": "G0204", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Dx mammo incl cad uni", "code_information": [{"code": "G0206", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "E COLI 0157 AG IA", "code_information": [{"code": "87335", "type": "CPT"}], "standard_charges": [{"minimum": 12.66, "maximum": 24.03, "discounted_cash": 20.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EACH ADDTNL CAST POST", "code_information": [{"code": "D2953", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EACH ADDTNL PREFAB POST", "code_information": [{"code": "D2957", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR CARTILAGE GRAFT", "code_information": [{"code": "21235", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7111.29, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR PROTECTOR EVALUATION", "code_information": [{"code": "92596", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EAR SPECULUM", "code_information": [{"code": "3100103947", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EAR TUBE", "code_information": [{"code": "3100104055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [{"code": "147", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8001.45, "maximum": 8001.45, "discounted_cash": 13797.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8001.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [{"code": "146", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12503.26, "maximum": 12503.26, "discounted_cash": 23568.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12503.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "148", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4835.67, "maximum": 4835.67, "discounted_cash": 9933.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4835.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EARDRUM REVISION", "code_information": [{"code": "69450", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EASY CAP II CO2 DETE", "code_information": [{"code": "3100100620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EASY CLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2550.8, "maximum": 3534.68, "gross_charge": 3644.0, "discounted_cash": 5466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3097.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2550.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3534.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2550.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3097.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2915.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EASY CLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1883.0, "maximum": 2609.3, "gross_charge": 2690.0, "discounted_cash": 4035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2286.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2017.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1883.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2609.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1883.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2017.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2286.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EASYCLIP BICORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1228.5, "maximum": 1702.35, "gross_charge": 1755.0, "discounted_cash": 2632.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1491.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1316.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1228.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1702.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1228.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1316.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1491.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1404.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECALLANTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1290", "type": "HCPCS"}], "standard_charges": [{"minimum": 545.62, "maximum": 545.62, "discounted_cash": 866.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93224", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93225", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93226", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG MONIT/REPRT UP TO 48 HRS", "code_information": [{"code": "93227", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG RECORD/REVIEW", "code_information": [{"code": "93268", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG/MONITORING AND ANALYSIS", "code_information": [{"code": "93271", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG/REVIEW INTERPRET ONLY", "code_information": [{"code": "93272", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECG/SIGNAL-AVERAGED", "code_information": [{"code": "93278", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHELON 60MM REINF*E", "code_information": [{"code": "3100210077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 820.0, "discounted_cash": 1230.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO COMPLT W CLR&SP", "code_information": [{"code": "93306", "type": "CPT"}, {"code": "3460101263", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 513.09, "maximum": 1746.97, "gross_charge": 1801.0, "discounted_cash": 844.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 582.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.97, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 579.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 669.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF ABDOMEN", "code_information": [{"code": "76705", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76519", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76529", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE THICKNESS", "code_information": [{"code": "76514", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76825", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76827", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76828", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF HEAD", "code_information": [{"code": "76506", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM UTERUS", "code_information": [{"code": "76831", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO EXAMINATION PROCEDURE", "code_information": [{"code": "76999", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "76965", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDANCE RADIOTHERAPY", "code_information": [{"code": "G6001", "type": "HCPCS"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR AMNIOCENTESIS", "code_information": [{"code": "76946", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR ARTERY REPAIR", "code_information": [{"code": "76936", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR HEART BIOPSY", "code_information": [{"code": "76932", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR TRANSFUSION", "code_information": [{"code": "76941", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO LTD/FOLLOW UP W", "code_information": [{"code": "93308", "type": "CPT"}, {"code": "3460101265", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 951.57, "gross_charge": 981.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 833.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 735.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 686.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 951.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 686.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 735.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 833.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93314", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93317", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93304", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHO WO CLR&SPC DOP", "code_information": [{"code": "93307", "type": "CPT"}, {"code": "3460101264", "type": "CDM"}, {"code": "483", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 1396.8, "gross_charge": 1440.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1396.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECHOSCLEROTHERAPY", "code_information": [{"code": "S2202", "type": "HCPCS"}], "standard_charges": [{"minimum": 1369.71, "maximum": 1369.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECLIPSE SPEEDSCAP*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 37*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5922.28, "maximum": 8206.58, "gross_charge": 8460.4, "discounted_cash": 12690.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7191.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6345.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5922.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8206.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5922.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6345.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7191.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6768.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 39*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6142.5, "maximum": 8511.75, "gross_charge": 8775.0, "discounted_cash": 13162.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8511.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 41*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 43*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 45*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206689", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 47*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6142.5, "maximum": 8511.75, "gross_charge": 8775.0, "discounted_cash": 13162.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8511.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 49*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECLIPSE TRUNION 51*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "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": 95176.3, "maximum": 95176.3, "discounted_cash": 238031.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 95176.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": [{"code": "33949", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT-VENOUS", "code_information": [{"code": "33948", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", "code_information": [{"code": "33947", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION VENOUS", "code_information": [{"code": "33946", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33951", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33952", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33953", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ PRPH CANNULA", "code_information": [{"code": "33954", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33957", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33958", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33963", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33964", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33985", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL CTR CANNULA", "code_information": [{"code": "33986", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33965", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PERPH CANNULA", "code_information": [{"code": "33969", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33966", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS RMVL PRPH CANNULA", "code_information": [{"code": "33984", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECOG IMPLTD BRN NPGT <30 D", "code_information": [{"code": "95836", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECOIN*EC-001", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100208121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 24500.0, "maximum": 33950.0, "gross_charge": 35000.0, "discounted_cash": 52500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 29750.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24500.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 33950.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24500.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 29750.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECP CILIARY BODY DESTRUCTION", "code_information": [{"code": "66711", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ECULIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1300", "type": "HCPCS"}], "standard_charges": [{"minimum": 225.7, "maximum": 225.7, "discounted_cash": 362.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 225.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD GRP PER SESSION", "code_information": [{"code": "G0421", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ED SVC CKD IND PER SESSION", "code_information": [{"code": "G0420", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EDETATE CALCIUM DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0600", "type": "HCPCS"}], "standard_charges": [{"minimum": 5994.02, "maximum": 5994.02, "discounted_cash": 10365.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5994.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EDETATE DISODIUM PER 150 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3520", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.77, "maximum": 0.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EDG BAND LIGATION ES", "code_information": [{"code": "43244", "type": "CPT"}, {"code": "3480101942", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EDG US GUI TMURAL IN", "code_information": [{"code": "43253", "type": "CPT"}, {"code": "3390102293", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 480.2, "maximum": 2310.63, "gross_charge": 686.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 583.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 480.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 665.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 480.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 583.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 548.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EDG W ABLATE TUMOR P", "code_information": [{"code": "43270", "type": "CPT"}, {"code": "3340102328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1941.71, "maximum": 3439.62, "gross_charge": 3546.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3014.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2659.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2482.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3439.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2482.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2659.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3014.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2836.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EE&MJ BSC PRTN ELISA EST DEV", "code_information": [{"code": "95U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1240.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG 41-60 MINUTES", "code_information": [{"code": "95812", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE AND ASLEEP", "code_information": [{"code": "95819", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG AWAKE AND DROWSY", "code_information": [{"code": "95816", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG CEREBRAL DEATH ONLY", "code_information": [{"code": "95824", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG COMA OR SLEEP ONLY", "code_information": [{"code": "95822", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG CONT REC W/VID EEG TECH", "code_information": [{"code": "95700", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG DIGITAL ANALYSIS", "code_information": [{"code": "95957", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG DURING SURGERY", "code_information": [{"code": "95955", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG EXTND MNTR 61-119 MIN", "code_information": [{"code": "95813", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING/FUNCTION TEST", "code_information": [{"code": "95958", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG MONITORING/GIVING DRUGS", "code_information": [{"code": "95954", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP EA INCR W/VEEG", "code_information": [{"code": "95720", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>36<60 HR W/O VID", "code_information": [{"code": "95721", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>36<60 HR W/VEEG", "code_information": [{"code": "95722", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>60<84 HR W/O VID", "code_information": [{"code": "95723", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>60<84 HR W/VEEG", "code_information": [{"code": "95724", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/O VID", "code_information": [{"code": "95725", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHY/QHP>84 HR W/VEEG", "code_information": [{"code": "95726", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/O VID", "code_information": [{"code": "95717", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP 2-12 HR W/VEEG", "code_information": [{"code": "95718", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG PHYS/QHP EA INCR W/O VID", "code_information": [{"code": "95719", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12 HR UNMNTR", "code_information": [{"code": "95705", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID 2-12HR CONT MNTR", "code_information": [{"code": "95707", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR CONT", "code_information": [{"code": "95710", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG W/O VID EA 12-26HR INTMT", "code_information": [{"code": "95709", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG WO VID 2-12HR INTMT MNTR", "code_information": [{"code": "95706", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EEG WO VID EA 12-26HR UNMNTR", "code_information": [{"code": "95708", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF ADULT FLUIDS AND ELECTRO", "code_information": [{"code": "B4102", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF PED CALORIC DENSE>/=0.7KC", "code_information": [{"code": "B4160", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF PED COMPLETE INTACT NUT", "code_information": [{"code": "B4158", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF PED COMPLETE SOY BASED", "code_information": [{"code": "B4159", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF PED FLUID AND ELECTROLYTE", "code_information": [{"code": "B4103", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF PED HYDROLYZED/AMINO ACID", "code_information": [{"code": "B4161", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF PED SPECMETABOLIC INHERIT", "code_information": [{"code": "B4162", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EF SPECIAL METABOLIC INHERIT", "code_information": [{"code": "B4157", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD /ESOPH BALL DILA", "code_information": [{"code": "43233", "type": "CPT"}, {"code": "3390100600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 413.7, "maximum": 2310.63, "gross_charge": 591.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 502.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 443.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 573.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 443.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 502.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ENDO MUCOSAL RESECTION", "code_information": [{"code": "43254", "type": "CPT"}], "standard_charges": [{"minimum": 2883.16, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD ESOPHAGOGASTRC FNDOPLSTY", "code_information": [{"code": "43210", "type": "CPT"}], "standard_charges": [{"minimum": 5382.28, "maximum": 5382.28, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLEX TRANSORAL D", "code_information": [{"code": "43235", "type": "CPT"}, {"code": "3390100627", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2116.54, "gross_charge": 2182.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], "standard_charges": [{"minimum": 1526.35, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL DX BR/WA", "code_information": [{"code": "652T", "type": "CPT"}], "standard_charges": [{"minimum": 1526.35, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL TUBE/CATH", "code_information": [{"code": "654T", "type": "CPT"}], "standard_charges": [{"minimum": 1526.35, "maximum": 1526.35, "discounted_cash": 5862.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD INJECTION VARICES", "code_information": [{"code": "43243", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 5382.28, "maximum": 5382.28, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US EXAM DUODENUM/JEJUNUM", "code_information": [{"code": "43259", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43238", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W CONTROL OF BLE", "code_information": [{"code": "43255", "type": "CPT"}, {"code": "3390100637", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W DILATION < 30", "code_information": [{"code": "43249", "type": "CPT"}, {"code": "3390100633", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W GUIDE WIRE", "code_information": [{"code": "43248", "type": "CPT"}, {"code": "3390100632", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2116.54, "gross_charge": 2182.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W INJECTION SUBM", "code_information": [{"code": "43239", "type": "CPT"}, {"code": "3390100628", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2116.54, "gross_charge": 2182.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W PEGTUBE INSERT", "code_information": [{"code": "43246", "type": "CPT"}, {"code": "3390100630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W REMOVAL FB", "code_information": [{"code": "43247", "type": "CPT"}, {"code": "3390100631", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2539.46, "gross_charge": 2618.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2225.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2539.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2225.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/DILATION", "code_information": [{"code": "43245", "type": "CPT"}, {"code": "3390100629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3775.24, "gross_charge": 3892.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3308.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2919.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2724.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3775.24, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2724.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2919.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3308.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3113.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/REM LESION /SN", "code_information": [{"code": "43251", "type": "CPT"}, {"code": "3390100635", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/REMOVAL TUMOR/", "code_information": [{"code": "43250", "type": "CPT"}, {"code": "3390100634", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/THRML TXMNT GERD", "code_information": [{"code": "43257", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2883.16, "discounted_cash": 5862.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD W/TRANSMURAL DRAIN CYST", "code_information": [{"code": "43240", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5382.28, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGD WI STENT", "code_information": [{"code": "43266", "type": "CPT"}, {"code": "3390100642", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 6920.72, "gross_charge": 588.0, "discounted_cash": 8723.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6013.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5990.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6920.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EGFR GENE ANAYLSIS", "code_information": [{"code": "81235", "type": "CPT"}, {"code": "3440103060", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 218.94, "maximum": 1921.57, "gross_charge": 1981.0, "discounted_cash": 521.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 359.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1921.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 354.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 358.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 347.63, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 413.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 347.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 324.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 347.63, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 354.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EHL PROBE*M00546620", "code_information": [{"code": "3100203605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1287.0, "discounted_cash": 1930.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EHRLICHA CHAFFEENSIS AMP PRB", "code_information": [{"code": "87484", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 35.09, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EHRLICHIA ANTIBODY", "code_information": [{"code": "86666", "type": "CPT"}], "standard_charges": [{"minimum": 10.18, "maximum": 30.26, "discounted_cash": 16.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EIA HIV-1/HIV-2 SCRE", "code_information": [{"code": "G0432", "type": "HCPCS"}, {"code": "3440101257", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.96, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 31.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EKG FOR INITIAL PREVENT EXAM", "code_information": [{"code": "G0403", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EKG INTERPRET & REPORT PREVE", "code_information": [{"code": "G0405", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EKG TRACING FOR INITIAL PREV", "code_information": [{"code": "G0404", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EKG- INTERP & REPORT", "code_information": [{"code": "93010", "type": "CPT"}, {"code": "3500102284", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 56.52, "maximum": 106.7, "gross_charge": 110.0, "discounted_cash": 165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 82.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 77.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 106.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 77.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 82.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 93.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 88.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EKG-12 LEAD TECHNICA", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "3270102298", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 56.52, "maximum": 199.82, "gross_charge": 206.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 154.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 144.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 144.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 154.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EKG-INTERP & REPORT", "code_information": [{"code": "93005", "type": "CPT"}, {"code": "3500102247", "type": "CDM"}, {"code": "730", "type": "RC"}], "standard_charges": [{"minimum": 56.52, "maximum": 199.82, "gross_charge": 206.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 154.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 144.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 144.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 154.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EL-1 FECAL QUANTITATIVE", "code_information": [{"code": "82653", "type": "CPT"}], "standard_charges": [{"minimum": 22.97, "maximum": 40.05, "discounted_cash": 36.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.97, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELASTASE, PANCREATIC", "code_information": [{"code": "82656", "type": "CPT"}, {"code": "3440103085", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 69.84, "gross_charge": 72.0, "discounted_cash": 18.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 69.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW ARTHROSCOPY", "code_information": [{"code": "29830", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELBOW HUMERAL XS*32-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELBOW ULNAR XS*32-81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS CPLX PRGRMG IINS", "code_information": [{"code": "590T", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEC ALYS SMPL PRGRMG IINS", "code_information": [{"code": "589T", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEC AN NSTIM GEN W/", "code_information": [{"code": "95970", "type": "CPT"}, {"code": "3340102327", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 123.2, "maximum": 303.49, "gross_charge": 176.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 170.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEC IMPD SPECTRSC 1+SKN LES", "code_information": [{"code": "658T", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEC STIM OTHER THAN WOUND", "code_information": [{"code": "G0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEC STIM UNATTEND FOR PRESS", "code_information": [{"code": "G0281", "type": "HCPCS"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECT STIM WOUND CARE NOT PD", "code_information": [{"code": "G0282", "type": "HCPCS"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRIC BONE STIM I", "code_information": [{"code": "20975", "type": "CPT"}, {"code": "3480101452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 2542.29, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRIC STIMULATION THERAPY", "code_information": [{"code": "97014", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRICAL BONE STIMULATION", "code_information": [{"code": "20974", "type": "CPT"}], "standard_charges": [{"minimum": 453.46, "maximum": 453.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 453.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TEST ONE", "code_information": [{"code": "92594", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRO HEARNG AID TST BOTH", "code_information": [{"code": "92595", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRO-OCULOGRAPHY W/I&R", "code_information": [{"code": "92270", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRO-UROFLOWMETRY FIRST", "code_information": [{"code": "51741", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROCARDIOGRAM COMPLETE", "code_information": [{"code": "93000", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROCOCHLEOGRAPHY", "code_information": [{"code": "92584", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROCONVULSIVE THERAPY", "code_information": [{"code": "90870", "type": "CPT"}], "standard_charges": [{"minimum": 382.26, "maximum": 382.26, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 382.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRODE", "code_information": [{"code": "3100102154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE", "code_information": [{"code": "3100103690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE 24FR COAG*", "code_information": [{"code": "3100209159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.12, "discounted_cash": 502.68, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ARTHROSCOP", "code_information": [{"code": "3100100622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE BUGBEE", "code_information": [{"code": "3100100623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 389.0, "discounted_cash": 583.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COAG", "code_information": [{"code": "3100100624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 591.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE COAG", "code_information": [{"code": "3100102764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE FRONT LOAD", "code_information": [{"code": "3100100625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1668.0, "discounted_cash": 2502.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE FRONT LOAD", "code_information": [{"code": "3100104329", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE HOOK COOLC", "code_information": [{"code": "3100100626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP", "code_information": [{"code": "3100104649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1408.0, "discounted_cash": 2112.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP 24FR*", "code_information": [{"code": "3100204706", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1353.24, "discounted_cash": 2029.86, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE LOOP LARGE", "code_information": [{"code": "3100100627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE MED LOOP*L", "code_information": [{"code": "3100207269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE MONO NITIN", "code_information": [{"code": "3100100628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4004.0, "discounted_cash": 6006.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NIM*822730", "code_information": [{"code": "3100206865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.6, "discounted_cash": 801.9, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NITINOL", "code_information": [{"code": "3100104742", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NITINOL RF", "code_information": [{"code": "3100100629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE NITINOL RF", "code_information": [{"code": "3100102765", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ONESTEP RE", "code_information": [{"code": "3100100630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.0, "discounted_cash": 412.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE PEDIATRIC", "code_information": [{"code": "3100100631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 169.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE STEER", "code_information": [{"code": "3100104608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE STIM BRAIN ADD-ON", "code_information": [{"code": "95962", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRODE STIMULATIO", "code_information": [{"code": "95961", "type": "CPT"}, {"code": "3340102425", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 358.67, "maximum": 1269.62, "gross_charge": 999.0, "discounted_cash": 1600.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 849.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1103.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 749.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 969.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1088.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1098.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 749.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1269.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 849.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 799.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1088.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRODE SUBDRML 2-", "code_information": [{"code": "3100100632", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE SUBDRML 4-", "code_information": [{"code": "3100100633", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 502.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE ULTRTHIN*L", "code_information": [{"code": "3100207108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 856.05, "discounted_cash": 1284.08, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE URO", "code_information": [{"code": "3100100634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 382.0, "discounted_cash": 573.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE URO", "code_information": [{"code": "3100102766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 398.0, "discounted_cash": 597.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODE VAPORZNT P", "code_information": [{"code": "3100100635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1477.0, "discounted_cash": 2215.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTRODES", "code_information": [{"code": "3100104578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELECTROEJACULATION", "code_information": [{"code": "55870", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY", "code_information": [{"code": "91132", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROGASTROGRAPHY W/TEST", "code_information": [{"code": "91133", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROLYTE PANEL", "code_information": [{"code": "80051", "type": "CPT"}, {"code": "3440100794", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.01, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 11.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNETIC THERAPY ONC", "code_information": [{"code": "G0295", "type": "HCPCS"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROMAGNTIC TX FOR ULCERS", "code_information": [{"code": "G0329", "type": "HCPCS"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRON BEAM COMPUTED TOMOG", "code_information": [{"code": "S8092", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY", "code_information": [{"code": "D0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTRON MICROSCOPY DX", "code_information": [{"code": "88348", "type": "CPT"}], "standard_charges": [{"minimum": 182.01, "maximum": 285.39, "discounted_cash": 1316.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 285.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHERETIC TECH", "code_information": [{"code": "82664", "type": "CPT"}, {"code": "3440100901", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 53.85, "maximum": 298.76, "gross_charge": 308.0, "discounted_cash": 98.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 215.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 298.76, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 215.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 78.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 65.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYS MAP 3D ADD-ON", "code_information": [{"code": "93613", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGIC STUDY", "code_information": [{"code": "93624", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93619", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93620", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93621", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93622", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93641", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93642", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 1821.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELECTROPHYSIOLOGY EVALUATION", "code_information": [{"code": "93644", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100100637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100102767", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100102768", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 345.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100102769", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 433.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100102770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100102771", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 549.0, "discounted_cash": 823.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR", "code_information": [{"code": "3100102772", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 419.0, "discounted_cash": 628.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR COGSWELL", "code_information": [{"code": "3100104402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 387.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR SEPTAL", "code_information": [{"code": "3100100638", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 455.0, "discounted_cash": 682.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVATOR SEPTAL", "code_information": [{"code": "3100102773", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVELATOR COBB BLAD", "code_information": [{"code": "3100100639", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 550.0, "discounted_cash": 825.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELEVIEW SUBMUCOSAL I", "code_information": [{"code": "3100203162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELIF LARGE 12MM*1432", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELIF LARGE 12MM*1432", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELIF SMALL 10MM*1428", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELIF SMALL 12MM*1428", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELIF SMALL 8MM*14280", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELIMINATOR HOLE DEPU", "code_information": [{"code": "3100100640", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 912.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ELISA HIV-1/HIV-2 SC", "code_information": [{"code": "G0433", "type": "HCPCS"}, {"code": "3440101258", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.59, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 29.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ELLIOTTS B SOLUTION PER ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9175", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.46, "maximum": 5.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ELOSULFASE ALFA, INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1322", "type": "HCPCS"}], "standard_charges": [{"minimum": 283.22, "maximum": 283.22, "discounted_cash": 451.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 283.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EM 5 PERCENT WL", "code_information": [{"code": "G9880", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EM 9 PERCENT WL", "code_information": [{"code": "G9881", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EM BRIDGE PAYMENT", "code_information": [{"code": "G9890", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EMA EACH IG CLASS", "code_information": [{"code": "86231", "type": "CPT"}], "standard_charges": [{"minimum": 12.09, "maximum": 30.26, "discounted_cash": 19.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EMBEDDED IP CATH EXIT-SITE", "code_information": [{"code": "49436", "type": "CPT"}], "standard_charges": [{"minimum": 1083.58, "maximum": 1083.58, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EMBOLIZATION MREYE*G", "code_information": [{"code": "3100206652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 489.51, "discounted_cash": 734.27, "setting": "both", "billing_class": "facility"}]}, {"description": "EMBOLIZATION NESTER*", "code_information": [{"code": "3100206651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 657.9, "discounted_cash": 986.85, "setting": "both", "billing_class": "facility"}]}, {"description": "EMBRYO HATCHING", "code_information": [{"code": "89253", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EMERGE MATRIX, PER SQ CM", "code_information": [{"code": "Q4297", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "EMERGENCY TRACHEOTOMY", "code_information": [{"code": "D7990", "type": "HCPCS"}], "standard_charges": [{"minimum": 3345.07, "maximum": 3345.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENAMEL MICROABRASION", "code_information": [{"code": "D9970", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENCEPHALITIS CALIFORN ANTBDY", "code_information": [{"code": "86651", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS EAST EQNE ANBDY", "code_information": [{"code": "86652", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS ST LOUIS ANTBODY", "code_information": [{"code": "86653", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENCEPHALTIS WEST EQNE ANTBDY", "code_information": [{"code": "86654", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENCORE 26 INFLATION*", "code_information": [{"code": "3100203612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "END CAP *1818-0005S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 540.75, "maximum": 749.32, "gross_charge": 772.5, "discounted_cash": 1158.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 656.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 579.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 540.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 749.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 540.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 579.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 656.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 618.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END CAP FEM NAIL*04.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 395.19, "maximum": 547.63, "gross_charge": 564.57, "discounted_cash": 846.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 479.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 423.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 395.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 547.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 395.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 423.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 479.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 451.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END CAP SCREW*AR-896", "code_information": [{"code": "3100208458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "END CAP T25*04.008.0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.02, "maximum": 582.02, "gross_charge": 600.03, "discounted_cash": 900.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END CAP THREADED*182", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 398.91, "maximum": 552.78, "gross_charge": 569.88, "discounted_cash": 854.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 398.91, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 398.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 455.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END CAP TI TIBIAL 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 442.57, "maximum": 613.28, "gross_charge": 632.25, "discounted_cash": 948.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 537.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 442.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 613.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 442.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 474.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 537.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 505.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END CAP*6240064", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END CAPS 19 X 4*9401", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 635.25, "maximum": 880.27, "gross_charge": 907.5, "discounted_cash": 1361.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 771.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 680.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 635.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 880.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 635.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 680.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 771.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 726.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "END OF LIFE COUNSELING", "code_information": [{"code": "S0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "END THXPY, ANTERIOR TOOTH", "code_information": [{"code": "D3310", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "END THXPY, MOLAR TOOTH", "code_information": [{"code": "D3330", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "END THXPY, PREMOLAR TOOTH", "code_information": [{"code": "D3320", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDCAP 0 DEG 22M*482", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 606.37, "maximum": 840.26, "gross_charge": 866.25, "discounted_cash": 1299.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 736.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 649.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 840.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 649.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 736.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO ASSAY SEVEN ANAL", "code_information": [{"code": "81506", "type": "CPT"}], "standard_charges": [{"minimum": 68.92, "maximum": 79.66, "discounted_cash": 110.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO CARPAL TUNNEL R", "code_information": [{"code": "3100100641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO CATCH POUCH", "code_information": [{"code": "3100100642", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 484.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO CHOLANGIOPANCREATOGRAPH", "code_information": [{"code": "43262", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3714.42, "discounted_cash": 5862.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3714.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO KIT", "code_information": [{"code": "3100104263", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO RING FOAM*ERFB", "code_information": [{"code": "3100204235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.8, "discounted_cash": 197.7, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO RING KIT*825-00", "code_information": [{"code": "3100204234", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 365.0, "discounted_cash": 547.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO STITCH DEVICE", "code_information": [{"code": "3100100643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.0, "discounted_cash": 781.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 2883.16, "maximum": 2883.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDO-KNIFE BOSTON*16", "code_information": [{"code": "3100204524", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 885.5, "maximum": 1227.05, "gross_charge": 1265.0, "discounted_cash": 1897.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1075.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 885.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1227.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 885.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 948.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1075.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1012.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCAVITY BALLOON*6", "code_information": [{"code": "3100203192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.6, "discounted_cash": 239.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCERV CURETTAGE W/SCOPE", "code_information": [{"code": "57456", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE", "code_information": [{"code": "57505", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOCLIP APPLIER LIG", "code_information": [{"code": "3100100644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.7, "discounted_cash": 791.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH CC", "code_information": [{"code": "644", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4309.37, "maximum": 4309.37, "discounted_cash": 11853.42, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4309.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [{"code": "643", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6828.96, "maximum": 6828.96, "discounted_cash": 18366.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6828.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCRINE DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "645", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3325.02, "maximum": 3325.02, "discounted_cash": 8495.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3325.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCUFF LRG GREEN*A", "code_information": [{"code": "3100202647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 144.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCUFF MED BLUE*AR", "code_information": [{"code": "3100206430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 144.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCUTTER", "code_information": [{"code": "3100100645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 697.0, "discounted_cash": 1045.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCUTTER", "code_information": [{"code": "3100102774", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCUTTER RELOAD", "code_information": [{"code": "3100100646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDODONTIC ENDOSSEOUS IMPLAN", "code_information": [{"code": "D3460", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDODONTIC PROCEDURE", "code_information": [{"code": "D3999", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLAP PNEUMO NEEDL", "code_information": [{"code": "3100100647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.5, "discounted_cash": 117.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLOOP COATED VICR", "code_information": [{"code": "3100100648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [{"code": "92978", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C EA", "code_information": [{"code": "92979", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL ABLTJ", "code_information": [{"code": "58353", "type": "CPT"}, {"code": "3480102104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 10753.42, "gross_charge": 11086.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9423.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8314.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7760.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10753.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7760.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8314.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9423.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8868.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOMETRIAL CRYOABLATION", "code_information": [{"code": "58356", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOPEARL", "code_information": [{"code": "3100100649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOPLATE DISC*PDL-M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6961.5, "maximum": 9646.65, "gross_charge": 9945.0, "discounted_cash": 14917.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8453.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9646.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8453.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOPLATE DISC*PDL-M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6961.5, "maximum": 9646.65, "gross_charge": 9945.0, "discounted_cash": 14917.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8453.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9646.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8453.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC INJECTION", "code_information": [{"code": "51715", "type": "CPT"}, {"code": "3480103177", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC INJECTION", "code_information": [{"code": "51715", "type": "CPT"}, {"code": "3480103223", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC NEEDLE 3.", "code_information": [{"code": "3100203196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCOPIC PANCREATOSCOPY", "code_information": [{"code": "43273", "type": "CPT"}], "standard_charges": [{"minimum": 5261.68, "maximum": 5261.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC US EXAM ESOPH", "code_information": [{"code": "43237", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPIC VEIN HARVEST", "code_information": [{"code": "33508", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY BOWEL POUCH/BIOP", "code_information": [{"code": "44386", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY LIGATE PERF VEINS", "code_information": [{"code": "37500", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF BOWEL POUCH", "code_information": [{"code": "44385", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50953", "type": "CPT"}, {"code": "3480103172", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 11828.18, "gross_charge": 12194.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11828.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY OF URETER", "code_information": [{"code": "50953", "type": "CPT"}, {"code": "3480103217", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) I&R", "code_information": [{"code": "92613", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY SWALLOW (FEES) VID", "code_information": [{"code": "92612", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCOPY W/DIRECTED", "code_information": [{"code": "45335", "type": "CPT"}, {"code": "3340102457", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "gross_charge": 1614.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1371.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1210.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1565.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1210.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1371.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1291.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOSCRUB 4/0*191200", "code_information": [{"code": "3100208401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 252.2, "discounted_cash": 378.3, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCRUB 4/0*191203", "code_information": [{"code": "3100204650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.16, "discounted_cash": 327.24, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCRUB 4/30*19120", "code_information": [{"code": "3100204628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSCRUB 4/30*19120", "code_information": [{"code": "3100208402", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.76, "discounted_cash": 343.14, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSHEATH", "code_information": [{"code": "3100100650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSHEATH", "code_information": [{"code": "3100102775", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 327.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSHEATH", "code_information": [{"code": "3100102776", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.0, "discounted_cash": 375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOSKELETON TC*5146", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSKELETON TC*5166", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2047.5, "maximum": 2837.25, "gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2837.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSKELETON TC*5166", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSKELETON TC*5166", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2047.5, "maximum": 2837.25, "gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2837.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSKELETON TC*5166", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOSTEAL IMPLANT", "code_information": [{"code": "D6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOTRACHEAL LASER 8", "code_information": [{"code": "3100204644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.76, "discounted_cash": 226.14, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOTRACHEAL LASER T", "code_information": [{"code": "3100203792", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.68, "discounted_cash": 226.02, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOTRACHEAL LASER T", "code_information": [{"code": "3100203793", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.68, "discounted_cash": 226.02, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOTRACHEAL LASER T", "code_information": [{"code": "3100203794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.68, "discounted_cash": 226.02, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOVAS ILIAC A DEVICE ADDON", "code_information": [{"code": "34808", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH DELAYED", "code_information": [{"code": "33886", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC PROSTH TAA ADD-ON", "code_information": [{"code": "33884", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR INCL SUBCL", "code_information": [{"code": "33880", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TAA REPR W/O SUBCL", "code_information": [{"code": "33881", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC TEMPORY VESSEL OCCL", "code_information": [{"code": "61623", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 1 GRAFT", "code_information": [{"code": "34841", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 2 GRAFT", "code_information": [{"code": "34842", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 3 GRAFT", "code_information": [{"code": "34843", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [{"code": "266", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38116.63, "maximum": 38116.63, "discounted_cash": 69734.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38116.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [{"code": "267", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32049.45, "maximum": 32049.45, "discounted_cash": 54485.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32049.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM 1ST VEIN", "code_information": [{"code": "36473", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS MCHNCHEM ADD-ON", "code_information": [{"code": "36474", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF 1ST VEIN", "code_information": [{"code": "36475", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS RF VEIN ADD-ON", "code_information": [{"code": "36476", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENFUVIRTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1324", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.63, "maximum": 0.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "3400300039", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 18.04, "gross_charge": 18.6, "discounted_cash": 27.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "3400300040", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 26.96, "gross_charge": 27.8, "discounted_cash": 41.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 22.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "3400300041", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 35.98, "gross_charge": 37.1, "discounted_cash": 55.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "3400300042", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 45.0, "gross_charge": 46.4, "discounted_cash": 69.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 34.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 34.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 37.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENOXAPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}, {"code": "3400300043", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.62, "maximum": 15.61, "gross_charge": 16.1, "discounted_cash": 24.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENSEAL TISSUE SEALER", "code_information": [{"code": "3100100651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENT SURGERY 1ST 30 M", "code_information": [{"code": "3480103107", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 11197.0, "discounted_cash": 16795.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENT SURGERY EA ADDL", "code_information": [{"code": "3480103108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5007.0, "discounted_cash": 7510.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST DISPR AG IA", "code_information": [{"code": "87336", "type": "CPT"}], "standard_charges": [{"minimum": 16.0, "maximum": 24.03, "discounted_cash": 25.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTAMOEB HIST GROUP AG IA", "code_information": [{"code": "87337", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERAL SUPP NOT OTHERWISE C", "code_information": [{"code": "B9998", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CADAVER DONOR", "code_information": [{"code": "44132", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY CONG ADD-ON", "code_information": [{"code": "44128", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY LIVE DONOR", "code_information": [{"code": "44133", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/O TAPER CONG", "code_information": [{"code": "44126", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTERECTOMY W/TAPER CONG", "code_information": [{"code": "44127", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY", "code_information": [{"code": "86658", "type": "CPT"}], "standard_charges": [{"minimum": 13.03, "maximum": 30.26, "discounted_cash": 20.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS ANTIBODY DFA", "code_information": [{"code": "87267", "type": "CPT"}], "standard_charges": [{"minimum": 13.42, "maximum": 24.03, "discounted_cash": 21.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENTEROVIRUS PROBE&REVRS TRNS", "code_information": [{"code": "87498", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENUCLEATION OR EXCIS", "code_information": [{"code": "46320", "type": "CPT"}, {"code": "3480101982", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4341.72, "gross_charge": 4476.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4341.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3580.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENVERSE, PER SQ CM", "code_information": [{"code": "Q4258", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.33, "maximum": 71.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 71.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENVI MINI STICK 6FR*", "code_information": [{"code": "3100206647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ENVIRONMENTAL MANIPULATION", "code_information": [{"code": "90882", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENZYME ACTVTY BLD CE", "code_information": [{"code": "82657", "type": "CPT"}, {"code": "3440100900", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 22.17, "maximum": 190.12, "gross_charge": 196.0, "discounted_cash": 35.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 28.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENZYME CARTRIDGE ENTERAL NUT", "code_information": [{"code": "B4105", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ENZYME CELL ACTIVITY RA", "code_information": [{"code": "82658", "type": "CPT"}], "standard_charges": [{"minimum": 44.03, "maximum": 53.85, "discounted_cash": 70.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EOSINOPHIL BLOOD COUNT", "code_information": [{"code": "S3630", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.92, "maximum": 20.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPHEDRINE SULFATE", "code_information": [{"code": "3400300306", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.2, "discounted_cash": 24.3, "setting": "both", "billing_class": "facility"}]}, {"description": "EPHYS EVAL ICDS SS", "code_information": [{"code": "577T", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 1821.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPI DISC OTOLOGIC LA", "code_information": [{"code": "3100100652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 338.0, "discounted_cash": 507.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EPICORD 1 SQ CM", "code_information": [{"code": "Q4187", "type": "HCPCS"}], "standard_charges": [{"minimum": 248.37, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 248.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT F/N/HF/G ADDL", "code_information": [{"code": "15116", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM A-GRFT FACE/NCK/HF/G", "code_information": [{"code": "15115", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT T/A/L ADD-ON", "code_information": [{"code": "15111", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDRM AUTOGRFT TRNK/ARM/LEG", "code_information": [{"code": "15110", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIDUROGRAPHY", "code_information": [{"code": "72275", "type": "CPT"}, {"code": "3430102307", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIEFFECT, PER SQ CM", "code_information": [{"code": "Q4278", "type": "HCPCS"}], "standard_charges": [{"minimum": 406.36, "maximum": 406.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 406.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPIFIX 1 SQ CM", "code_information": [{"code": "Q4186", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.45, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 153.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPIFIX, INJ, 1MG", "code_information": [{"code": "Q4145", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.47, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPILEPSY GEN SEQ ALYS PANEL", "code_information": [{"code": "81419", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2448.56, "discounted_cash": 3933.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPINEPHRINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0171", "type": "HCPCS"}, {"code": "3400300322", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.81, "maximum": 14.25, "gross_charge": 14.7, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISIOTOMY OR VAGINAL REPAIR", "code_information": [{"code": "59300", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2385.2, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITH MCC", "code_information": [{"code": "150", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8146.55, "maximum": 8146.55, "discounted_cash": 14675.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8146.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPISTAXIS WITHOUT MCC", "code_information": [{"code": "151", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2490.69, "maximum": 2490.69, "discounted_cash": 8604.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2490.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN ALFA, 100 UNITS ESRD", "code_information": [{"code": "Q4081", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.83, "maximum": 0.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN ALFA, NON-ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0885", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.27, "maximum": 8.27, "discounted_cash": 14.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA ESRD USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0887", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.44, "maximum": 1.44, "discounted_cash": 2.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOETIN BETA NON ESRD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0888", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.38, "maximum": 1.38, "discounted_cash": 2.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPOPROSTENOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1325", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.65, "maximum": 15.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EPSTEIN BARR VIRUS A", "code_information": [{"code": "86665", "type": "CPT"}, {"code": "3440101103", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.14, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 29.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR ANTIBODY", "code_information": [{"code": "86663", "type": "CPT"}], "standard_charges": [{"minimum": 13.12, "maximum": 30.26, "discounted_cash": 21.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPSTEIN-BARR NUCLEAR ANTIGEN", "code_information": [{"code": "86664", "type": "CPT"}], "standard_charges": [{"minimum": 15.29, "maximum": 30.26, "discounted_cash": 24.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EPTIFIBATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1327", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.24, "maximum": 21.24, "discounted_cash": 5.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP", "code_information": [{"code": "74328", "type": "CPT"}, {"code": "3270102314", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 83.3, "maximum": 217.16, "gross_charge": 119.0, "discounted_cash": 178.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 115.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP BAL DIL BIL/PAC", "code_information": [{"code": "43277", "type": "CPT"}, {"code": "3390100645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 708.4, "maximum": 5261.68, "gross_charge": 1012.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 860.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 759.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 708.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 981.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 708.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 759.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 860.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 809.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP BIL/PAC DCT STN", "code_information": [{"code": "43276", "type": "CPT"}, {"code": "3390100626", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 887.6, "maximum": 6920.72, "gross_charge": 1268.0, "discounted_cash": 8723.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1077.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6013.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 951.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 887.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1229.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 887.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5990.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 951.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6920.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1077.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1014.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP DIAGNOSTIC", "code_information": [{"code": "43260", "type": "CPT"}, {"code": "3390100638", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5864.62, "gross_charge": 6046.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5139.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4534.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4232.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5864.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4232.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4534.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5139.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4836.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3714.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP LES ABLA W/DILA", "code_information": [{"code": "43278", "type": "CPT"}, {"code": "3390100647", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 805.0, "maximum": 5261.68, "gross_charge": 1150.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 977.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 862.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 805.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1115.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 805.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 862.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 977.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 920.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP LITHOTRIPSY CALCULI", "code_information": [{"code": "43265", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5261.68, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP REMOV FB/STNT B", "code_information": [{"code": "43275", "type": "CPT"}, {"code": "3390100644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 3714.42, "gross_charge": 1005.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3714.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP SPHINCTER PRESSURE MEAS", "code_information": [{"code": "43263", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3714.42, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3714.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP STENT BILI/PANC", "code_information": [{"code": "43274", "type": "CPT"}, {"code": "3390100643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 853.3, "maximum": 6920.72, "gross_charge": 1219.0, "discounted_cash": 8723.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1036.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6013.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 914.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 853.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1182.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 853.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5990.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 914.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6920.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1036.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 975.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W REMOV DEBRI /", "code_information": [{"code": "43264", "type": "CPT"}, {"code": "3390100641", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5864.62, "gross_charge": 6046.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5139.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4534.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4232.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5864.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4232.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4534.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5139.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4836.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3714.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP W/OPTICAL ENDOMICROSCPY", "code_information": [{"code": "397T", "type": "CPT"}], "standard_charges": [{"minimum": 5261.68, "maximum": 5261.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5261.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERCP WI BIOPSIES", "code_information": [{"code": "43261", "type": "CPT"}, {"code": "3390100639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5864.62, "gross_charge": 6046.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5139.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4534.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4232.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5864.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4232.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4534.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5139.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4836.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3714.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ERGONOVINE MALEATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1330", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.19, "maximum": 2.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERIBULIN MESYLATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9179", "type": "HCPCS"}], "standard_charges": [{"minimum": 137.67, "maximum": 137.67, "discounted_cash": 215.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERTAPENEM SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1335", "type": "HCPCS"}, {"code": "3400300008", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 11.9, "maximum": 153.26, "gross_charge": 158.0, "discounted_cash": 237.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 153.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERWINAZE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9019", "type": "HCPCS"}], "standard_charges": [{"minimum": 448.63, "maximum": 448.63, "discounted_cash": 686.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 448.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROMYCIN BASE", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300225", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.9, "discounted_cash": 14.85, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "ERYTHROMYCIN LACTOBI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1364", "type": "HCPCS"}, {"code": "3400300128", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 25.76, "maximum": 102.95, "gross_charge": 36.8, "discounted_cash": 129.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31.28, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 89.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 88.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.76, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 89.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.6, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 102.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.28, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 86.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 77.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 86.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 88.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERYTHROPOIETIN", "code_information": [{"code": "82668", "type": "CPT"}, {"code": "3440100902", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.79, "maximum": 162.96, "gross_charge": 168.0, "discounted_cash": 30.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESANO A, PER SQ CM", "code_information": [{"code": "Q4272", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESANO AAA, PER SQ CM", "code_information": [{"code": "Q4273", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESANO AC, PER SQ CM", "code_information": [{"code": "Q4274", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESANO ACA, PER SQ CM", "code_information": [{"code": "Q4275", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESCAPE 1.9F*M0063902", "code_information": [{"code": "3100206324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 940.5, "discounted_cash": 1410.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ESCHAROTOMY ADDL INCISION", "code_information": [{"code": "16036", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESD ENDOSCOPY OR COLONOSCOPY", "code_information": [{"code": "C9779", "type": "HCPCS"}], "standard_charges": [{"minimum": 2883.16, "maximum": 2883.16, "discounted_cash": 5862.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESKETAMINE, NASAL SPRAY", "code_information": [{"code": "S0013", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.12, "maximum": 13.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESMOLOL HCL", "code_information": [{"code": "3400300309", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.9, "discounted_cash": 31.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ESOMEPRAZOLE MAG TRI", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300066", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 18.2, "discounted_cash": 27.3, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "ESOPH BALLOON DISTENSION TST", "code_information": [{"code": "91040", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY LAP", "code_information": [{"code": "43327", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH FUNDOPLASTY THOR", "code_information": [{"code": "43328", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH IMPED FUNCT TEST > 1HR", "code_information": [{"code": "91038", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH LENGTHENING", "code_information": [{"code": "43338", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43206", "type": "CPT"}], "standard_charges": [{"minimum": 2883.16, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SCLEROSIS INJ", "code_information": [{"code": "43204", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAG MUC INTEG W/", "code_information": [{"code": "C9777", "type": "HCPCS"}, {"code": "3270102319", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 1526.35, "maximum": 1526.35, "gross_charge": 11413.59, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAG STENT 18X103", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG STENT 18X123", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG STENT 18X153", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG STENT 23X105", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG STENT 23X125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAG STENT 23X155", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL ENDO CAP*", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3100209529", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1190.7, "maximum": 1649.97, "gross_charge": 1701.0, "discounted_cash": 2551.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1445.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1275.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1190.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1649.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1190.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1275.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1445.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1360.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL FUNCTION", "code_information": [{"code": "91037", "type": "CPT"}, {"code": "3390100674", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 932.72, "gross_charge": 480.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY", "code_information": [{"code": "91010", "type": "CPT"}, {"code": "3390100672", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.94, "maximum": 1027.23, "gross_charge": 1059.0, "discounted_cash": 820.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 565.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 557.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 563.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 650.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 847.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 557.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93615", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 1821.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL RECORDING", "code_information": [{"code": "93616", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 1821.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [{"code": "391", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6360.46, "maximum": 6360.46, "discounted_cash": 14242.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6360.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [{"code": "392", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3925.1, "maximum": 3925.1, "discounted_cash": 8770.88, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3925.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY ABDOMINAL", "code_information": [{"code": "43330", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOMYOTOMY THORACIC", "code_information": [{"code": "43331", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOPLASTY CONGENITAL", "code_information": [{"code": "43313", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP MUCOSAL RESECT", "code_information": [{"code": "43211", "type": "CPT"}], "standard_charges": [{"minimum": 1526.35, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOP ULTRASOUND EXAM", "code_information": [{"code": "43231", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY CONTROL BLEED", "code_information": [{"code": "43227", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 5382.28, "maximum": 5382.28, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY SNARE LES REMV", "code_information": [{"code": "43217", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY W FNA", "code_information": [{"code": "43232", "type": "CPT"}, {"code": "3480101940", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP DILA W B", "code_information": [{"code": "43214", "type": "CPT"}, {"code": "3390100620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 349.3, "maximum": 2883.16, "gross_charge": 499.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 424.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 484.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 424.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP FLEX TOR", "code_information": [{"code": "43229", "type": "CPT"}, {"code": "3390100625", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1341.9, "maximum": 4650.57, "gross_charge": 1917.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1629.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1437.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1341.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1859.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1341.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1437.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1629.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1533.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPY & LIGAT", "code_information": [{"code": "43205", "type": "CPT"}, {"code": "3390100617", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPY FLEXI T", "code_information": [{"code": "43197", "type": "CPT"}, {"code": "3390100612", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 338.8, "maximum": 1526.35, "gross_charge": 484.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 469.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 387.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPY FLEXI T", "code_information": [{"code": "43198", "type": "CPT"}, {"code": "3390100613", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 377.3, "maximum": 1526.35, "gross_charge": 539.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 458.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 404.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 377.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 522.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 377.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 404.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 458.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 431.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPY W BX SI", "code_information": [{"code": "43202", "type": "CPT"}, {"code": "3390100616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2310.63, "gross_charge": 2182.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPY W DIL B", "code_information": [{"code": "43220", "type": "CPT"}, {"code": "3390100623", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3775.24, "gross_charge": 3892.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3308.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2919.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2724.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3775.24, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2724.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2919.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3308.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3113.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPY W/DILAT", "code_information": [{"code": "43226", "type": "CPT"}, {"code": "3390100624", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCPYT ORAL W", "code_information": [{"code": "43202", "type": "CPT"}, {"code": "3390100615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2310.63, "gross_charge": 2182.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCP REM/LES W", "code_information": [{"code": "43216", "type": "CPT"}, {"code": "3390100622", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6339.92, "gross_charge": 6536.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5555.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4902.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4575.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6339.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4575.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4902.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5555.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5228.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RETR DIL", "code_information": [{"code": "43213", "type": "CPT"}, {"code": "3390100619", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1526.35, "maximum": 3171.9, "gross_charge": 3270.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2779.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2452.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2289.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3171.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2289.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2452.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2779.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2616.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RGD TORA", "code_information": [{"code": "43193", "type": "CPT"}, {"code": "3390100608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 322.7, "maximum": 2883.16, "gross_charge": 461.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 447.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RGD TORA", "code_information": [{"code": "43194", "type": "CPT"}, {"code": "3390100609", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 290.5, "maximum": 2883.16, "gross_charge": 415.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 311.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 402.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 311.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 332.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RGD TORA", "code_information": [{"code": "43195", "type": "CPT"}, {"code": "3390100610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 5382.28, "gross_charge": 462.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RGD TORA", "code_information": [{"code": "43196", "type": "CPT"}, {"code": "3390100611", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 351.4, "maximum": 2883.16, "gross_charge": 502.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 426.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 351.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 486.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 351.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 426.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 401.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RGD/ FLE", "code_information": [{"code": "43215", "type": "CPT"}, {"code": "3390100621", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3146.68, "gross_charge": 3244.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3146.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2270.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2433.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2757.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2595.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY RGD/FLEX", "code_information": [{"code": "43200", "type": "CPT"}, {"code": "3390100614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2116.54, "gross_charge": 2182.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGSCPY T ORAL W", "code_information": [{"code": "43212", "type": "CPT"}, {"code": "3390100618", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 338.8, "maximum": 6920.72, "gross_charge": 484.0, "discounted_cash": 8723.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6013.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 469.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5990.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6920.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 387.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5815.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5932.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5382.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHAGUS, GASTROESO", "code_information": [{"code": "91035", "type": "CPT"}, {"code": "3390100673", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 546.94, "maximum": 1027.23, "gross_charge": 1059.0, "discounted_cash": 820.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 565.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 557.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 563.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 650.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 847.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 557.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHASCP RGD TORAL", "code_information": [{"code": "43191", "type": "CPT"}, {"code": "3390100606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 228.2, "maximum": 2883.16, "gross_charge": 326.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 277.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 244.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 228.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 316.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 228.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 244.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 277.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 260.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHASCP RGD TORAL", "code_information": [{"code": "43192", "type": "CPT"}, {"code": "3390100607", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 2883.16, "gross_charge": 388.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHGL MOTIL W/STIM/PERFUS", "code_information": [{"code": "91013", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESOPHOGEAL STETHOSCO", "code_information": [{"code": "3100100653", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ESPHG DSTL 2/3 W/LAPS MOBLJ", "code_information": [{"code": "43287", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG THRSC MOBLJ", "code_information": [{"code": "43288", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/LAPS MOBLJ", "code_information": [{"code": "43286", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESPHG TOT W/THRCM", "code_information": [{"code": "43112", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD DEMO BUNDLE LEVEL I", "code_information": [{"code": "G9013", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD DEMO BUNDLE-LEVEL II", "code_information": [{"code": "G9014", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 12-19", "code_information": [{"code": "90965", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 2-11", "code_information": [{"code": "90964", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO 20+", "code_information": [{"code": "90966", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD HOME PT SERV P MO <2YRS", "code_information": [{"code": "90963", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD ON DIALYSI DRUG/BIO NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3591", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO 20+", "code_information": [{"code": "90962", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VISIT P MO <2YRS", "code_information": [{"code": "90953", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 1 VST P MO 12-19", "code_information": [{"code": "90959", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 2-3 VSTS P MO <2YR", "code_information": [{"code": "90952", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VISITS P MO <2YR", "code_information": [{"code": "90951", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SERV 4 VSTS P MO 2-11", "code_information": [{"code": "90954", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 1 VISIT P MO 2-11", "code_information": [{"code": "90956", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 12-19", "code_information": [{"code": "90958", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 2-11", "code_information": [{"code": "90955", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 2-3 VSTS P MO 20+", "code_information": [{"code": "90961", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VISITS P MO 20+", "code_information": [{"code": "90960", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SRV 4 VSTS P MO 12-19", "code_information": [{"code": "90957", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 12-19", "code_information": [{"code": "90969", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 2-11", "code_information": [{"code": "90968", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT 20+", "code_information": [{"code": "90970", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESRD SVC PR DAY PT <2", "code_information": [{"code": "90967", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EST PT LEVEL 1 PROF", "code_information": [{"code": "99211", "type": "CPT"}, {"code": "3500102253", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 183.4, "maximum": 254.14, "gross_charge": 262.0, "discounted_cash": 393.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 254.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 209.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EST PT LEVEL 2 PROF", "code_information": [{"code": "99212", "type": "CPT"}, {"code": "3500102254", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EST PT LEVEL 3 PROF", "code_information": [{"code": "99213", "type": "CPT"}, {"code": "3500102255", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EST PT LEVEL 4 PROF", "code_information": [{"code": "99214", "type": "CPT"}, {"code": "3500102256", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EST PT LEVEL 5 PROF", "code_information": [{"code": "99215", "type": "CPT"}, {"code": "3500102257", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 414.4, "maximum": 574.24, "gross_charge": 592.0, "discounted_cash": 888.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 503.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 414.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 574.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 414.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 503.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 473.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO AORTA", "code_information": [{"code": "36160", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH ACCESS TO ARTERY", "code_information": [{"code": "36100", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62180", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62190", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL", "code_information": [{"code": "82670", "type": "CPT"}, {"code": "3440100903", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.94, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 44.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 35.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESTRADIOL", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300248", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 55.2, "discounted_cash": 82.8, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "ESTRADIOL VALERATE 10 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1380", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.66, "maximum": 8.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTROGEN CONJUGATED", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300017", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 15.7, "discounted_cash": 23.55, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "ESTROGEN CONJUGATED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}, {"code": "3400300016", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 474.3, "gross_charge": 320.0, "discounted_cash": 597.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 412.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 410.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 398.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 474.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 398.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 398.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG 1ST WND", "code_information": [{"code": "512T", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW INTEG WND HLG EA ADDL", "code_information": [{"code": "513T", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW MUSCSKEL SYS NOS", "code_information": [{"code": "101T", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESW PHY ANES LAT HMRL EPCNDL", "code_information": [{"code": "102T", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ESWL FOR GALLSTONES", "code_information": [{"code": "S9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ETANERCEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1438", "type": "HCPCS"}], "standard_charges": [{"minimum": 650.4, "maximum": 650.4, "discounted_cash": 1270.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 650.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHANOLAMINE OLEATE 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1430", "type": "HCPCS"}], "standard_charges": [{"minimum": 474.44, "maximum": 474.44, "discounted_cash": 761.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 474.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETHI-PACK STEEL", "code_information": [{"code": "3100104640", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ETIDRONATE DISODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1436", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9181", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ETOPOSIDE ORAL 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8560", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.49, "maximum": 76.49, "discounted_cash": 123.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 76.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUFLEXXA INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7323", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.57, "maximum": 115.57, "discounted_cash": 204.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 115.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EUGLOBULIN LYSIS", "code_information": [{"code": "85360", "type": "CPT"}], "standard_charges": [{"minimum": 8.41, "maximum": 20.92, "discounted_cash": 13.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EV CATH DIR CHEM ABLTJ W/IMG", "code_information": [{"code": "524T", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EV FEMPOP ARTL REVSC", "code_information": [{"code": "505T", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAC MEIBOMIAN GLND HEAT BI", "code_information": [{"code": "563T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAC RPR A-BIILIAC NDGFT", "code_information": [{"code": "34705", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVACUATE MOLE OF UTERUS", "code_information": [{"code": "59870", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5342.67, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAL AMNIOTIC FLUID PROTEIN", "code_information": [{"code": "84112", "type": "CPT"}], "standard_charges": [{"minimum": 98.11, "maximum": 181.56, "discounted_cash": 157.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 98.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ 1ST HOUR", "code_information": [{"code": "92626", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAL AUD FUNCJ EA ADDL 15", "code_information": [{"code": "92627", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVAL MOD/DEEP SED/GEN ANEST", "code_information": [{"code": "D9219", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATE SPEECH PRODUCTION", "code_information": [{"code": "92522", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATE SWALLOWING FUNCTION", "code_information": [{"code": "92610", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATION CERVICAL MUCUS", "code_information": [{"code": "89330", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 16.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATION HEART DEVICE", "code_information": [{"code": "93640", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF SPEECH FLUENCY", "code_information": [{"code": "92521", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVALUATION OF WHEEZING", "code_information": [{"code": "94070", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT 1ST", "code_information": [{"code": "61650", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC PRLNG ADMN RX AGNT ADD", "code_information": [{"code": "61651", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT", "code_information": [{"code": "34701", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-AO NDGFT RPT", "code_information": [{"code": "34702", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-ILIAC NDGFT", "code_information": [{"code": "34717", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT", "code_information": [{"code": "34703", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-UNILAC NDGFT RPT", "code_information": [{"code": "34704", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC NDGFT", "code_information": [{"code": "34707", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR ILIO-ILIAC RPT", "code_information": [{"code": "34708", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC RPR N/A A-ILIAC NDGFT", "code_information": [{"code": "34718", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA ACRS BR", "code_information": [{"code": "33894", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC ST RPR THRC/AA X CRSG", "code_information": [{"code": "33895", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVASC VEN ARTLZ TIBL/PRNL VN", "code_information": [{"code": "620T", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 44179.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVERCROSS 4X20*A35HP", "code_information": [{"code": "3100206653", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 5X20*A35HP", "code_information": [{"code": "3100206654", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 5X40*A35HP", "code_information": [{"code": "3100206655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 6X20*A35HP", "code_information": [{"code": "3100206656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 6X20*A35HP", "code_information": [{"code": "3100206657", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 6X40*A35HP", "code_information": [{"code": "3100206658", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 6X40*A35HP", "code_information": [{"code": "3100206659", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 7X20*A35HP", "code_information": [{"code": "3100206660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 7X40*A35HP", "code_information": [{"code": "3100206661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 7X40*A35HP", "code_information": [{"code": "3100206662", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 8X20*A35HP", "code_information": [{"code": "3100206663", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 8X20*A35HP", "code_information": [{"code": "3100206664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 8X40*A35HP", "code_information": [{"code": "3100206665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 8X40*A35HP", "code_information": [{"code": "3100206666", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 9X20*A35HP", "code_information": [{"code": "3100206667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 9X40*A35HP", "code_information": [{"code": "3100206668", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVERCROSS 9X40*AB35W", "code_information": [{"code": "3100206669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EVEROLIMUS", "code_information": [{"code": "80169", "type": "CPT"}, {"code": "3440100813", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.73, "maximum": 118.34, "gross_charge": 122.0, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 118.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 97.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVICEL FLEX TIP", "code_information": [{"code": "3100101995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EVICEL FLEX TIP", "code_information": [{"code": "C9250", "type": "HCPCS"}, {"code": "3100104544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 90.0, "discounted_cash": 213.24, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVO CAGE 10.5MM*4311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8827.0, "maximum": 12231.7, "gross_charge": 12610.0, "discounted_cash": 18915.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10718.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9457.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12231.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9457.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10718.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVO PLATE H 10.5MM*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST", "code_information": [{"code": "92588", "type": "CPT"}, {"code": "3500102300", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 147.3, "maximum": 381.15, "gross_charge": 392.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 380.24, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST LIMITED", "code_information": [{"code": "92587", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVOKED AUDITORY TEST QUAL", "code_information": [{"code": "92558", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EVOKED POTENTL STDY", "code_information": [{"code": "95939", "type": "CPT"}, {"code": "3480103014", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 414.74, "maximum": 1269.62, "gross_charge": 1067.0, "discounted_cash": 1600.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 906.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1103.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 746.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1034.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1088.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 746.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1098.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1269.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 906.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1088.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX FIX LG OUTRIGGER*", "code_information": [{"code": "3100206261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.3, "discounted_cash": 684.45, "setting": "both", "billing_class": "facility"}]}, {"description": "EX FIX LG OUTRIGGER*", "code_information": [{"code": "3100208749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.12, "discounted_cash": 700.68, "setting": "both", "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEV RX ADD", "code_information": [{"code": "92618", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX FOR NONSPEECH DEVICE RX", "code_information": [{"code": "92605", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX 1HR", "code_information": [{"code": "92607", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EX FOR SPEECH DEVICE RX ADDL", "code_information": [{"code": "92608", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM FECES FOR MEAT FIBERS", "code_information": [{"code": "89160", "type": "CPT"}], "standard_charges": [{"minimum": 4.85, "maximum": 35.16, "discounted_cash": 7.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF CERVIX W/SCOPE", "code_information": [{"code": "57452", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF VAGINA W/SCOPE", "code_information": [{"code": "57420", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM OF VULVA W/SCOPE", "code_information": [{"code": "56820", "type": "CPT"}], "standard_charges": [{"minimum": 167.32, "maximum": 277.43, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VAG W/SCOPE", "code_information": [{"code": "57421", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXAM/BIOPSY OF VULVA W/SCOPE", "code_information": [{"code": "56821", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD LESION SC <", "code_information": [{"code": "22902", "type": "CPT"}, {"code": "3480101530", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1654.43, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM 5 CM OR LESS", "code_information": [{"code": "49203", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 10 CM", "code_information": [{"code": "49205", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABD TUM OVER 5 CM", "code_information": [{"code": "49204", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC ABDL TUM DEEP < 5 CM", "code_information": [{"code": "22900", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BACK TUM DEEP < 5 CM", "code_information": [{"code": "21932", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LES TRUNK 3.", "code_information": [{"code": "11404", "type": "CPT"}, {"code": "3380103002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 0.5CM", "code_information": [{"code": "11400", "type": "CPT"}, {"code": "3480101306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1141.69, "gross_charge": 1177.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1141.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 941.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 0.6-1", "code_information": [{"code": "11421", "type": "CPT"}, {"code": "3480101313", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1981.71, "gross_charge": 2043.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 0.6-1", "code_information": [{"code": "11421", "type": "CPT"}, {"code": "3480103208", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2252.34, "gross_charge": 2322.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1973.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1741.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1625.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2252.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1625.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1741.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1973.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1857.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 1.1 T", "code_information": [{"code": "11422", "type": "CPT"}, {"code": "3480101314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 1.1 T", "code_information": [{"code": "11422", "type": "CPT"}, {"code": "3480103209", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5164.28, "gross_charge": 5324.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4525.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3993.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3726.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5164.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3726.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3993.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4525.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4259.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 2.1 -", "code_information": [{"code": "11403", "type": "CPT"}, {"code": "3480101309", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2377.47, "gross_charge": 2451.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2377.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION 2.1-3", "code_information": [{"code": "11423", "type": "CPT"}, {"code": "3480101315", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION EXC 1", "code_information": [{"code": "11402", "type": "CPT"}, {"code": "3480101308", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1141.69, "gross_charge": 1177.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1141.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 941.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION FACE", "code_information": [{"code": "11440", "type": "CPT"}, {"code": "3480101317", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1370.61, "gross_charge": 1413.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1370.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1130.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION FACE", "code_information": [{"code": "11441", "type": "CPT"}, {"code": "3480101318", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1370.61, "gross_charge": 1413.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1370.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1130.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION FACE", "code_information": [{"code": "11442", "type": "CPT"}, {"code": "3480101319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1981.71, "gross_charge": 2043.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION FACE", "code_information": [{"code": "11443", "type": "CPT"}, {"code": "3480101320", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2377.47, "gross_charge": 2451.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2377.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION OVER", "code_information": [{"code": "11406", "type": "CPT"}, {"code": "3480101311", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION OVER", "code_information": [{"code": "11426", "type": "CPT"}, {"code": "3480101316", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION TRUNK", "code_information": [{"code": "11401", "type": "CPT"}, {"code": "3480101307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1370.61, "gross_charge": 1413.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1370.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1130.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BEN LESION TRUNK", "code_information": [{"code": "11401", "type": "CPT"}, {"code": "3480103206", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1224.14, "gross_charge": 1262.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1072.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 946.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 883.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1224.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 883.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 946.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1072.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1009.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BENIGN TUMOR/CYS", "code_information": [{"code": "21030", "type": "CPT"}, {"code": "3480101456", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 7111.29, "gross_charge": 6299.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC BENIGN TUMOR/CYS", "code_information": [{"code": "21046", "type": "CPT"}, {"code": "3480101457", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/LYMPHADEC", "code_information": [{"code": "21603", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CH WAL TUM W/O LYMPHADEC", "code_information": [{"code": "21602", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CHALAZION ANES R", "code_information": [{"code": "67808", "type": "CPT"}, {"code": "3480102208", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC CHEST WALL TUMOR W/RIBS", "code_information": [{"code": "21601", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP 2 CM/>", "code_information": [{"code": "21014", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE TUM DEEP < 2 CM", "code_information": [{"code": "21013", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG 3.1-4 CM", "code_information": [{"code": "11444", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM B9+MARG >4 CM", "code_information": [{"code": "11446", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FACE-MM MALIG+MA", "code_information": [{"code": "11644", "type": "CPT"}, {"code": "3480101329", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOOT/TOE TUM DEP 1.5CM/>", "code_information": [{"code": "28041", "type": "CPT"}], "standard_charges": [{"minimum": 3498.15, "maximum": 3498.15, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP", "code_information": [{"code": "25073", "type": "CPT"}, {"code": "3480101583", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2899.57, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC FOREARM TUM DEEP < 3 CM", "code_information": [{"code": "25076", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H,F,NK, SP MLG+M", "code_information": [{"code": "11623", "type": "CPT"}, {"code": "3480101324", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2377.47, "gross_charge": 2451.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2377.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9 MAR", "code_information": [{"code": "11420", "type": "CPT"}, {"code": "3480101312", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP B9 MAR", "code_information": [{"code": "11420", "type": "CPT"}, {"code": "3480103207", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5164.28, "gross_charge": 5324.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4525.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3993.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3726.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5164.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3726.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3993.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4525.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4259.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC H-F-NK-SP MAL+MARG 0.5/<", "code_information": [{"code": "11620", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HAND TUM DEEP 1.5 CM/>", "code_information": [{"code": "26113", "type": "CPT"}], "standard_charges": [{"minimum": 1856.1, "maximum": 1856.1, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP 5 CM/>", "code_information": [{"code": "27045", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC HIP/PELV TUM DEEP < 5 CM", "code_information": [{"code": "27048", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE LES SC", "code_information": [{"code": "27632", "type": "CPT"}, {"code": "3480101717", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2899.57, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LEG/ANKLE TUM DEP 5 CM/>", "code_information": [{"code": "27634", "type": "CPT"}], "standard_charges": [{"minimum": 4111.8, "maximum": 4111.8, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LESION EYELID W/", "code_information": [{"code": "67840", "type": "CPT"}, {"code": "3480102209", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2090.35, "gross_charge": 2155.0, "discounted_cash": 1549.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1068.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2090.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1053.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1064.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1033.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1229.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1033.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1033.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1053.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC LESION/TUMOR DEN", "code_information": [{"code": "41826", "type": "CPT"}, {"code": "3480101912", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC MAL LESION 2.1-3", "code_information": [{"code": "11603", "type": "CPT"}, {"code": "3480101321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2377.47, "gross_charge": 2451.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2377.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC MAL LESION 3.1-4", "code_information": [{"code": "11604", "type": "CPT"}, {"code": "3480101322", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2377.47, "gross_charge": 2451.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2377.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1838.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2083.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC MAL LESION >4CM", "code_information": [{"code": "11606", "type": "CPT"}, {"code": "3480101323", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC MAL LESION >4CM", "code_information": [{"code": "11626", "type": "CPT"}, {"code": "3480101325", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC MAL LESION HEAD", "code_information": [{"code": "11642", "type": "CPT"}, {"code": "3480101327", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1141.69, "gross_charge": 1177.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1141.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 941.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC MAL LESION HEAD", "code_information": [{"code": "11643", "type": "CPT"}, {"code": "3480101328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK LESION SC 3", "code_information": [{"code": "21552", "type": "CPT"}, {"code": "3480101473", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2470.2, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NECK TUMOR DEEP", "code_information": [{"code": "21554", "type": "CPT"}, {"code": "3480101474", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2470.2, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC NEUROMA HND/FT X", "code_information": [{"code": "64782", "type": "CPT"}, {"code": "3340102339", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4698.68, "gross_charge": 4844.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4698.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3875.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC OF CYST OF AURIC", "code_information": [{"code": "69110", "type": "CPT"}, {"code": "3480102223", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC OF MALIG LESION", "code_information": [{"code": "11641", "type": "CPT"}, {"code": "3480101326", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1141.69, "gross_charge": 1177.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1141.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 941.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC PILONI CYST/SINU", "code_information": [{"code": "11770", "type": "CPT"}, {"code": "3480101334", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RCT TUM", "code_information": [{"code": "45171", "type": "CPT"}, {"code": "3480101968", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2865.18, "maximum": 7453.48, "gross_charge": 7684.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6531.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5763.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5378.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7453.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5378.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5763.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6531.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6147.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECT TUM TRANSANAL FULL", "code_information": [{"code": "45172", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC RECTAL TUMOR ENDOSCOPIC", "code_information": [{"code": "184T", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 0.6-1", "code_information": [{"code": "11621", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC S/N/H/F/G MAL+MRG 1.1-2", "code_information": [{"code": "11622", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP 5 CM/>", "code_information": [{"code": "23073", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SHOULDER TUM DEEP < 5 CM", "code_information": [{"code": "23076", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U COMPLEX", "code_information": [{"code": "11471", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN H/P/P/U SMPL/NTRM", "code_information": [{"code": "11470", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX COMPLEX", "code_information": [{"code": "11451", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT AX SMPL/NTRM", "code_information": [{"code": "11450", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING COMPLEX", "code_information": [{"code": "11463", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC SKN HDRDNT ING SMPL/NTRM", "code_information": [{"code": "11462", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE LES S", "code_information": [{"code": "27337", "type": "CPT"}, {"code": "3480103019", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 5639.36, "gross_charge": 5813.78, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.71, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.64, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.33, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.71, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC THIGH/KNEE TUM DEEP <5CM", "code_information": [{"code": "27328", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TR-EXT MAL+MARG 0.5 CM/<", "code_information": [{"code": "11600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TUMOR HIP 3CM", "code_information": [{"code": "27043", "type": "CPT"}, {"code": "3480101661", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TUMOR SOFT TISS", "code_information": [{"code": "24073", "type": "CPT"}, {"code": "3480101554", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2899.57, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TUMOR SOFT TISS", "code_information": [{"code": "25071", "type": "CPT"}, {"code": "3480101582", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1654.43, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TUMOR SOFT TISSU", "code_information": [{"code": "22903", "type": "CPT"}, {"code": "3480101531", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TUMOR SOFT TISSU", "code_information": [{"code": "24071", "type": "CPT"}, {"code": "3480101553", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC TUMR SFT TISSUE", "code_information": [{"code": "21930", "type": "CPT"}, {"code": "3480101478", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC VAGINAL CYST/TUM", "code_information": [{"code": "57135", "type": "CPT"}, {"code": "3480102088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM AGRF", "code_information": [{"code": "24115", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM HUM ALGR", "code_information": [{"code": "24116", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS AGRF", "code_information": [{"code": "24125", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CRTG B1 CST/TUM RDS ALGR", "code_information": [{"code": "24126", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CURTG B1 CST/B9 TUM HUM", "code_information": [{"code": "24110", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXC/CURTG CYST/TUMOR", "code_information": [{"code": "25130", "type": "CPT"}, {"code": "3340102304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCALIBUR HL 4.2X19*", "code_information": [{"code": "3100203486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCELLAGEN, 0.1 CC", "code_information": [{"code": "Q4149", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE BILIARY DRG CATH", "code_information": [{"code": "47536", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE DRAINAGE CATHETER", "code_information": [{"code": "49423", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1083.58, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE INTRAOC LEN", "code_information": [{"code": "66986", "type": "CPT"}, {"code": "3410100702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5875.29, "gross_charge": 6057.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5875.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4845.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHANGE NEPHROSTOMY CATH", "code_information": [{"code": "50435", "type": "CPT"}], "standard_charges": [{"minimum": 1571.3, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCHNG TRANSFU BLOOD", "code_information": [{"code": "36450", "type": "CPT"}, {"code": "3440103013", "type": "CDM"}, {"code": "391", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1769.28, "gross_charge": 1824.0, "discounted_cash": 664.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1550.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 458.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1276.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1769.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1276.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 456.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 527.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1550.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 442.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 451.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS 250-500", "code_information": [{"code": "96921", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS<250SQCM", "code_information": [{"code": "96920", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIMER LSR PSRIASIS>500SQCM", "code_information": [{"code": "96922", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIS BONE CST/BENIG", "code_information": [{"code": "25130", "type": "CPT"}, {"code": "3340102307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIS NEUROMA HAND/F", "code_information": [{"code": "64782", "type": "CPT"}, {"code": "3340102310", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4698.68, "gross_charge": 4844.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4698.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3875.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIS TEND PALM SING", "code_information": [{"code": "26170", "type": "CPT"}, {"code": "3340102345", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4245.69, "gross_charge": 4377.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4245.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3501.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCIS UPPR JAW CYST W/REPAIR", "code_information": [{"code": "21049", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE BREAST DUCT FISTULA", "code_information": [{"code": "19112", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1551.72, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EPIPHYSEAL BAR", "code_information": [{"code": "20150", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN & TISSUE", "code_information": [{"code": "15839", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN ARM/HAND", "code_information": [{"code": "15837", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN BUTTCK", "code_information": [{"code": "15835", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN THIGH", "code_information": [{"code": "15832", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28086", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE FOOT TENDON SHEATH", "code_information": [{"code": "28088", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ILEOANAL RESERVIOR", "code_information": [{"code": "45136", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTESTINE LESION(S)", "code_information": [{"code": "44110", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRASPINL LE", "code_information": [{"code": "63265", "type": "CPT"}, {"code": "3340102370", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3801.0, "maximum": 8687.35, "gross_charge": 5430.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4615.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4072.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3801.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5267.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3801.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4072.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4615.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4344.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION CRVL", "code_information": [{"code": "63270", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION LMBR", "code_information": [{"code": "63272", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION SCRL", "code_information": [{"code": "63273", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63266", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63271", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE LWR JAW CYST W/REPAIR", "code_information": [{"code": "21047", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MALIGNANT LES", "code_information": [{"code": "11601", "type": "CPT"}, {"code": "3340102416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1082.52, "gross_charge": 1116.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 948.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 837.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1082.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 837.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 948.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 892.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MANDIBLE LESION", "code_information": [{"code": "21040", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE MAX/ZYGOMA MAL TUMOR", "code_information": [{"code": "21034", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE ORAL MUCOSA FOR GRAFT", "code_information": [{"code": "40818", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42426", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE SUBLINGUAL GLAND", "code_information": [{"code": "42450", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE TENDON FOREARM/WRIST", "code_information": [{"code": "25109", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE WRIST TENDON", "code_information": [{"code": "25118", "type": "CPT"}, {"code": "3480101589", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE/EVAC LUMBAR-E", "code_information": [{"code": "63267", "type": "CPT"}, {"code": "3480102159", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2333.1, "maximum": 8687.35, "gross_charge": 3333.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2833.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2499.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2333.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3233.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2333.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2499.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2833.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2666.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISE/EVAC SACRAL-E", "code_information": [{"code": "63268", "type": "CPT"}, {"code": "3480102160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2438.8, "maximum": 8687.35, "gross_charge": 3484.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2961.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2613.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2438.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3379.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2438.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2613.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2961.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2787.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISI TUM SFT FOOT", "code_information": [{"code": "28039", "type": "CPT"}, {"code": "3340102295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2899.57, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION .5CM OR LES", "code_information": [{"code": "11640", "type": "CPT"}, {"code": "3340102444", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2175.71, "gross_charge": 2243.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1906.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1682.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1570.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2175.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1570.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1682.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1906.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1794.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION 5 CM>", "code_information": [{"code": "21933", "type": "CPT"}, {"code": "3340102436", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION ARM/ELBOW L", "code_information": [{"code": "24075", "type": "CPT"}, {"code": "3480101555", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1654.43, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESI", "code_information": [{"code": "11424", "type": "CPT"}, {"code": "3480103101", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3891.64, "gross_charge": 4012.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3891.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3209.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION COMPL", "code_information": [{"code": "D7412", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION>1.25C", "code_information": [{"code": "D7411", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN TUMO", "code_information": [{"code": "24120", "type": "CPT"}, {"code": "3480101557", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BONE MANDIB", "code_information": [{"code": "21025", "type": "CPT"}, {"code": "3480101454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BONE/OLECR", "code_information": [{"code": "24147", "type": "CPT"}, {"code": "3480101559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BRANCHIAL C", "code_information": [{"code": "42810", "type": "CPT"}, {"code": "3480101928", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION BRANCHIAL C", "code_information": [{"code": "42815", "type": "CPT"}, {"code": "3480101929", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION CHALAZION M", "code_information": [{"code": "67805", "type": "CPT"}, {"code": "3480102207", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 786.67, "gross_charge": 811.0, "discounted_cash": 445.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 307.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 786.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 306.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 353.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION CONSTRICTING TISSUE", "code_information": [{"code": "26596", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION CUTANEOUS N", "code_information": [{"code": "64788", "type": "CPT"}, {"code": "3480102196", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION DERMOID CYS", "code_information": [{"code": "30124", "type": "CPT"}, {"code": "3340102317", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6311.79, "gross_charge": 6507.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION EXCESS SKIN", "code_information": [{"code": "15836", "type": "CPT"}, {"code": "3480101381", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION EXCESS SKIN", "code_information": [{"code": "15847", "type": "CPT"}, {"code": "3480101382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3196.88, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 8721.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION FACIAL BONE", "code_information": [{"code": "21026", "type": "CPT"}, {"code": "3340102348", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7111.29, "gross_charge": 6507.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT EXTREMITY", "code_information": [{"code": "35903", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT NECK", "code_information": [{"code": "35901", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT THORAX", "code_information": [{"code": "35905", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION GUM EACH QUADRANT", "code_information": [{"code": "41820", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION HAND/FINGER TENDON", "code_information": [{"code": "26415", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION HYPERPLASTIC TISSUE", "code_information": [{"code": "D7970", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LES MUCOSA", "code_information": [{"code": "40814", "type": "CPT"}, {"code": "3340102298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6311.79, "gross_charge": 6507.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION LESION MOUTH ROOF", "code_information": [{"code": "42107", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2713.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LES >", "code_information": [{"code": "11646", "type": "CPT"}, {"code": "3340102333", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LES COMPLICAT", "code_information": [{"code": "D7415", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION<=1.25C", "code_information": [{"code": "D7413", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION MALIG LESION>1.25CM", "code_information": [{"code": "D7414", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION NEUROMA-SUR", "code_information": [{"code": "64774", "type": "CPT"}, {"code": "3480102194", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5478.56, "gross_charge": 5648.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5478.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4518.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT CYST", "code_information": [{"code": "47715", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47711", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BILE DUCT TUMOR", "code_information": [{"code": "47712", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL LESION(S)", "code_information": [{"code": "44111", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BOWEL POUCH", "code_information": [{"code": "44800", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF BRAIN TUMOR", "code_information": [{"code": "61545", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CYST OR", "code_information": [{"code": "60200", "type": "CPT"}, {"code": "3480102124", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 14956.43, "gross_charge": 15419.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13106.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11564.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10793.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14956.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10793.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11564.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13106.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12335.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43100", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF ESOPHAGUS LESION", "code_information": [{"code": "43101", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF EXCESSIV", "code_information": [{"code": "15830", "type": "CPT"}, {"code": "3480101380", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7918.71, "gross_charge": 6977.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF EXTRAPAR", "code_information": [{"code": "54512", "type": "CPT"}, {"code": "3480102063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6913.19, "gross_charge": 7127.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6057.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5345.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4988.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6913.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4988.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5345.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6057.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5701.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF FRENUM,", "code_information": [{"code": "40819", "type": "CPT"}, {"code": "3480101902", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3895.52, "gross_charge": 4016.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM FLAP", "code_information": [{"code": "41821", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 361.79, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41822", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41823", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41827", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF GUM LESION", "code_information": [{"code": "41828", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3777.61, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HIP JOINT/MUSCLE", "code_information": [{"code": "27036", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCEL", "code_information": [{"code": "55040", "type": "CPT"}, {"code": "3480102071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCEL", "code_information": [{"code": "55040", "type": "CPT"}, {"code": "3480103268", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11955.25, "gross_charge": 12325.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10476.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9243.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8627.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11955.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8627.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9243.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10476.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCEL", "code_information": [{"code": "55041", "type": "CPT"}, {"code": "3480102072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9895.94, "gross_charge": 10202.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9895.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8161.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF HYDROCEL", "code_information": [{"code": "55500", "type": "CPT"}, {"code": "3480102077", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION", "code_information": [{"code": "11602", "type": "CPT"}, {"code": "3340102376", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1082.52, "gross_charge": 1116.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 948.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 837.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1082.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 837.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 948.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 892.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION O", "code_information": [{"code": "27347", "type": "CPT"}, {"code": "3480101690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION O", "code_information": [{"code": "40812", "type": "CPT"}, {"code": "3480101901", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4674.43, "gross_charge": 4819.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4096.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3614.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3373.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4674.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3373.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3614.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4096.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3855.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION O", "code_information": [{"code": "41110", "type": "CPT"}, {"code": "3480101906", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION O", "code_information": [{"code": "41112", "type": "CPT"}, {"code": "3480101907", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION O", "code_information": [{"code": "41825", "type": "CPT"}, {"code": "3480101911", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION O", "code_information": [{"code": "55520", "type": "CPT"}, {"code": "3480102078", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION,", "code_information": [{"code": "28090", "type": "CPT"}, {"code": "3480101747", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION,", "code_information": [{"code": "28092", "type": "CPT"}, {"code": "3480101748", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL", "code_information": [{"code": "41115", "type": "CPT"}, {"code": "3480101908", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "gross_charge": 1745.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1692.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1396.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LINGUAL TONSIL", "code_information": [{"code": "42870", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2399.89, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LOCAL LE", "code_information": [{"code": "54830", "type": "CPT"}, {"code": "3480102069", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LOCAL LE", "code_information": [{"code": "54830", "type": "CPT"}, {"code": "3480103266", "type": "CDM"}, {"code": "760", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MESENTERY LESION", "code_information": [{"code": "44820", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LE", "code_information": [{"code": "40810", "type": "CPT"}, {"code": "3340102482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4134.14, "gross_charge": 4262.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4134.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3409.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "40816", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3777.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF MOUTH LESION", "code_information": [{"code": "41116", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF NAIL FOLD TOE", "code_information": [{"code": "11765", "type": "CPT"}], "standard_charges": [{"minimum": 226.95, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PAROTID", "code_information": [{"code": "42410", "type": "CPT"}, {"code": "3480101922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PAROTID", "code_information": [{"code": "42415", "type": "CPT"}, {"code": "3480101923", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF PAROTID", "code_information": [{"code": "42420", "type": "CPT"}, {"code": "3480101924", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL LESION", "code_information": [{"code": "45160", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45130", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL PROLAPSE", "code_information": [{"code": "45135", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF RECTAL STRICTURE", "code_information": [{"code": "45150", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SALIVARY GLAND", "code_information": [{"code": "D7981", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61563", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL TUMOR", "code_information": [{"code": "61564", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61558", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKULL/SUTURES", "code_information": [{"code": "61559", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SPERMATO", "code_information": [{"code": "54840", "type": "CPT"}, {"code": "3480103034", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SUBLINGU", "code_information": [{"code": "42408", "type": "CPT"}, {"code": "3480101921", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SUBMANDI", "code_information": [{"code": "42440", "type": "CPT"}, {"code": "3480101925", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SYNOVIAL", "code_information": [{"code": "27345", "type": "CPT"}, {"code": "3480101689", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF THYROGLO", "code_information": [{"code": "60280", "type": "CPT"}, {"code": "3480102131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12463.53, "gross_charge": 12849.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10921.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9636.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8994.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12463.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8994.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9636.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10921.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10279.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41113", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41114", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONSIL T", "code_information": [{"code": "42860", "type": "CPT"}, {"code": "3480103033", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TUMOR", "code_information": [{"code": "22901", "type": "CPT"}, {"code": "3480103135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TUMOR", "code_information": [{"code": "24076", "type": "CPT"}, {"code": "3340102458", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3891.64, "gross_charge": 4012.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3891.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3209.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF UMBILICUS", "code_information": [{"code": "49250", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VARICOCE", "code_information": [{"code": "55530", "type": "CPT"}, {"code": "3480102079", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VARICOCE", "code_information": [{"code": "55540", "type": "CPT"}, {"code": "3480102080", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OR CURETTAG", "code_information": [{"code": "27355", "type": "CPT"}, {"code": "3480101691", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OR CURETTAG", "code_information": [{"code": "27635", "type": "CPT"}, {"code": "3480101718", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OR CURETTAG", "code_information": [{"code": "27637", "type": "CPT"}, {"code": "3480101719", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 8074.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OR CURETTAG", "code_information": [{"code": "28104", "type": "CPT"}, {"code": "3480101749", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OR DESTRUCT", "code_information": [{"code": "30117", "type": "CPT"}, {"code": "3480101826", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4674.43, "gross_charge": 4819.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4096.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3614.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3373.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4674.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3373.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3614.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4096.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3855.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION OR DESTRUCT", "code_information": [{"code": "42808", "type": "CPT"}, {"code": "3480101927", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7332.23, "gross_charge": 7559.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7332.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6047.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION PERICORONAL GINGIVA", "code_information": [{"code": "D7971", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TUM ST THIG", "code_information": [{"code": "27339", "type": "CPT"}, {"code": "3340102299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT", "code_information": [{"code": "21011", "type": "CPT"}, {"code": "3480101453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1430.1, "maximum": 2542.29, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT", "code_information": [{"code": "21931", "type": "CPT"}, {"code": "3480101479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1654.43, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT", "code_information": [{"code": "23071", "type": "CPT"}, {"code": "3480101533", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1654.43, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR SOFT", "code_information": [{"code": "26111", "type": "CPT"}, {"code": "3340102421", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1654.43, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TUMOR, SOFT", "code_information": [{"code": "21555", "type": "CPT"}, {"code": "3480101475", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION TURBINATE,", "code_information": [{"code": "30130", "type": "CPT"}, {"code": "3480101827", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7332.23, "gross_charge": 7559.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7332.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6047.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION VAGINAL SEP", "code_information": [{"code": "57130", "type": "CPT"}, {"code": "3480102087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, INTERDIGIT", "code_information": [{"code": "28080", "type": "CPT"}, {"code": "3480101746", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, LESION OF", "code_information": [{"code": "42104", "type": "CPT"}, {"code": "3480101915", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, LESION OF", "code_information": [{"code": "42106", "type": "CPT"}, {"code": "3480101916", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, PREPATELLA", "code_information": [{"code": "27340", "type": "CPT"}, {"code": "3480101688", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6336.04, "gross_charge": 6532.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6336.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5225.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, TUMOR, FOO", "code_information": [{"code": "28043", "type": "CPT"}, {"code": "3480101744", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, TUMOR, FOO", "code_information": [{"code": "28045", "type": "CPT"}, {"code": "3480101745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, TUMOR, LEG", "code_information": [{"code": "27618", "type": "CPT"}, {"code": "3480101715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, TUMOR, LEG", "code_information": [{"code": "27619", "type": "CPT"}, {"code": "3480101716", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, TUMOR, PEL", "code_information": [{"code": "27047", "type": "CPT"}, {"code": "3480101662", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION, TUMOR, THI", "code_information": [{"code": "27327", "type": "CPT"}, {"code": "3480101684", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION,MALIGNANT", "code_information": [{"code": "11624", "type": "CPT"}, {"code": "3480103090", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3891.64, "gross_charge": 4012.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3891.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3209.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION/TRANSPOSITI", "code_information": [{"code": "65420", "type": "CPT"}, {"code": "3480102200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3834.41, "gross_charge": 3953.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3360.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2964.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2767.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3834.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2767.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2964.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3360.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3162.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISION/TRANSPOSITI", "code_information": [{"code": "65426", "type": "CPT"}, {"code": "3480102201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "gross_charge": 7042.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5985.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5281.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4929.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6830.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4929.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5281.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5985.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5633.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCISOR FISHER CONE", "code_information": [{"code": "3100100654", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCISOR FISHER CONE", "code_information": [{"code": "3100102777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCISOR FISHER CONE", "code_information": [{"code": "3100102778", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCISOR FISHER CONE", "code_information": [{"code": "3100104477", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXCISSION OF EXTERNA", "code_information": [{"code": "46230", "type": "CPT"}, {"code": "3480101975", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4341.72, "gross_charge": 4476.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4341.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3580.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPEN ANY METHOD", "code_information": [{"code": "33267", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA OPN OTH PX ANY METH", "code_information": [{"code": "33268", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCL LAA THRSCP ANY METHOD", "code_information": [{"code": "33269", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXCSN TUMR ST F/S SU", "code_information": [{"code": "21012", "type": "CPT"}, {"code": "3480103051", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1430.1, "maximum": 2542.29, "gross_charge": 2043.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1981.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1430.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1532.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1736.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXERCISE CLASS", "code_information": [{"code": "S9451", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM W/ECG", "code_information": [{"code": "94617", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXERCISE TST BRNCSPSM WO ECG", "code_information": [{"code": "94619", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXERCISE W/HEMODYNAMIC MEAS", "code_information": [{"code": "93464", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXFOLIATIVE CYTOLOG COLLECT", "code_information": [{"code": "D7287", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS", "code_information": [{"code": "94690", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2", "code_information": [{"code": "94680", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXHALED AIR ANALYSIS O2/CO2", "code_information": [{"code": "94681", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXHALED BREATH CONDENSATE", "code_information": [{"code": "83987", "type": "CPT"}], "standard_charges": [{"minimum": 3.58, "maximum": 20.92, "discounted_cash": 5.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXHALED NITRIC OXIDE MEAS", "code_information": [{"code": "95012", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXOME RE-EVALUATION", "code_information": [{"code": "81417", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 320.0, "discounted_cash": 514.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81415", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 4780.0, "discounted_cash": 7679.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4780.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXOME SEQUENCE ANALYSIS", "code_information": [{"code": "81416", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 12000.0, "discounted_cash": 19278.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXP/TRT HAND IP JNT", "code_information": [{"code": "26080", "type": "CPT"}, {"code": "3480101620", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXP/TRT HAND MCP JNT", "code_information": [{"code": "26075", "type": "CPT"}, {"code": "3480101619", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG LXTR ART", "code_information": [{"code": "35703", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG NECK ART", "code_information": [{"code": "35701", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPL N/FLWD SURG UXTR ART", "code_information": [{"code": "35702", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND ABDOMEN", "code_information": [{"code": "49010", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND UPPER JAW", "code_information": [{"code": "31040", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54560", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2109.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR UNDE", "code_information": [{"code": "54550", "type": "CPT"}, {"code": "3480102066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOM", "code_information": [{"code": "49000", "type": "CPT"}, {"code": "3340102365", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4404.17, "gross_charge": 2574.0, "discounted_cash": 3861.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2187.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1930.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1801.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2496.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1801.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1930.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2187.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2059.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ABDOMEN", "code_information": [{"code": "58960", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF ANKLE JOINT", "code_information": [{"code": "27612", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF BILE DUCTS", "code_information": [{"code": "47700", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31070", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 7111.29, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF FRONTAL SINUS", "code_information": [{"code": "31075", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF HIP JOINT", "code_information": [{"code": "27033", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF MIDDLE EAR", "code_information": [{"code": "69440", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SINUSES", "code_information": [{"code": "31090", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF SPINA", "code_information": [{"code": "22830", "type": "CPT"}, {"code": "3480101514", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1404.2, "maximum": 5178.02, "gross_charge": 2006.0, "discounted_cash": 3009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1705.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1504.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1945.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1504.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1705.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1604.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF URETER", "code_information": [{"code": "50600", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF VAGINA", "code_information": [{"code": "57000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION SPHENOID SINUS", "code_information": [{"code": "31050", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45562", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATION/REPAIR OF RECTUM", "code_information": [{"code": "45563", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33310", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY HEART SURGERY", "code_information": [{"code": "33315", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23040", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": [{"code": "23044", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1927.74, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69805", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE INNER EAR", "code_information": [{"code": "69806", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE NECK VESSELS", "code_information": [{"code": "35800", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 5635.04, "maximum": 5635.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SINUS REMOVE POLYPS", "code_information": [{"code": "31032", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE SMALL INTESTINE", "code_information": [{"code": "44020", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE TREAT SHOULDER JOINT", "code_information": [{"code": "23107", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND ABDOMEN", "code_information": [{"code": "20102", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND CHEST", "code_information": [{"code": "20101", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE WOUND NECK", "code_information": [{"code": "20100", "type": "CPT"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/BIOPSY EYE SOCKET", "code_information": [{"code": "67450", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67405", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67440", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/IRRIGATE TEAR DUCTS", "code_information": [{"code": "68840", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE", "code_information": [{"code": "27620", "type": "CPT"}, {"code": "3340102426", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT ANKLE JOINT", "code_information": [{"code": "27610", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67412", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67413", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67420", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67430", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT HAND JOINT", "code_information": [{"code": "26070", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT KNEE JOINT", "code_information": [{"code": "27331", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST", "code_information": [{"code": "25101", "type": "CPT"}, {"code": "3480103076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORE/TREAT WRIST JOINT", "code_information": [{"code": "25040", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLORER DOUBLE END", "code_information": [{"code": "3100100655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67414", "type": "CPT"}], "standard_charges": [{"minimum": 3980.08, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPLR/DECOMPRESS EYE SOCKET", "code_information": [{"code": "67445", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXPOSURE OF UNERUPTED TOOTH", "code_information": [{"code": "D7280", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REC SCAN A/R", "code_information": [{"code": "93241", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D RECORDING", "code_information": [{"code": "93242", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D REV&INTERPJ", "code_information": [{"code": "93244", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>48HR<7D SCAN A/R", "code_information": [{"code": "93243", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REC SCAN A/R", "code_information": [{"code": "93245", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D RECORDING", "code_information": [{"code": "93246", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D REV&INTERPJ", "code_information": [{"code": "93248", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXT ECG>7D<15D SCAN A/R", "code_information": [{"code": "93247", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENDED CONN 30MM*7", "code_information": [{"code": "3100209119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.6, "discounted_cash": 801.9, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENDED CULTURE OF OOCYTES", "code_information": [{"code": "89272", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 1316.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENDED HEAD*41-401", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1136.1, "maximum": 1574.31, "gross_charge": 1623.0, "discounted_cash": 2434.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1379.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1217.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1136.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1574.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1136.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1217.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1379.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1298.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENDED VISUAL FIELD XM", "code_information": [{"code": "92083", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSION KIT 60CM*3", "code_information": [{"code": "3100204624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION KIT 60CM*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1314.6, "maximum": 1821.66, "gross_charge": 1878.0, "discounted_cash": 2817.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1596.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1408.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1314.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1821.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1314.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1408.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1596.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1502.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSION KIT UNIVER", "code_information": [{"code": "3100100656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSION PERCUTANEO", "code_information": [{"code": "3100206911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [{"code": "927", "type": "MS-DRG"}], "standard_charges": [{"minimum": 129338.32, "maximum": 129338.32, "discounted_cash": 294283.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 129338.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [{"code": "933", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13884.18, "maximum": 13884.18, "discounted_cash": 33850.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13884.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR CANAL SURGERY", "code_information": [{"code": "69150", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE EAR/NECK SURGERY", "code_information": [{"code": "69155", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HAND SURGERY", "code_information": [{"code": "26250", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58200", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58210", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE JAW SURGERY", "code_information": [{"code": "21045", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69511", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69530", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [{"code": "982", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9796.76, "maximum": 9796.76, "discounted_cash": 27755.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9796.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [{"code": "981", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25499.01, "maximum": 25499.01, "discounted_cash": 52924.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25499.01, "methodology": "fee schedule"}], "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": 7432.73, "maximum": 7432.73, "discounted_cash": 18256.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7432.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55810", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55812", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55815", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55840", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55842", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55845", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55862", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21632", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 2399.89, "maximum": 2399.89, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 2399.89, "maximum": 2399.89, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"minimum": 2399.89, "maximum": 2399.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 2109.3, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56630", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56631", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56632", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56633", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56634", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56637", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56640", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTENSV ORAL EVAL PROB FOCUS", "code_information": [{"code": "D0160", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL BLEACHING HOME APP", "code_information": [{"code": "D9975", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL CANNULA DECLOTTING", "code_information": [{"code": "36860", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 447.23, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL GENERATOR*3", "code_information": [{"code": "3100210016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTERNAL NEUROSTIM*9", "code_information": [{"code": "3100203330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTERNAL OCULAR PHOTOGRAPHY", "code_information": [{"code": "92285", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTERNAL TRIAL STIMU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 462.0, "maximum": 640.2, "gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 640.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 528.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTND COLOR VISION XM", "code_information": [{"code": "92283", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRA ORAL POST RADIO IMAGE", "code_information": [{"code": "D0705", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [{"code": "38", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7522.49, "maximum": 7522.49, "discounted_cash": 17862.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7522.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [{"code": "37", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12805.76, "maximum": 12805.76, "discounted_cash": 37687.11, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12805.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACRANIAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "39", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5006.59, "maximum": 5006.59, "discounted_cash": 12738.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5006.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRACT BALLOON 9-12", "code_information": [{"code": "3100203669", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACT BALLOON12-15", "code_information": [{"code": "3100203670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACT BALLOON15-18", "code_information": [{"code": "3100203671", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACT STONE *NCT4-", "code_information": [{"code": "3100203002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 873.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACT STONE *NTSE-", "code_information": [{"code": "3100203000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 783.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACT STONE TIPL*N", "code_information": [{"code": "3100202999", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 931.56, "discounted_cash": 1397.34, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTBL NUC ANTIGN", "code_information": [{"code": "86235", "type": "CPT"}, {"code": "3440101072", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.93, "maximum": 188.18, "gross_charge": 194.0, "discounted_cash": 28.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 188.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION CORONAL REMNANTS", "code_information": [{"code": "D7111", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION ERUPTED TOOTH/EXR", "code_information": [{"code": "D7140", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRACTION HOOK*355.", "code_information": [{"code": "3100205479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.78, "discounted_cash": 1724.67, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR NAIL*SXT04", "code_information": [{"code": "3100207287", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 122*", "code_information": [{"code": "3100206834", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 157*", "code_information": [{"code": "3100206833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 2MM*", "code_information": [{"code": "3100206797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1095.0, "discounted_cash": 1642.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 2MM*", "code_information": [{"code": "3100206826", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 2MM*", "code_information": [{"code": "3100206832", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 3MM*", "code_information": [{"code": "3100206798", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1095.0, "discounted_cash": 1642.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 3MM*", "code_information": [{"code": "3100206827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 4MM*", "code_information": [{"code": "3100206799", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 4MM*", "code_information": [{"code": "3100206828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 5MM*", "code_information": [{"code": "3100206823", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 5MM*", "code_information": [{"code": "3100206829", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 6MM*", "code_information": [{"code": "3100206824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 6MM*", "code_information": [{"code": "3100206830", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 7MM*", "code_information": [{"code": "3100206825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 7MM*", "code_information": [{"code": "3100206831", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 1395.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 8MM*", "code_information": [{"code": "3100207171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW 9MM*", "code_information": [{"code": "3100207172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW*SXT0", "code_information": [{"code": "3100207173", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1290.0, "discounted_cash": 1935.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR SCREW*SXT0", "code_information": [{"code": "3100207174", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1290.0, "discounted_cash": 1935.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR STONE", "code_information": [{"code": "3100100657", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 725.0, "discounted_cash": 1087.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-11", "code_information": [{"code": "3100207954", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-12", "code_information": [{"code": "3100207955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-13", "code_information": [{"code": "3100207956", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-14", "code_information": [{"code": "3100207957", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-15", "code_information": [{"code": "3100207958", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-16", "code_information": [{"code": "3100207959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-17", "code_information": [{"code": "3100207960", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-18", "code_information": [{"code": "3100207961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-19", "code_information": [{"code": "3100207962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-20", "code_information": [{"code": "3100207963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-21", "code_information": [{"code": "3100207964", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-22", "code_information": [{"code": "3100207965", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-23", "code_information": [{"code": "3100207966", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-24", "code_information": [{"code": "3100207967", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-25", "code_information": [{"code": "3100207968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-26", "code_information": [{"code": "3100207969", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-27", "code_information": [{"code": "3100207970", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-28", "code_information": [{"code": "3100207971", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-29", "code_information": [{"code": "3100207972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRACTOR TIP*104-30", "code_information": [{"code": "3100207973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [{"code": "115", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7245.82, "maximum": 7245.82, "discounted_cash": 17465.85, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7245.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL 2D PROJECT IMAGE", "code_information": [{"code": "D0250", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRAORAL POSTERIOR IMAGE", "code_information": [{"code": "D0251", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [{"code": "790", "type": "MS-DRG"}], "standard_charges": [{"minimum": 23641.6, "maximum": 23641.6, "discounted_cash": 66988.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23641.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTRNL BLEACHING PER ARCH", "code_information": [{"code": "D9972", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRNL BLEACHING PER TOOTH", "code_information": [{"code": "D9973", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EXTRNL COUNTERPULSE, PER TX", "code_information": [{"code": "G0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE ALLERGY TESTS", "code_information": [{"code": "95060", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE BOLT*03.311.092", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.27, "maximum": 447.96, "gross_charge": 461.82, "discounted_cash": 692.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 447.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EYE MASK SWISS TX", "code_information": [{"code": "3100100658", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 49.0, "discounted_cash": 73.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE MVMT ALYS W/O CALBRJ I&R", "code_information": [{"code": "615T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE PHOTODYNAMIC THER ADD-ON", "code_information": [{"code": "67225", "type": "CPT"}], "standard_charges": [{"minimum": 902.02, "maximum": 902.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE PIECE KNURLED RI", "code_information": [{"code": "3100100659", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE PROTECTOR DUPACO", "code_information": [{"code": "3100100660", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "EYE SURGERY FOLLOW-UP ADD-ON", "code_information": [{"code": "67331", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EYE SUTURE DURING SURGERY", "code_information": [{"code": "67335", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EZ- STABILIZER*9066-", "code_information": [{"code": "3100203250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EZ-IO 15MM NEEDLE*90", "code_information": [{"code": "3100203249", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2628.0, "discounted_cash": 3942.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EZDERM", "code_information": [{"code": "Q4136", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE COMMON VARIANTS", "code_information": [{"code": "81237", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 175.4, "discounted_cash": 281.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EZH2 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81236", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 282.88, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies, Major", "code_information": [{"code": "110.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17565.52, "maximum": 17565.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17565.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies, Minor", "code_information": [{"code": "110.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9853.45, "maximum": 9853.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9853.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies, Moderate", "code_information": [{"code": "110.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10949.14, "maximum": 10949.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10949.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ear, Nose, Mouth, Throat And Cranial Or Facial Malignancies, Severe", "code_information": [{"code": "110.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29533.45, "maximum": 29533.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29533.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eating Disorders, Major", "code_information": [{"code": "759.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37068.67, "maximum": 37068.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37068.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eating Disorders, Minor", "code_information": [{"code": "759.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12670.19, "maximum": 12670.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12670.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eating Disorders, Moderate", "code_information": [{"code": "759.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24970.03, "maximum": 24970.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24970.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eating Disorders, Severe", "code_information": [{"code": "759.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 80662.74, "maximum": 80662.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 80662.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Hip Joint Replacement, Major", "code_information": [{"code": "324.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29004.19, "maximum": 29004.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29004.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Hip Joint Replacement, Minor", "code_information": [{"code": "324.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17122.12, "maximum": 17122.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17122.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Hip Joint Replacement, Moderate", "code_information": [{"code": "324.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23889.72, "maximum": 23889.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23889.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Hip Joint Replacement, Severe", "code_information": [{"code": "324.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 54647.0, "maximum": 54647.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 54647.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Knee Joint Replacement, Major", "code_information": [{"code": "326.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35747.44, "maximum": 35747.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35747.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Knee Joint Replacement, Minor", "code_information": [{"code": "326.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17327.16, "maximum": 17327.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17327.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Knee Joint Replacement, Moderate", "code_information": [{"code": "326.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21895.71, "maximum": 21895.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21895.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Elective Knee Joint Replacement, Severe", "code_information": [{"code": "326.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 49669.66, "maximum": 49669.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 49669.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Electrocardiogram (Ekg), Electroencephalogram (Eeg)", "code_information": [{"code": "730", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Electroencephalogram (Eeg), General", "code_information": [{"code": "740", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Enter infusion pump w/o alrm", "code_information": [{"code": "B9000", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Enzyme cartridge enteral nut", "code_information": [{"code": "Q9994", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Epifix or epicord", "code_information": [{"code": "Q4131", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eval oral and pharyn", "code_information": [{"code": "3290100250", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "Examination Of Bladder And Urethra With Mechanical Dilation And Drug Delivery For Narrowing Of Urethra Using An Endoscope", "code_information": [{"code": "499T", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma, Major", "code_information": [{"code": "911.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38491.13, "maximum": 38491.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38491.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma, Minor", "code_information": [{"code": "911.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24176.78, "maximum": 24176.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24176.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma, Moderate", "code_information": [{"code": "911.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27304.92, "maximum": 27304.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27304.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma, Severe", "code_information": [{"code": "911.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 81140.74, "maximum": 81140.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 81140.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedure Unrelated To Principal Diagnosis, Major", "code_information": [{"code": "950.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50105.37, "maximum": 50105.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50105.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedure Unrelated To Principal Diagnosis, Minor", "code_information": [{"code": "950.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19896.57, "maximum": 19896.57, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19896.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedure Unrelated To Principal Diagnosis, Moderate", "code_information": [{"code": "950.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27704.75, "maximum": 27704.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27704.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedure Unrelated To Principal Diagnosis, Severe", "code_information": [{"code": "950.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 113424.28, "maximum": 113424.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 113424.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedures For Other Complications Of Treatment, Major", "code_information": [{"code": "792.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28954.21, "maximum": 28954.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28954.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedures For Other Complications Of Treatment, Minor", "code_information": [{"code": "792.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17876.93, "maximum": 17876.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17876.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedures For Other Complications Of Treatment, Moderate", "code_information": [{"code": "792.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21311.35, "maximum": 21311.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21311.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive O.R. Procedures For Other Complications Of Treatment, Severe", "code_information": [{"code": "792.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 59829.39, "maximum": 59829.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59829.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns With Skin Graft, Major", "code_information": [{"code": "841.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 109142.79, "maximum": 109142.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109142.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns With Skin Graft, Minor", "code_information": [{"code": "841.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24093.48, "maximum": 24093.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24093.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns With Skin Graft, Moderate", "code_information": [{"code": "841.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27425.38, "maximum": 27425.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27425.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns With Skin Graft, Severe", "code_information": [{"code": "841.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 297400.27, "maximum": 297400.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 297400.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns Without Skin Graft, Major", "code_information": [{"code": "843.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14525.8, "maximum": 14525.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14525.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns Without Skin Graft, Minor", "code_information": [{"code": "843.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6543.34, "maximum": 6543.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6543.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns Without Skin Graft, Moderate", "code_information": [{"code": "843.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8441.24, "maximum": 8441.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8441.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extensive Third Degree Burns Without Skin Graft, Severe", "code_information": [{"code": "843.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29992.23, "maximum": 29992.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29992.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "External Heart Assist Systems, Major", "code_information": [{"code": "178.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 94540.1, "maximum": 94540.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 94540.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "External Heart Assist Systems, Minor", "code_information": [{"code": "178.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 75013.88, "maximum": 75013.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 75013.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "External Heart Assist Systems, Moderate", "code_information": [{"code": "178.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 84922.44, "maximum": 84922.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84922.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "External Heart Assist Systems, Severe", "code_information": [{"code": "178.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 110335.87, "maximum": 110335.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 110335.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extracorporeal Membrane Oxygenation (Ecmo), Major", "code_information": [{"code": "9.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 110474.27, "maximum": 110474.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 110474.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extracorporeal Membrane Oxygenation (Ecmo), Minor", "code_information": [{"code": "9.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 61267.23, "maximum": 61267.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61267.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extracorporeal Membrane Oxygenation (Ecmo), Moderate", "code_information": [{"code": "9.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 74652.5, "maximum": 74652.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 74652.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Extracorporeal Membrane Oxygenation (Ecmo), Severe", "code_information": [{"code": "9.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 341542.82, "maximum": 341542.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 341542.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eye Infections And Other Eye Disorders, Major", "code_information": [{"code": "82.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14671.89, "maximum": 14671.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eye Infections And Other Eye Disorders, Minor", "code_information": [{"code": "82.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6301.14, "maximum": 6301.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6301.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eye Infections And Other Eye Disorders, Moderate", "code_information": [{"code": "82.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10081.56, "maximum": 10081.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10081.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Eye Infections And Other Eye Disorders, Severe", "code_information": [{"code": "82.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28986.25, "maximum": 28986.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28986.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "F EMB TRNS CANC CASE RATE", "code_information": [{"code": "S4018", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "F18 FDG", "code_information": [{"code": "A9552", "type": "HCPCS"}], "standard_charges": [{"minimum": 326.32, "maximum": 326.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 326.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "F2 GENE", "code_information": [{"code": "81240", "type": "CPT"}, {"code": "3440103041", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 65.69, "maximum": 414.19, "gross_charge": 427.0, "discounted_cash": 105.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 72.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 320.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 414.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 72.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 320.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 70.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 83.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 70.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 70.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "F5 GENE", "code_information": [{"code": "81241", "type": "CPT"}, {"code": "3440103042", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 73.37, "maximum": 515.07, "gross_charge": 531.0, "discounted_cash": 117.87, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 81.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 515.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 93.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 78.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 424.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 73.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 78.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "F9 FULL GENE SEQUENCE", "code_information": [{"code": "81238", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 600.0, "discounted_cash": 963.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FABRIC WRAPPING OF ANEURYSM", "code_information": [{"code": "M0301", "type": "HCPCS"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FABRICATION ATHLETIC GUARD", "code_information": [{"code": "D9941", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACE BONE GRAFT", "code_information": [{"code": "21210", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7111.29, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL AUGMENTATION IMPLANT", "code_information": [{"code": "D5925", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL MOULAGE COMPLETE", "code_information": [{"code": "D5912", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL MOULAGE SECTIONAL", "code_information": [{"code": "D5911", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL NERVE FUNCTION TEST", "code_information": [{"code": "92516", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL PROSTHESIS", "code_information": [{"code": "D5919", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACIAL REPLACEMENT", "code_information": [{"code": "D5929", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACILITY SVS DENTAL REHAB", "code_information": [{"code": "G0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 1187.04, "maximum": 1187.04, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1187.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR INHIBITOR TEST", "code_information": [{"code": "85335", "type": "CPT"}], "standard_charges": [{"minimum": 12.87, "maximum": 20.47, "discounted_cash": 20.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FACTOR IX ALPROLIX RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7201", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.47, "maximum": 3.47, "discounted_cash": 5.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7194", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.61, "maximum": 1.61, "discounted_cash": 2.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX IDELVION INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7202", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.09, "maximum": 5.09, "discounted_cash": 7.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX NON-RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7193", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.32, "maximum": 1.32, "discounted_cash": 2.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMB GLY REBINYN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7203", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.47, "maximum": 4.47, "discounted_cash": 7.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMBINAN RIXUBIS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7200", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.53, "maximum": 1.53, "discounted_cash": 2.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR IX RECOMBINANT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7195", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.75, "maximum": 1.75, "discounted_cash": 2.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA RECOMB NOVOSEVEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7189", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.45, "maximum": 2.45, "discounted_cash": 3.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIIA RECOMB SEVENFACT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7212", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.15, "maximum": 2.15, "discounted_cash": 3.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7190", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.11, "maximum": 1.11, "discounted_cash": 1.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII (PORCINE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7191", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII FC FUSION RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7205", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.21, "maximum": 2.21, "discounted_cash": 3.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII NUWIQ RECOMB 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7209", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.25, "maximum": 1.25, "discounted_cash": 2.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII PEGYLATED RECOMB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7207", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.05, "maximum": 2.05, "discounted_cash": 3.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMB NOVOEIGHT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7182", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.38, "maximum": 1.38, "discounted_cash": 2.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMB OBIZUR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7188", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.22, "maximum": 3.22, "discounted_cash": 5.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR VIII RECOMBINANT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7192", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.51, "maximum": 1.51, "discounted_cash": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR XIII ANTI-HEM FACTOR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7180", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.15, "maximum": 10.15, "discounted_cash": 15.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FACTOR XIII RECOMB A-SUBUNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7181", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.1, "maximum": 17.1, "discounted_cash": 27.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FAM ADAPT BHV TX GDN PHY/QHP", "code_information": [{"code": "97156", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY ASSESSMENT", "code_information": [{"code": "H1011", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY HOMECARE TRAIN/SESSIO", "code_information": [{"code": "S5111", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY HOMECARE TRAINING 15M", "code_information": [{"code": "S5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/O PT 50 MIN", "code_information": [{"code": "90846", "type": "CPT"}], "standard_charges": [{"minimum": 138.84, "maximum": 138.84, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY PSYTX W/PT 50 MIN", "code_information": [{"code": "90847", "type": "CPT"}], "standard_charges": [{"minimum": 138.84, "maximum": 138.84, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY STABILIZATION 15 MIN", "code_information": [{"code": "S9482", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.84, "maximum": 138.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAMILY/COUPLE COUNSELING", "code_information": [{"code": "T1006", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.84, "maximum": 138.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAN BATTERY*DYND80FA", "code_information": [{"code": "3100210272", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.32, "discounted_cash": 73.98, "setting": "both", "billing_class": "facility"}]}, {"description": "FAN MEDPOR TITAN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2262.4, "maximum": 3135.04, "gross_charge": 3232.0, "discounted_cash": 4848.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2747.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2424.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2262.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3135.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2262.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2424.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2747.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2585.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FANCC GENE", "code_information": [{"code": "81242", "type": "CPT"}], "standard_charges": [{"minimum": 36.62, "maximum": 79.66, "discounted_cash": 58.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY, HIP OR T", "code_information": [{"code": "27025", "type": "CPT"}, {"code": "3480101660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1606.5, "maximum": 4985.78, "gross_charge": 2295.0, "discounted_cash": 3442.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1950.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2226.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1950.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FASCIOTOMY, ILIOTIBI", "code_information": [{"code": "27305", "type": "CPT"}, {"code": "3480101681", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6336.04, "gross_charge": 6532.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6336.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5225.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAT EMULSION", "code_information": [{"code": "3400300072", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 73.4, "discounted_cash": 110.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FAT OR LIPIDS,FECES,", "code_information": [{"code": "82705", "type": "CPT"}, {"code": "3440103050", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.1, "maximum": 28.13, "gross_charge": 29.0, "discounted_cash": 8.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FAT/LIPIDS FECES QUA", "code_information": [{"code": "82710", "type": "CPT"}, {"code": "3440100904", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.8, "maximum": 147.44, "gross_charge": 152.0, "discounted_cash": 26.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 147.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 121.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FCSD US ABLTJ LEIOMYOM>=200", "code_information": [{"code": "72T", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FDL IMPLANT 5.5MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.94, "maximum": 3958.9, "gross_charge": 4081.35, "discounted_cash": 6122.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FDL IMPLANT SYSTEM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.94, "maximum": 3958.9, "gross_charge": 4081.35, "discounted_cash": 6122.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FE PYRO CIT POW 0.1 MG IRON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1444", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FECAL BILIRUBIN TEST", "code_information": [{"code": "82252", "type": "CPT"}], "standard_charges": [{"minimum": 4.56, "maximum": 20.92, "discounted_cash": 7.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FECAL BLOOD SCRN IMMUNOASSAY", "code_information": [{"code": "G0328", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 29.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FECAL MICROBIOTA JSLM 1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1440", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.21, "maximum": 63.21, "discounted_cash": 101.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 63.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 11 BOOSTER", "code_information": [{"code": "103A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 11 DOSE 1", "code_information": [{"code": "101A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 11 DOSE 2", "code_information": [{"code": "102A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 2 RES", "code_information": [{"code": "14A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 3 BOOSTER", "code_information": [{"code": "23A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 3 RES", "code_information": [{"code": "24A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 4 BOOSTER", "code_information": [{"code": "33A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 4 DOSE 2", "code_information": [{"code": "32A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 7 BOOSTER", "code_information": [{"code": "63A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 7 DOSE 1", "code_information": [{"code": "61A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 7 DOSE 2", "code_information": [{"code": "62A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEE COVID-19 VAC 9 RES", "code_information": [{"code": "84A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEEDING AID", "code_information": [{"code": "D5951", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE I&R", "code_information": [{"code": "92617", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEES W/LARYNGEAL SENSE TEST", "code_information": [{"code": "92616", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FELT TEFLON", "code_information": [{"code": "3100100661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEM ADAP +2 OFFSET B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 606.37, "maximum": 840.26, "gross_charge": 866.25, "discounted_cash": 1299.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 736.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 649.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 840.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 649.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 736.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM ADAP NEUTRAL BOL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.52, "maximum": 728.22, "gross_charge": 750.75, "discounted_cash": 1126.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 638.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 563.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 728.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 563.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 638.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM AUG 360 10X 67.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2307.76, "maximum": 3197.89, "gross_charge": 3296.8, "discounted_cash": 4945.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2802.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2472.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2307.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3197.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2307.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2472.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2802.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2637.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM COMP SZ E*596415", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM DISTAL BLOCK*648", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1276.27, "maximum": 1768.55, "gross_charge": 1823.25, "discounted_cash": 2734.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1549.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1367.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1276.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1768.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1276.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1367.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1549.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1458.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM GII SPC CR OX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7556.5, "maximum": 10471.15, "gross_charge": 10795.0, "discounted_cash": 16192.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9175.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8096.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7556.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10471.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7556.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8096.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9175.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8636.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM GII SPC CR OX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.0, "maximum": 11203.5, "gross_charge": 11550.0, "discounted_cash": 17325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM GII SPC CR OX SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.22, "maximum": 11203.81, "gross_charge": 11550.32, "discounted_cash": 17325.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM HCON LAT LT*3214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16800.0, "maximum": 23280.0, "gross_charge": 24000.0, "discounted_cash": 36000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20400.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23280.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM HCON LAT RT*3214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15995.0, "maximum": 22164.5, "gross_charge": 22850.0, "discounted_cash": 34275.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19422.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17137.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15995.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22164.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15995.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17137.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19422.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM POST AUG SZ 2.5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM 15 160MM*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM 15 160MM*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM 16 171MM*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM 9MM *007864", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM S10 106MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM S12 128MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM S13 138MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM STEM S14 149MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5796.7, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 12421.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ10*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ10*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ3*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ3*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ3*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ4*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ4*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ5*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ5*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ6*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ6*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ7*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ7*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ8*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ8*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ9*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM TKA PS SZ9*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/ATHER", "code_information": [{"code": "37225", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVAS W/TLA", "code_information": [{"code": "37224", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC STNT & ATHER", "code_information": [{"code": "37227", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/POPL REVASC W/STENT", "code_information": [{"code": "37226", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEM/TIB CHECKPOINT K", "code_information": [{"code": "3100205158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 418.6, "discounted_cash": 627.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [{"code": "748", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6514.78, "maximum": 6514.78, "discounted_cash": 15685.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6514.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORA LPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG CONE*554", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8003.92, "maximum": 11091.15, "gross_charge": 11434.18, "discounted_cash": 17151.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11091.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9147.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG CONE*554", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8003.92, "maximum": 11091.15, "gross_charge": 11434.18, "discounted_cash": 17151.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11091.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9147.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG CONE*554", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8003.92, "maximum": 11091.15, "gross_charge": 11434.18, "discounted_cash": 17151.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11091.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9147.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 3*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 3*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 3*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 4*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 4*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 4*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 5*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 5*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 5*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 5*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 6*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 6*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 6*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 6*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 6*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 7*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 7*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 7*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 7*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 7*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1724.8, "maximum": 2390.08, "gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2390.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1971.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 8*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 8*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 8*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 8*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1232.0, "maximum": 1707.2, "gross_charge": 1760.0, "discounted_cash": 2640.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1496.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1232.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1707.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1232.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1496.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 9*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1828.68, "maximum": 2534.02, "gross_charge": 2612.4, "discounted_cash": 3918.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2220.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1828.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1828.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2220.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2089.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 9*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1828.68, "maximum": 2534.02, "gross_charge": 2612.4, "discounted_cash": 3918.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2220.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1828.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1828.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2220.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2089.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL AUG SZ 9*154", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1828.68, "maximum": 2534.02, "gross_charge": 2612.4, "discounted_cash": 3918.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2220.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1828.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1828.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2220.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2089.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL BLOCK", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100100662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2624.49, "gross_charge": 2705.66, "discounted_cash": 4058.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2299.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2029.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1893.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2624.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1893.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2029.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2299.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2164.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL BONE CEMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CAN", "code_information": [{"code": "3100100664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL CAN", "code_information": [{"code": "3100102779", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL CAN", "code_information": [{"code": "3100104455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL CHECKPOINT K", "code_information": [{"code": "3100205662", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.6, "discounted_cash": 221.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8098.3, "maximum": 11221.93, "gross_charge": 11569.0, "discounted_cash": 17353.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9833.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8676.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8098.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11221.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8098.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8676.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9833.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9255.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP BIOMET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP BIOMET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2031.4, "maximum": 2814.94, "gross_charge": 2902.0, "discounted_cash": 4353.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2466.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2031.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2814.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2031.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2466.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2321.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP BIOMET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP DEPUY C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8097.6, "maximum": 11220.96, "gross_charge": 11568.0, "discounted_cash": 17352.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9832.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8676.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8097.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11220.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8097.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8676.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9832.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9254.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP DEPUY U", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7529.2, "maximum": 10433.32, "gross_charge": 10756.0, "discounted_cash": 16134.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9142.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8067.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10433.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7529.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8067.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9142.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE HI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3731.0, "maximum": 5170.1, "gross_charge": 5330.0, "discounted_cash": 7995.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4530.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3997.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3731.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5170.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3731.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3997.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4530.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE NE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE ST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE ZI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3731.0, "maximum": 5170.1, "gross_charge": 5330.0, "discounted_cash": 7995.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4530.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3997.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3731.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5170.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3731.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3997.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4530.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE ZI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE ZI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP KNEE ZI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2821.0, "maximum": 3909.1, "gross_charge": 4030.0, "discounted_cash": 6045.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3909.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1893.96, "maximum": 2624.49, "gross_charge": 2705.66, "discounted_cash": 4058.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2299.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2029.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1893.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2624.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1893.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2029.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2299.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2164.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2121.0, "maximum": 2939.1, "gross_charge": 3030.0, "discounted_cash": 4545.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2575.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2272.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2121.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2939.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2121.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2272.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2575.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2424.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8472.57, "maximum": 11740.56, "gross_charge": 12103.68, "discounted_cash": 18155.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10288.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9077.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8472.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11740.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8472.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9077.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10288.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9682.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2121.0, "maximum": 2939.1, "gross_charge": 3030.0, "discounted_cash": 4545.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2575.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2272.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2121.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2939.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2121.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2272.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2575.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2424.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7939.4, "maximum": 11001.74, "gross_charge": 11342.0, "discounted_cash": 17013.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9640.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8506.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7939.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11001.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7939.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8506.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9640.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9073.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9324.0, "maximum": 12920.4, "gross_charge": 13320.0, "discounted_cash": 19980.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11322.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9990.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9324.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12920.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9324.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9990.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11322.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP SYNTHES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2775.5, "maximum": 3846.05, "gross_charge": 3965.0, "discounted_cash": 5947.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3370.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2973.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2775.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3846.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2775.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2973.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3370.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP SZ G*59", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMP ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL COMPONENT*59", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CONDYLE M/L*", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100203400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 22639.8, "gross_charge": 23340.0, "discounted_cash": 35010.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19839.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17505.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16338.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22639.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16338.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17505.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19839.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18672.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL CONDYLE M/RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17220.0, "maximum": 23862.0, "gross_charge": 24600.0, "discounted_cash": 36900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20910.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17220.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23862.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17220.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20910.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CONE MED*005", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8576.4, "maximum": 11884.44, "gross_charge": 12252.0, "discounted_cash": 18378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10414.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8576.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11884.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8576.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10414.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9801.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CONE SM*00-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7056.0, "maximum": 9777.6, "gross_charge": 10080.0, "discounted_cash": 15120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8568.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7560.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7056.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9777.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7056.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7560.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8568.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CONE*42-5450", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8395.66, "maximum": 11633.98, "gross_charge": 11993.8, "discounted_cash": 17990.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10194.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8995.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8395.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11633.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8395.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8995.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10194.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9595.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CORTICAL STR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2207.8, "maximum": 3059.38, "gross_charge": 3154.0, "discounted_cash": 4731.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2680.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2365.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2207.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3059.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2207.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2365.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2680.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2523.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CORTICAL STR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2717.4, "maximum": 3765.54, "gross_charge": 3882.0, "discounted_cash": 5823.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3299.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2911.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2717.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3765.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2717.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2911.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3299.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3105.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #1 LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #2 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #2 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #3 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #3 RT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100205878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #4 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #4 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #4 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #5 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3314.07, "maximum": 4592.35, "gross_charge": 4734.39, "discounted_cash": 7101.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4024.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3550.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3314.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4592.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3314.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3550.79, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4024.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3787.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #6 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #6 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #7 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #7 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #8 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM #8 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR CEM*5517F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR SZ4 LT*71", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.22, "maximum": 11203.81, "gross_charge": 11550.32, "discounted_cash": 17325.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CR SZ5 LT*71", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.22, "maximum": 11203.81, "gross_charge": 11550.32, "discounted_cash": 17325.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 3*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 3*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 4*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 4*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 5*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8365.0, "maximum": 11591.5, "gross_charge": 11950.0, "discounted_cash": 17925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10157.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8962.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11591.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8962.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10157.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 6*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 6*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 7*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8699.6, "maximum": 12055.16, "gross_charge": 12428.0, "discounted_cash": 18642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12055.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8699.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10563.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 7*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8365.0, "maximum": 11591.5, "gross_charge": 11950.0, "discounted_cash": 17925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10157.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8962.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11591.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8962.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10157.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 8*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8365.0, "maximum": 11591.5, "gross_charge": 11950.0, "discounted_cash": 17925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10157.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8962.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11591.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8962.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10157.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 8*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6692.0, "maximum": 9273.2, "gross_charge": 9560.0, "discounted_cash": 14340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8126.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6692.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9273.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6692.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8126.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRS SZ 9*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7274.4, "maximum": 10080.24, "gross_charge": 10392.0, "discounted_cash": 15588.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8833.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7794.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10080.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7274.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7794.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8833.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8313.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRUCIATE RE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3703.7, "maximum": 5132.27, "gross_charge": 5291.0, "discounted_cash": 7936.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4497.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3968.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3703.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5132.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3703.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3968.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4497.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4232.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRUCIATE RET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2691.68, "maximum": 3729.91, "gross_charge": 3845.27, "discounted_cash": 5767.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3268.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2691.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3729.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2691.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3268.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL CRUCIATE SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102157", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5362.0, "maximum": 7430.2, "gross_charge": 7660.0, "discounted_cash": 11490.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6511.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5745.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5362.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7430.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5362.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5745.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6511.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DIST PEG BIO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 489.3, "maximum": 678.03, "gross_charge": 699.0, "discounted_cash": 1048.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 594.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 524.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 489.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 678.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 489.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 524.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 594.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 559.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL LT*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2145.78, "maximum": 2973.43, "gross_charge": 3065.4, "discounted_cash": 4598.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2605.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2299.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2145.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2973.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2145.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2299.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2605.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2452.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ3 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2084.08, "maximum": 2887.94, "gross_charge": 2977.26, "discounted_cash": 4465.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2530.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2232.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2084.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2887.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2084.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2232.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2530.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2381.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ3 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ4 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1986.98, "maximum": 2753.39, "gross_charge": 2838.55, "discounted_cash": 4257.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2412.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2128.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1986.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2753.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1986.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2128.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2412.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2270.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ4 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2087.02, "maximum": 2892.02, "gross_charge": 2981.47, "discounted_cash": 4472.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2534.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2236.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2087.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2892.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2087.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2236.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2534.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2385.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ4 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207949", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2087.02, "maximum": 2892.02, "gross_charge": 2981.47, "discounted_cash": 4472.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2534.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2236.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2087.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2892.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2087.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2236.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2534.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2385.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ5 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2253.88, "maximum": 3123.24, "gross_charge": 3219.84, "discounted_cash": 4829.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2736.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2414.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2253.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3123.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2253.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2414.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2736.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2575.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ5 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2087.02, "maximum": 2892.02, "gross_charge": 2981.47, "discounted_cash": 4472.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2534.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2236.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2087.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2892.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2087.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2236.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2534.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2385.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ5 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1893.96, "maximum": 2624.49, "gross_charge": 2705.66, "discounted_cash": 4058.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2299.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2029.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1893.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2624.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1893.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2029.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2299.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2164.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ6 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL DISTAL SZ6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL ENDOVAS GRAFT ADD-ON", "code_information": [{"code": "34813", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEMORAL GII", "code_information": [{"code": "3100103809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10088.0, "discounted_cash": 15132.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL HD 36*008018", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HD 36MM*0080", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3433.5, "maximum": 4757.85, "gross_charge": 4905.0, "discounted_cash": 7357.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4169.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3678.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3433.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4757.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3433.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3678.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4169.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3924.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1799.0, "maximum": 2492.9, "gross_charge": 2570.0, "discounted_cash": 3855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2492.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2238.6, "maximum": 3102.06, "gross_charge": 3198.0, "discounted_cash": 4797.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2718.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2398.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2238.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3102.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2238.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2398.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2718.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2558.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD *418470", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 12/14*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 12/14*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 12/14*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 12/14*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 28MM*10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 32*00-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 823.2, "maximum": 1140.72, "gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 32*18-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 32*18-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 32MM*05", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 32MM*36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7096.18, "maximum": 9833.27, "gross_charge": 10137.4, "discounted_cash": 15206.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8616.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7603.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7096.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9833.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7096.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7603.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8616.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8109.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 36/0*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2051.14, "maximum": 2842.29, "gross_charge": 2930.2, "discounted_cash": 4395.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2490.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2197.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2051.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2842.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2051.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2197.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2490.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2344.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 36MM*71", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8954.4, "maximum": 12408.24, "gross_charge": 12792.0, "discounted_cash": 19188.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10873.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9594.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8954.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12408.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8954.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9594.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10873.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10233.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD 40*GVHD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD BIOMET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD C-TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2704.7, "maximum": 3747.94, "gross_charge": 3863.86, "discounted_cash": 5795.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3284.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2897.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2704.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3747.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2704.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2897.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3284.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3091.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD C-TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1232.7, "maximum": 1708.17, "gross_charge": 1761.0, "discounted_cash": 2641.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1496.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1320.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1232.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1708.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1232.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1320.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1496.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1408.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD CERM*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2704.7, "maximum": 3747.94, "gross_charge": 3863.86, "discounted_cash": 5795.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3284.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2897.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2704.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3747.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2704.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2897.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3284.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3091.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD CM 32*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4752.3, "maximum": 6585.33, "gross_charge": 6789.0, "discounted_cash": 10183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5770.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5091.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4752.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6585.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4752.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5091.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5770.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5431.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7401.8, "maximum": 10256.78, "gross_charge": 10574.0, "discounted_cash": 15861.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8987.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7930.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7401.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10256.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7401.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7930.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8987.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8459.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 936.6, "maximum": 1297.86, "gross_charge": 1338.0, "discounted_cash": 2007.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1297.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1070.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1504.3, "maximum": 2084.53, "gross_charge": 2149.0, "discounted_cash": 3223.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1826.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1611.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1504.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2084.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1504.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1611.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1826.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1719.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3143.7, "maximum": 4356.27, "gross_charge": 4491.0, "discounted_cash": 6736.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3817.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3368.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3143.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4356.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3143.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3368.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3817.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3592.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3129.7, "maximum": 4336.87, "gross_charge": 4471.0, "discounted_cash": 6706.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3800.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3353.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3129.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4336.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3129.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3353.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3800.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3576.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3622.5, "maximum": 5019.75, "gross_charge": 5175.0, "discounted_cash": 7762.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3881.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3622.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5019.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3622.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3881.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3982.3, "maximum": 5518.33, "gross_charge": 5689.0, "discounted_cash": 8533.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4835.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4266.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3982.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5518.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3982.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4266.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4835.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4551.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1397.2, "maximum": 1936.12, "gross_charge": 1996.0, "discounted_cash": 2994.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1696.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1497.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1397.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1936.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1397.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1497.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1696.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1596.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1799.0, "maximum": 2492.9, "gross_charge": 2570.0, "discounted_cash": 3855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2492.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1799.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1927.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2184.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD DEPUY M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1964.2, "maximum": 2721.82, "gross_charge": 2806.0, "discounted_cash": 4209.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2385.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1964.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2721.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1964.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2104.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2385.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2244.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD SM*GVHD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.0, "maximum": 3492.0, "gross_charge": 3600.0, "discounted_cash": 5400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100689", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3180.8, "maximum": 4407.68, "gross_charge": 4544.0, "discounted_cash": 6816.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3862.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3180.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4407.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3180.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3408.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3635.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100690", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1507.8, "maximum": 2089.38, "gross_charge": 2154.0, "discounted_cash": 3231.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1830.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1615.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1507.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2089.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1507.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1615.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1830.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1723.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1628.9, "maximum": 2257.19, "gross_charge": 2327.0, "discounted_cash": 3490.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1977.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1745.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1628.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2257.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1628.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1745.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1977.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1861.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2892.4, "maximum": 4008.04, "gross_charge": 4132.0, "discounted_cash": 6198.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3512.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3099.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2892.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4008.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2892.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3099.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3512.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3305.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD V40 32M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 910.22, "maximum": 1261.31, "gross_charge": 1300.32, "discounted_cash": 1950.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1105.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 975.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 910.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1261.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 910.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 975.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1105.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1040.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD V40 32M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD V40 36M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1498.0, "maximum": 2075.8, "gross_charge": 2140.0, "discounted_cash": 3210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1819.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1605.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1498.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2075.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1498.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1605.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1819.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1712.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL HEAD ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL KNEE CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL KNEE LT 67.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10588.2, "maximum": 14672.22, "gross_charge": 15126.0, "discounted_cash": 22689.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12857.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11344.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10588.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14672.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10588.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11344.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12857.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL KNEE RT SZ 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8472.57, "maximum": 11740.56, "gross_charge": 12103.68, "discounted_cash": 18155.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10288.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9077.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8472.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11740.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8472.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9077.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10288.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9682.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL KNEE STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL LM/RL SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL LM/RL SZ 8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL LPS E*005964", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL LPS G LT*005", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL LT INTRLK 57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2134.86, "maximum": 2958.3, "gross_charge": 3049.8, "discounted_cash": 4574.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2592.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2134.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2958.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2134.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2592.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2439.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL OP F-RT*0057", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POST SZ2 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POST SZ4 10M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1986.98, "maximum": 2753.39, "gross_charge": 2838.55, "discounted_cash": 4257.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2412.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2128.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1986.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2753.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1986.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2128.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2412.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2270.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POST SZ5 10M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POST SZ6 10M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1990.05, "maximum": 2757.65, "gross_charge": 2842.94, "discounted_cash": 4264.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2757.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1990.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2132.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2416.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2274.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POSTER", "code_information": [{"code": "3100104493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL POSTER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POSTER #1LT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POSTER #1PS*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5243.78, "maximum": 7266.38, "gross_charge": 7491.12, "discounted_cash": 11236.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6367.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5618.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5243.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7266.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5243.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5618.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6367.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5992.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POSTER #6 LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL POSTERIORLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PRESSURIZ SE", "code_information": [{"code": "3100100697", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL PROSTHESIS", "code_information": [{"code": "3100102411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2917.0, "discounted_cash": 4375.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL PROSTHESIS", "code_information": [{"code": "3100104282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11210.0, "discounted_cash": 16815.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 3*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 3*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 4*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 4*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 5*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 5*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 5*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 5*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 6*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 6*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 6*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 6*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 7*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 7*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 8*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ 9*1504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS SZ H*00-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL PS VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL RT 65MM*1852", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8411.2, "maximum": 11655.52, "gross_charge": 12016.0, "discounted_cash": 18024.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10213.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8411.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11655.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8411.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9012.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10213.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9612.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL RT 70MM*1852", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12705.0, "maximum": 17605.5, "gross_charge": 18150.0, "discounted_cash": 27225.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15427.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13612.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12705.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17605.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12705.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13612.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15427.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14520.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL RT-INTERLOK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4360.72, "maximum": 6042.71, "gross_charge": 6229.6, "discounted_cash": 9344.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5295.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4672.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4360.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6042.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4360.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4672.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5295.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4983.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4360.72, "maximum": 6042.71, "gross_charge": 6229.6, "discounted_cash": 9344.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5295.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4672.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4360.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6042.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4360.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4672.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5295.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4983.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5603.5, "maximum": 7764.85, "gross_charge": 8005.0, "discounted_cash": 12007.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6804.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6003.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5603.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7764.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5603.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6003.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6804.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6404.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 20MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3700.06, "maximum": 5127.22, "gross_charge": 5285.8, "discounted_cash": 7928.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3964.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3700.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5127.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3700.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3964.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 30*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5325.32, "maximum": 7379.37, "gross_charge": 7607.6, "discounted_cash": 11411.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6466.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5705.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5325.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7379.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5325.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5705.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6466.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6086.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 30*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4260.62, "maximum": 5904.0, "gross_charge": 6086.6, "discounted_cash": 9129.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5904.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4869.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 35*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4260.62, "maximum": 5904.0, "gross_charge": 6086.6, "discounted_cash": 9129.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5904.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4869.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 40*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4260.62, "maximum": 5904.0, "gross_charge": 6086.6, "discounted_cash": 9129.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5904.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4869.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 40*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4260.62, "maximum": 5904.0, "gross_charge": 6086.6, "discounted_cash": 9129.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5904.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4869.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 45*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205647", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5325.32, "maximum": 7379.37, "gross_charge": 7607.6, "discounted_cash": 11411.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6466.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5705.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5325.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7379.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5325.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5705.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6466.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6086.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SLEEVE 50*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4260.62, "maximum": 5904.0, "gross_charge": 6086.6, "discounted_cash": 9129.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5904.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4260.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4564.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5173.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4869.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STBLZR LT SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9599.52, "maximum": 13302.19, "gross_charge": 13713.6, "discounted_cash": 20570.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11656.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10285.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9599.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13302.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9599.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10285.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11656.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10970.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2766.4, "maximum": 3833.44, "gross_charge": 3952.0, "discounted_cash": 5928.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3359.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2766.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2766.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3359.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3161.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 0*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 0*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 1*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 1*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 11 X150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5164.25, "maximum": 7156.17, "gross_charge": 7377.5, "discounted_cash": 11066.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6270.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5533.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5164.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7156.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5164.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5533.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6270.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5902.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 12*1010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 2*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 2*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 3*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3503.04, "maximum": 4854.21, "gross_charge": 5004.35, "discounted_cash": 7506.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4253.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3753.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3503.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4854.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3503.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3753.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4253.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4003.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 3*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 4*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 4*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 5*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 5*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 6*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 6*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 7*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 7*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 8*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 8*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 9*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206949", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM 9*1010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM BOWED*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7154.14, "maximum": 9913.6, "gross_charge": 10220.21, "discounted_cash": 15330.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8687.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7665.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7154.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9913.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7154.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7665.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8687.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8176.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM LONG*GV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM SM*GVST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM STAND*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL STEM SZ 1 *1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8860.85, "maximum": 12278.6, "gross_charge": 12658.36, "discounted_cash": 18987.54, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10759.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9493.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8860.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8860.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9493.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10759.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10126.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SZ 3 RT*00-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6734.0, "maximum": 9331.4, "gross_charge": 9620.0, "discounted_cash": 14430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9331.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SZ 3*00-5926", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6734.0, "maximum": 9331.4, "gross_charge": 9620.0, "discounted_cash": 14430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9331.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SZ 4 COMP*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1856.4, "maximum": 2572.44, "gross_charge": 2652.0, "discounted_cash": 3978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2572.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SZ 4*00-5926", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6734.0, "maximum": 9331.4, "gross_charge": 9620.0, "discounted_cash": 14430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9331.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SZ 5 COMP*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL SZ 6 COMP*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TC3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8098.3, "maximum": 11221.93, "gross_charge": 11569.0, "discounted_cash": 17353.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9833.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8676.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8098.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11221.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8098.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8676.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9833.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9255.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TC3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7794.5, "maximum": 10800.95, "gross_charge": 11135.0, "discounted_cash": 16702.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9464.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8351.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7794.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10800.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7794.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8351.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9464.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8908.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TC3 SZ2 LT*9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7794.71, "maximum": 10801.24, "gross_charge": 11135.3, "discounted_cash": 16702.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10801.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8908.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TC3 SZ2.5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7794.71, "maximum": 10801.24, "gross_charge": 11135.3, "discounted_cash": 16702.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10801.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8908.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TC3 SZ2.5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7794.71, "maximum": 10801.24, "gross_charge": 11135.3, "discounted_cash": 16702.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10801.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8908.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TC3 SZ4 LT*9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7794.71, "maximum": 10801.24, "gross_charge": 11135.3, "discounted_cash": 16702.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10801.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7794.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8351.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9465.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8908.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TI SZ E LT*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4280.64, "maximum": 5931.74, "gross_charge": 6115.2, "discounted_cash": 9172.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5197.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4586.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4280.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5931.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4280.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4586.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5197.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4892.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TI SZ E RT*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TI SZ F-LT*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL TI SZ F-RT*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2031.4, "maximum": 2814.94, "gross_charge": 2902.0, "discounted_cash": 4353.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2466.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2031.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2814.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2031.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2466.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2321.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL VANGUARD 70X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2770.95, "maximum": 3839.74, "gross_charge": 3958.5, "discounted_cash": 5937.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3839.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL VNGD SSK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10588.2, "maximum": 14672.22, "gross_charge": 15126.0, "discounted_cash": 22689.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12857.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11344.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10588.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14672.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10588.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11344.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12857.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMORAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM LT MED 3*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM LT MED 4*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3094.0, "maximum": 4287.4, "gross_charge": 4420.0, "discounted_cash": 6630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4287.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM LT MED 5*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM RT MED 3*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM RT MED 4*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3094.0, "maximum": 4287.4, "gross_charge": 4420.0, "discounted_cash": 6630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4287.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM RT MED 5*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR CEM RT MED 6*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE STRY", "code_information": [{"code": "3100103810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6204.0, "discounted_cash": 9306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE STRY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4051.6, "maximum": 5614.36, "gross_charge": 5788.0, "discounted_cash": 8682.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4919.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4341.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4051.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5614.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4051.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4341.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4919.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4630.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE STRY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3096.8, "maximum": 4291.28, "gross_charge": 4424.0, "discounted_cash": 6636.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3760.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3318.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3096.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4291.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3096.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3318.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3760.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3539.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE STRY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4393.2, "maximum": 6087.72, "gross_charge": 6276.0, "discounted_cash": 9414.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5334.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4707.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4393.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6087.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4393.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4707.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5334.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5020.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE STRY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4404.4, "maximum": 6103.24, "gross_charge": 6292.0, "discounted_cash": 9438.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5348.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4719.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4404.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6103.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4404.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4719.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5348.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE STRY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3000.9, "maximum": 4158.39, "gross_charge": 4287.0, "discounted_cash": 6430.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3643.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3215.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3000.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4158.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3000.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3215.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3643.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP KNEE ZIMM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR COMP ZIMMER FE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 10*42-50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 10*42500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 10*42500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 10*42500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "411592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 11 LT*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 11 LT*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 11*42-50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 12 LT*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 12 RT*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 2*42-500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 4 LT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 5 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 5 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 5 LT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 1901.2, "gross_charge": 1960.0, "discounted_cash": 2940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1901.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 5 RT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 1901.2, "gross_charge": 1960.0, "discounted_cash": 2940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1901.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 6 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 6 LT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 6 RT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 7 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 7 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 7 LT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 7 RT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 7*42-500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 8 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 8 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 8*42-500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 9 *42-57", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 9 LT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 9 RT*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 9*42-500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR PS SZ 9R *42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FEMUR SZ 6 *42-5706", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.8, "maximum": 7540.78, "gross_charge": 7774.0, "discounted_cash": 11661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7540.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FENTANYL CITRATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3010", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERN TEST", "code_information": [{"code": "Q0114", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.74, "maximum": 35.16, "discounted_cash": 15.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FERRITIN", "code_information": [{"code": "82728", "type": "CPT"}, {"code": "3440100905", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.63, "maximum": 118.34, "gross_charge": 122.0, "discounted_cash": 21.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 118.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 97.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, ESRD USE", "code_information": [{"code": "Q0139", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.39, "maximum": 0.39, "discounted_cash": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FERUMOXYTOL, NON-ESRD", "code_information": [{"code": "Q0138", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.39, "maximum": 0.39, "discounted_cash": 0.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL ANEUPLOIDY TRISOM RISK", "code_information": [{"code": "81507", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 795.0, "discounted_cash": 1277.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFIL W/O NST", "code_information": [{"code": "76819", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL BIOPHYS PROFILE W/NST", "code_information": [{"code": "76818", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML ANEUPLOIDY", "code_information": [{"code": "81420", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 759.05, "discounted_cash": 1219.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CHRMOML MICRODELTJ", "code_information": [{"code": "81422", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 759.05, "discounted_cash": 1219.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 759.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CONTRACT STRESS TEST", "code_information": [{"code": "59020", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 303.94, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL CORD PUNCTURE PRENATAL", "code_information": [{"code": "59012", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2169.82, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL FLUID DRAINAGE W/US", "code_information": [{"code": "59074", "type": "CPT"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL MONITOR W/REPORT", "code_information": [{"code": "59050", "type": "CPT"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL NON-STRESS TEST", "code_information": [{"code": "59025", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 303.94, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SCALP BLOOD SAMPLE", "code_information": [{"code": "59030", "type": "CPT"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SHUNT PLACEMENT W/US", "code_information": [{"code": "59076", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1526.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONG CYST MALF", "code_information": [{"code": "S2402", "type": "HCPCS"}], "standard_charges": [{"minimum": 1526.8, "maximum": 1526.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONGEN HERNIA", "code_information": [{"code": "S2400", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG MYELOMENINGO", "code_information": [{"code": "S2404", "type": "HCPCS"}], "standard_charges": [{"minimum": 1526.8, "maximum": 1526.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG NOC", "code_information": [{"code": "S2409", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG PULMON SEQUEST", "code_information": [{"code": "S2403", "type": "HCPCS"}], "standard_charges": [{"minimum": 1526.8, "maximum": 1526.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG SACROCOC TERATOMA", "code_information": [{"code": "S2405", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETAL SURG URIN TRAC OBSTR", "code_information": [{"code": "S2401", "type": "HCPCS"}], "standard_charges": [{"minimum": 1526.8, "maximum": 1526.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FETOSCOP LASER THER TTTS", "code_information": [{"code": "S2411", "type": "HCPCS"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [{"code": "864", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3874.68, "maximum": 3874.68, "discounted_cash": 9856.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3874.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FFP THAWING EA UNIT", "code_information": [{"code": "86927", "type": "CPT"}, {"code": "3440101152", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 70.2, "maximum": 207.41, "gross_charge": 117.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FHL 7.0 IMPLANT*AR15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FHL IMPLANT 6.25M*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIASP FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1811", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.42, "maximum": 7.42, "discounted_cash": 10.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIB REMOVAL KIT*ST69", "code_information": [{"code": "3100206249", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER SELECT OMNIGUI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBER STRIPPING TOOL", "code_information": [{"code": "3100203009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 637.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBER TAK BICEPS KIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1891.89, "maximum": 2621.61, "gross_charge": 2702.7, "discounted_cash": 4054.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2297.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2027.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1891.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2621.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1891.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2027.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2297.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2162.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERAK 2.6 DISP KIT", "code_information": [{"code": "3100206862", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERLINK W/CLOSED L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERLOCK SUSPEN SYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3048.04, "maximum": 4223.71, "gross_charge": 4354.35, "discounted_cash": 6531.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3701.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3265.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3048.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4223.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3048.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3265.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3701.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3483.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERLOOP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 81.2, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERLOOP #2-0 13IN", "code_information": [{"code": "3100204407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERLOOP #4-0*AR722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 81.2, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERLOOP W/STRT NDL", "code_information": [{"code": "3100100702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERLOOP W/STRT NDL", "code_information": [{"code": "3100102792", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSNARE #2 FBWIRE", "code_information": [{"code": "3100100703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 661.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTICK", "code_information": [{"code": "3100102308", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTICK", "code_information": [{"code": "3100103747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTITCH 24 CUR*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERSTITCH CUR*AR-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERSTITCH RC 1.5*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERSTITCH REV CUR*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERSTITCH ST*AR-45", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK 2.6*AR-3750", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1089.75, "maximum": 1510.08, "gross_charge": 1556.79, "discounted_cash": 2335.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1323.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1167.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1089.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1510.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1089.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1167.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1323.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1245.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK ANCHOR W #2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1249.5, "maximum": 1731.45, "gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1731.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK BICEPS KIT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1378.12, "maximum": 1909.68, "gross_charge": 1968.75, "discounted_cash": 2953.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1673.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1378.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1909.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1378.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1476.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1673.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK BUTTON*AR-3", "code_information": [{"code": "3100209325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2319.66, "discounted_cash": 3479.49, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK KNEE BUTTON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK KNEE DBL*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK KNEE KIT*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.5, "maximum": 712.95, "gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK KNOTLESS 2.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 992.25, "maximum": 1374.97, "gross_charge": 1417.5, "discounted_cash": 2126.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1204.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1063.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 992.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1374.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 992.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1063.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1204.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK KNOTLESS HI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK KNOTLESS*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK RC BLK/BLU*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.35, "maximum": 1436.08, "gross_charge": 1480.5, "discounted_cash": 2220.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK RC BLK/BLU*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1113.0, "maximum": 1542.3, "gross_charge": 1590.0, "discounted_cash": 2385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1351.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1113.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1542.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1113.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1351.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK RC BLUE*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.35, "maximum": 1436.08, "gross_charge": 1480.5, "discounted_cash": 2220.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK RC KIT*AR-3", "code_information": [{"code": "3100207691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK SELF-PUN 2.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.05, "maximum": 1252.75, "gross_charge": 1291.5, "discounted_cash": 1937.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1097.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 968.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1252.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 968.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1097.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK SPEED*2600F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4951.18, "maximum": 6860.92, "gross_charge": 7073.12, "discounted_cash": 10609.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6012.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5304.84, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4951.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6860.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4951.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5304.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6012.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5658.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK SPEED*AR-26", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4722.9, "maximum": 6544.59, "gross_charge": 6747.0, "discounted_cash": 10120.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5734.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5060.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4722.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6544.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4722.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5060.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5734.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5397.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK SUT ANC KIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAK SUT ANCH*AR", "code_information": [{"code": "3100203762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1065.0, "discounted_cash": 1597.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE", "code_information": [{"code": "3100100704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE", "code_information": [{"code": "3100102793", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE", "code_information": [{"code": "3100102794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE 2MM*AR7237", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202466", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERTAPE CERCLAGE*A", "code_information": [{"code": "3100203871", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 54.6, "maximum": 75.66, "gross_charge": 78.0, "discounted_cash": 117.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 75.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 58.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 66.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 62.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 47.6, "maximum": 65.96, "gross_charge": 68.0, "discounted_cash": 102.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 65.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 57.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 64.68, "maximum": 89.62, "gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 89.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 61.6, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 116.73, "maximum": 161.75, "gross_charge": 166.76, "discounted_cash": 250.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 125.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 125.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 133.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBERWIRE 3-0 POLY 1", "code_information": [{"code": "3100206450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 1188.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERWIRE SUTURE KIT", "code_information": [{"code": "3100205041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN DEGRAD D-DIME", "code_information": [{"code": "85380", "type": "CPT"}, {"code": "3440101044", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 10.18, "maximum": 71.78, "gross_charge": 74.0, "discounted_cash": 16.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADATION PRODUCTS", "code_information": [{"code": "85362", "type": "CPT"}], "standard_charges": [{"minimum": 6.89, "maximum": 20.47, "discounted_cash": 11.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADE SEMIQUANT", "code_information": [{"code": "85378", "type": "CPT"}], "standard_charges": [{"minimum": 9.72, "maximum": 20.47, "discounted_cash": 15.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRIN DGRAD D-DIMER", "code_information": [{"code": "85379", "type": "CPT"}, {"code": "3440101043", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 10.18, "maximum": 71.78, "gross_charge": 74.0, "discounted_cash": 16.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ACTIVITY", "code_information": [{"code": "85384", "type": "CPT"}, {"code": "3440101045", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 9.72, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 15.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN ANTIGEN", "code_information": [{"code": "85385", "type": "CPT"}], "standard_charges": [{"minimum": 14.46, "maximum": 20.47, "discounted_cash": 23.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85366", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 80.46, "discounted_cash": 129.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOGEN TEST", "code_information": [{"code": "85370", "type": "CPT"}], "standard_charges": [{"minimum": 12.43, "maximum": 20.47, "discounted_cash": 19.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYSINS SCREEN I&R", "code_information": [{"code": "85390", "type": "CPT"}], "standard_charges": [{"minimum": 15.48, "maximum": 20.47, "discounted_cash": 24.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC ANTIPLASMIN", "code_information": [{"code": "85410", "type": "CPT"}], "standard_charges": [{"minimum": 7.71, "maximum": 20.47, "discounted_cash": 12.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC FACTRS", "code_information": [{"code": "85420", "type": "CPT"}, {"code": "3440103007", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.53, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMIN", "code_information": [{"code": "85400", "type": "CPT"}], "standard_charges": [{"minimum": 7.71, "maximum": 20.47, "discounted_cash": 12.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85415", "type": "CPT"}], "standard_charges": [{"minimum": 17.19, "maximum": 20.47, "discounted_cash": 27.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBRINOLYTIC PLASMINOGEN", "code_information": [{"code": "85421", "type": "CPT"}], "standard_charges": [{"minimum": 10.18, "maximum": 20.47, "discounted_cash": 16.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBULA BONE GRAFT MICROVASC", "code_information": [{"code": "20955", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIBULA NAIL RT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5723.44, "maximum": 7931.05, "gross_charge": 8176.35, "discounted_cash": 12264.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6949.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6132.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5723.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7931.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5723.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6132.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6949.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6541.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULA NAIL RT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULINK REMOVAL KIT", "code_information": [{"code": "3100207254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2740.4, "discounted_cash": 4110.6, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBULINK REPAIR KIT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3168.25, "maximum": 4390.29, "gross_charge": 4526.08, "discounted_cash": 6789.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3847.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3394.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3168.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4390.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3168.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3394.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3847.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3620.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBULOCK IMPLANT SYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIDUCIAL MARK *MTCTX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.3, "maximum": 503.43, "gross_charge": 519.0, "discounted_cash": 778.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 503.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIDUCIAL MARK *MTCTX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILLETED FINGER/TOE FLAP", "code_information": [{"code": "14350", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FILTEK SUPREME", "code_information": [{"code": "3100104757", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER", "code_information": [{"code": "3100102158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER", "code_information": [{"code": "3100103691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER", "code_information": [{"code": "3100103692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER", "code_information": [{"code": "3100103693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 183.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER BAIRHUGGER", "code_information": [{"code": "3100100706", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER BLOOD TRANSFU", "code_information": [{"code": "3100100707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER HEPA", "code_information": [{"code": "3100104508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 490.0, "discounted_cash": 735.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER IVC*G52918", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FILTER NEPTUNE", "code_information": [{"code": "3100102159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.44, "discounted_cash": 87.66, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER NEPTUNE*N2FOU", "code_information": [{"code": "3100205862", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.44, "discounted_cash": 57.66, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER SMOKE EVAC", "code_information": [{"code": "3100102160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1576.0, "discounted_cash": 2364.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTER SUPREME PLUS", "code_information": [{"code": "3100100708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.6, "discounted_cash": 33.9, "setting": "both", "billing_class": "facility"}]}, {"description": "FILTERED SPEECH HEARING TEST", "code_information": [{"code": "92571", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FILTERS,LIPOSUCTION*", "code_information": [{"code": "3100202717", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 138.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIMBRIOPLASTY", "code_information": [{"code": "58760", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINDER HAMATE", "code_information": [{"code": "3100100709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FINE NEEDLE ASP WO I", "code_information": [{"code": "10021", "type": "CPT"}, {"code": "3480101288", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 484.2, "gross_charge": 429.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 364.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 321.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 300.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 416.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 300.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 321.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 364.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 343.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINE NEEDLE ASPIR BI", "code_information": [{"code": "10007", "type": "CPT"}, {"code": "3480103336", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2289.2, "gross_charge": 2360.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2006.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1770.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2289.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1652.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1770.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2006.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1888.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINE NEEDLE ASPIRATI", "code_information": [{"code": "10005", "type": "CPT"}, {"code": "3480103335", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2289.2, "gross_charge": 2360.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2006.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1770.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2289.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1652.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1770.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2006.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1888.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FINGER SENSOR NONIN", "code_information": [{"code": "3100100710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26497", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINGER TENDON TRANSFER", "code_information": [{"code": "26498", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FINGER TRAP", "code_information": [{"code": "3100100711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FINGERSHIELD", "code_information": [{"code": "3100100712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIRST FRACT TRAY*KEX", "code_information": [{"code": "3100205542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIRST FRACTURE TRAY*", "code_information": [{"code": "3100209883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7335.95, "discounted_cash": 11003.93, "setting": "both", "billing_class": "facility"}]}, {"description": "FISTULA REPAIR & COLOSTOMY", "code_information": [{"code": "57307", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FISTULA REPAIR TRANSPERINE", "code_information": [{"code": "57308", "type": "CPT"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MONOFOCL", "code_information": [{"code": "92352", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIT APHAKIA SPECTCL MULTIFOC", "code_information": [{"code": "92353", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES BIFOCAL", "code_information": [{"code": "92341", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MONOFOCAL", "code_information": [{"code": "92340", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIT SPECTACLES MULTIFOCAL", "code_information": [{"code": "92342", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FITG C-LENS KERATOCONUS 1ST", "code_information": [{"code": "92072", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LOW VIS 1SYSTEM", "code_information": [{"code": "92354", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FITG SPECT LW VIS CMPND LENS", "code_information": [{"code": "92355", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FITTING OF DIAPHRAGM/CAP", "code_information": [{"code": "57170", "type": "CPT"}], "standard_charges": [{"minimum": 167.32, "maximum": 167.32, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIX G/COLON TUBE W/DEVICE", "code_information": [{"code": "49460", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIX PARTIAL DENTURE SECTION", "code_information": [{"code": "D9120", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION DEVICE SECU", "code_information": [{"code": "3100100713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 1732.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION OF ANKLE JOINT", "code_information": [{"code": "27860", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION OF SHLDR UN", "code_information": [{"code": "23700", "type": "CPT"}, {"code": "3480101552", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3527.89, "gross_charge": 3637.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3527.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2909.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION OF SHOULDER BLADE", "code_information": [{"code": "23400", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXATION PIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 247.8, "maximum": 343.38, "gross_charge": 354.0, "discounted_cash": 531.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 265.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 343.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 265.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 283.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXATION PIN 110*270", "code_information": [{"code": "3100202483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 445.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION PIN UKA*AR-", "code_information": [{"code": "3100203445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION STRAP", "code_information": [{"code": "3100100715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 1980.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM ABSO", "code_information": [{"code": "3100100716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM ABSO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXATION SYSTEM ACCU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1176.0, "maximum": 1629.6, "gross_charge": 1680.0, "discounted_cash": 2520.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1344.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXED APPLIANCE THERAPY HABT", "code_information": [{"code": "D8220", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXED BEAR SZ11*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1856.4, "maximum": 2572.44, "gross_charge": 2652.0, "discounted_cash": 3978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2572.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXED BILAT SPACE MAINT, MAN", "code_information": [{"code": "D1517", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXED BILAT SPACE MAINT, MAX", "code_information": [{"code": "D1516", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXED BRNG SZ10*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIXED PARTIAL REPAIR", "code_information": [{"code": "D6980", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FIXED PROSTHODONTIC PROC", "code_information": [{"code": "D6999", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FL HIP SCOPE", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "3270102312", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 1008.8, "gross_charge": 1040.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 884.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 728.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1008.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 728.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 884.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FL SPINAL INJECTION", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "3270100101", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 822.56, "gross_charge": 848.0, "discounted_cash": 1272.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 720.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 822.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 720.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 678.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLANGE COLOSTOMY", "code_information": [{"code": "3100100718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEBOGAMMA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1572", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.12, "maximum": 56.12, "discounted_cash": 90.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 56.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEX LONG STEM SZ 8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6036.94, "maximum": 8365.47, "gross_charge": 8624.2, "discounted_cash": 12936.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7330.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6468.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6036.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8365.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6036.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6468.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7330.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6899.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEX MATRIX LG*703-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6825.0, "maximum": 9457.5, "gross_charge": 9750.0, "discounted_cash": 14625.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7312.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9457.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7312.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXHD/ALLOPATCHHD/SQ CM", "code_information": [{"code": "Q4128", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.69, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLEXIBLE OSTETOME*AR", "code_information": [{"code": "3100205711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXIBLE OSTETOME*AR", "code_information": [{"code": "3100207531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXIBLE OSTETOME*AR", "code_information": [{"code": "3100208256", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXIVA 1000 LASER*M", "code_information": [{"code": "3100203173", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2237.25, "discounted_cash": 3355.88, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXIVA 200 LASER*M0", "code_information": [{"code": "3100203815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1222.65, "discounted_cash": 1833.98, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXIVA 365 LASER*M0", "code_information": [{"code": "3100203816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1023.15, "discounted_cash": 1534.73, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXIVA 550 LASER*M0", "code_information": [{"code": "3100203172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1336.65, "discounted_cash": 2004.98, "setting": "both", "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBOW", "code_information": [{"code": "24330", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLEXOR-PLASTY ELBW W/ADVMNT", "code_information": [{"code": "24331", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLEXWIRE 1.1MM*AR-41", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLEXWIRE 1.6MM*AR-41", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLORBETABEN F18 DIAGNOSTIC", "code_information": [{"code": "Q9983", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLORBETAPIR F18", "code_information": [{"code": "A9586", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOSEAL 10ML*ADS2018", "code_information": [{"code": "3100206264", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 706.29, "discounted_cash": 1059.44, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL 5ML*1505288", "code_information": [{"code": "3100204730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 528.68, "discounted_cash": 793.02, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSEAL APPLICATOR*0", "code_information": [{"code": "3100205665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.88, "discounted_cash": 343.32, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOSWITCH", "code_information": [{"code": "3100102161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOTUFOLASTAT F18 DIAG 1 MCI", "code_information": [{"code": "A9608", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 1016.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLOW CYTOMTRY SURF M", "code_information": [{"code": "88184", "type": "CPT"}, {"code": "3440101216", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 83.3, "maximum": 436.49, "gross_charge": 155.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOW CYTOMTRY SURF M", "code_information": [{"code": "88185", "type": "CPT"}, {"code": "3440101217", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 43.61, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOW IT COMPOSITE SY", "code_information": [{"code": "3100100719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOW VOLUME LOOP", "code_information": [{"code": "94375", "type": "CPT"}, {"code": "3310100272", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 207.2, "maximum": 381.15, "gross_charge": 296.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWABLE 10CC*OAFL-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4846.66, "maximum": 6716.08, "gross_charge": 6923.8, "discounted_cash": 10385.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5885.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5192.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4846.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6716.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4846.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5192.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5885.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5539.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 16 & >", "code_information": [{"code": "88189", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 118.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 118.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 2-8", "code_information": [{"code": "88187", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 75.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 75.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWCYTOMETRY/READ 9", "code_information": [{"code": "88188", "type": "CPT"}, {"code": "3440103025", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 43.61, "maximum": 1725.63, "gross_charge": 1779.0, "discounted_cash": 2668.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1512.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1334.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1245.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1725.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1245.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1334.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1512.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1423.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 93.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWERAMNIOFLO, 0.1 CC", "code_information": [{"code": "Q4177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWERAMNIOPATCH, PER SQ CM", "code_information": [{"code": "Q4178", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.47, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 74.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWERDERM, PER SQ CM", "code_information": [{"code": "Q4179", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLOWMETER", "code_information": [{"code": "3100104507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLOXURIDINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9200", "type": "HCPCS"}], "standard_charges": [{"minimum": 3728.55, "maximum": 3728.55, "discounted_cash": 5979.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3728.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE", "code_information": [{"code": "81245", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 165.51, "discounted_cash": 265.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 165.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ANALYSIS", "code_information": [{"code": "81246", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 83.0, "discounted_cash": 133.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 83.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLT3 GENE ITD VARIANTS QUAN", "code_information": [{"code": "46U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 654.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLU DNA AMP PROM 1ST", "code_information": [{"code": "87502", "type": "CPT"}, {"code": "3440103113", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 82.77, "maximum": 246.38, "gross_charge": 254.0, "discounted_cash": 153.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 106.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 104.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 105.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 102.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 122.09, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 102.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 102.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 104.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLU VAC PANDEM PRSRV FREE IM", "code_information": [{"code": "90666", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV3 NO PRESERV ID", "code_information": [{"code": "90654", "type": "CPT"}], "standard_charges": [{"minimum": 22.01, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLU VACC IIV4 NO PRESERV ID", "code_information": [{"code": "90630", "type": "CPT"}], "standard_charges": [{"minimum": 19.28, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLU VACCINE ADMINIST", "code_information": [{"code": "G0008", "type": "HCPCS"}, {"code": "3400300329", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 57.68, "gross_charge": 44.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUCICLOVINE F-18", "code_information": [{"code": "A9588", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUCONAZOLE/SOD CL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1450", "type": "HCPCS"}, {"code": "3400300116", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.77, "maximum": 15.52, "gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUDARABINE PHOSPHATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9185", "type": "HCPCS"}], "standard_charges": [{"minimum": 190.9, "maximum": 190.9, "discounted_cash": 279.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 190.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUID FLOW OR FLUID GF 1 CC", "code_information": [{"code": "Q4206", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUID IRRIG", "code_information": [{"code": "3100102162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IRRIG", "code_information": [{"code": "3100103694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IRRIG", "code_information": [{"code": "3100103695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.64, "discounted_cash": 51.96, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IRRIG", "code_information": [{"code": "3100103696", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IRRIG", "code_information": [{"code": "3100103697", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IRRIG LR 3000M", "code_information": [{"code": "3100207121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.32, "discounted_cash": 39.48, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IRRIG NACL 300", "code_information": [{"code": "3100202307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.88, "discounted_cash": 50.82, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IV", "code_information": [{"code": "3100102163", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID IV", "code_information": [{"code": "3100104479", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID PRESSURE MUSCLE", "code_information": [{"code": "20950", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 453.46, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 453.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLULAVAL VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2036", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUMAZENIL", "code_information": [{"code": "3400300053", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.5, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUMIST NASAL VACCIN", "code_information": [{"code": "90660", "type": "CPT"}, {"code": "3400300328", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 32.89, "maximum": 55.18, "gross_charge": 50.0, "discounted_cash": 75.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 42.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 48.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 42.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUNISOLIDE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7641", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGIOSCOPY I&R", "code_information": [{"code": "92230", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN ANGRPH MLTIFRAME", "code_information": [{"code": "92235", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORESCEIN&ICG ANGIOGRAPHY", "code_information": [{"code": "92242", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORIDE APPLICATOR", "code_information": [{"code": "D5986", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORINE-18 FLUORODEOXYGLUCO", "code_information": [{"code": "S8085", "type": "HCPCS"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORO EXAM OF G/COLON TUBE", "code_information": [{"code": "49465", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORO POLARIZE FETAL LUNG", "code_information": [{"code": "83663", "type": "CPT"}], "standard_charges": [{"minimum": 18.91, "maximum": 40.05, "discounted_cash": 30.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORODOPA F-18 DIAG PER MCI", "code_information": [{"code": "A9602", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 717.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROESTRADIOL F 18", "code_information": [{"code": "A9591", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUOROURACIL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9190", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.95, "maximum": 2.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORSC NONNFCT AGT", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "3440101073", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 19.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUORSC NONNFCT AGT", "code_information": [{"code": "86256", "type": "CPT"}, {"code": "3440101074", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 19.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUPHENAZINE DECANOATE 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2680", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.72, "maximum": 9.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUTEMETAMOL F18 DIAGNOSTIC", "code_information": [{"code": "Q9982", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FLUVIRIN VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2037", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FLUZONE VACC, 3 YRS & >, IM", "code_information": [{"code": "Q2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81243", "type": "CPT"}], "standard_charges": [{"minimum": 57.04, "maximum": 79.66, "discounted_cash": 91.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 57.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 44.89, "maximum": 79.66, "discounted_cash": 72.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY TECH", "code_information": [{"code": "70554", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN EA ADDL", "code_information": [{"code": "10010", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/FLUOR GDN EA ADDL", "code_information": [{"code": "10008", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN EA ADDL", "code_information": [{"code": "10012", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/O IMG GDN EA ADDL", "code_information": [{"code": "10004", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN 1ST", "code_information": [{"code": "10005", "type": "CPT"}, {"code": "3480103308", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2330.91, "gross_charge": 2403.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2042.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1802.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1682.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2330.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1682.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1802.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2042.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1922.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/US GDN EA ADDL", "code_information": [{"code": "10006", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA- EVAL INTERP & R", "code_information": [{"code": "88173", "type": "CPT"}, {"code": "3440101215", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 55.3, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 82.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOAM ANKLE PROTECTOR", "code_information": [{"code": "3100102164", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FOAM CONV RELV", "code_information": [{"code": "3100100720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FOAM PACK VIT CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100102309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5523.18, "gross_charge": 5694.0, "discounted_cash": 8541.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4839.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4270.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3985.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5523.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3985.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4270.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4839.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4555.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOAM PACK VIT CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100103748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3447.38, "gross_charge": 3554.0, "discounted_cash": 5331.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3020.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2665.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2487.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3447.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2487.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2665.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3020.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2843.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOAM PACK VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100100721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 693.0, "maximum": 1725.27, "gross_charge": 990.0, "discounted_cash": 1485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 742.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 960.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 742.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 18.91, "maximum": 40.05, "discounted_cash": 30.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOGARTY HYDRAJAW INS", "code_information": [{"code": "3100100722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLATE ACID RBC", "code_information": [{"code": "82747", "type": "CPT"}, {"code": "3440100907", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.65, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 28.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOLEY CATH KIT*A8000", "code_information": [{"code": "3100207098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.16, "discounted_cash": 60.24, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLIC ACID SERUM", "code_information": [{"code": "82746", "type": "CPT"}, {"code": "3440100906", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.7, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 23.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP ANGIOGRAPHY", "code_information": [{"code": "75898", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP/REASSESSMENT", "code_information": [{"code": "S0316", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOMEPIZOLE, 15 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1451", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "discounted_cash": 9.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FONDAPARINUX SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1652", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.03, "maximum": 1.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOD THICKENER ORAL", "code_information": [{"code": "B4100", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT COVER RIGID SOL", "code_information": [{"code": "3100100723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 387.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOOT COVER RIGID SOL", "code_information": [{"code": "3100100724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 285.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FOOT INTRAOP", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "3270102316", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH CC", "code_information": [{"code": "504", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8041.41, "maximum": 8041.41, "discounted_cash": 19282.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8041.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITH MCC", "code_information": [{"code": "503", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16166.45, "maximum": 16166.45, "discounted_cash": 29942.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16166.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "505", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7803.47, "maximum": 7803.47, "discounted_cash": 19043.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7803.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOOT RING 155MM LONG", "code_information": [{"code": "3100209116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5670.08, "discounted_cash": 8505.12, "setting": "both", "billing_class": "facility"}]}, {"description": "FOOT/ANKLE KIT*ABS-2", "code_information": [{"code": "3100207683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP BIPOLAR", "code_information": [{"code": "3100104136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2749.0, "discounted_cash": 4123.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP DISP", "code_information": [{"code": "3100104537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1376.0, "discounted_cash": 2064.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP DISP 8\" 1.0M*", "code_information": [{"code": "3100202645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1377.0, "discounted_cash": 2065.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP EXTRACT DEN", "code_information": [{"code": "3100104204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP HEMO", "code_information": [{"code": "3100104697", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP MULTIBITE", "code_information": [{"code": "3100103891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP RAD JAW PULMO", "code_information": [{"code": "3100104369", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS 4 BROKEN SCR", "code_information": [{"code": "3100100725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2095.0, "discounted_cash": 3142.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ADSON", "code_information": [{"code": "3100100726", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.2, "discounted_cash": 34.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ADSON SERR J", "code_information": [{"code": "3100100727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ASSI", "code_information": [{"code": "3100100728", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 760.0, "discounted_cash": 1140.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BACKHAUS TOW", "code_information": [{"code": "3100100729", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.8, "discounted_cash": 59.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BACKHAUS TOW", "code_information": [{"code": "3100100730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.4, "discounted_cash": 62.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BAYONET GERA", "code_information": [{"code": "3100100731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 366.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BAYONET SERR", "code_information": [{"code": "3100100732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOP SPYBITE", "code_information": [{"code": "3100203606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY ENDO", "code_information": [{"code": "3100100733", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 1944.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY MARBE", "code_information": [{"code": "3100100734", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3660.0, "discounted_cash": 5490.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY RADIA", "code_information": [{"code": "3100100735", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.5, "discounted_cash": 78.75, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR ANGL", "code_information": [{"code": "3100100736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2358.0, "discounted_cash": 3537.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR TIP", "code_information": [{"code": "3100100737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 246.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BONE REDUCTI", "code_information": [{"code": "3100100738", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.0, "discounted_cash": 465.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BONN", "code_information": [{"code": "3100100739", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 915.0, "discounted_cash": 1372.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BX BLOADING*", "code_information": [{"code": "3100202989", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.95, "discounted_cash": 1546.43, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CASTRO VIEJO", "code_information": [{"code": "3100100740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 885.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CATROVIEJO", "code_information": [{"code": "3100100741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 782.0, "discounted_cash": 1173.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CHANDLER SPI", "code_information": [{"code": "3100100742", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CLICKLINE CL", "code_information": [{"code": "3100100743", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1698.0, "discounted_cash": 2547.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CRILE ARTERY", "code_information": [{"code": "3100100744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.7, "discounted_cash": 71.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CUP BX*22013", "code_information": [{"code": "3100202988", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 905.25, "discounted_cash": 1357.88, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CUTTING HALO", "code_information": [{"code": "3100100745", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1438.0, "discounted_cash": 2157.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS DRESSING SER", "code_information": [{"code": "3100100746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.4, "discounted_cash": 71.1, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS DRESSING THU", "code_information": [{"code": "3100100747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.2, "discounted_cash": 147.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS EXTRACTION", "code_information": [{"code": "3100100748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 502.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS EXTRACTION D", "code_information": [{"code": "3100100749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1767.0, "discounted_cash": 2650.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS FERRIS SMITH", "code_information": [{"code": "3100100750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.6, "discounted_cash": 80.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS FLEXIBLE FOR", "code_information": [{"code": "3100100751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1505.0, "discounted_cash": 2257.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS FOERSTER SPO", "code_information": [{"code": "3100100752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.3, "discounted_cash": 108.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GERALD DELIC", "code_information": [{"code": "3100100753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 169.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GIRAFFE THRU", "code_information": [{"code": "3100100754", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2058.0, "discounted_cash": 3087.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GORNEY-ADSON", "code_information": [{"code": "3100100755", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 604.0, "discounted_cash": 906.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GRASP/DESSCT", "code_information": [{"code": "3100100756", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1235.0, "discounted_cash": 1852.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GUARD PLASTI", "code_information": [{"code": "3100100757", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.8, "discounted_cash": 112.2, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HANDLE RATCH", "code_information": [{"code": "3100100758", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1107.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HEANEY-BALLE", "code_information": [{"code": "3100100759", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 483.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HOLDING TEND", "code_information": [{"code": "3100100760", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HORTON-ADSON", "code_information": [{"code": "3100100761", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 651.0, "discounted_cash": 976.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS INTESTINAL T", "code_information": [{"code": "3100100762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 747.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS IRRIGATING B", "code_information": [{"code": "3100100763", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1730.0, "discounted_cash": 2595.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS JACOBS UTERI", "code_information": [{"code": "3100100764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 278.0, "discounted_cash": 417.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS JAW PEAR SHA", "code_information": [{"code": "3100100765", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1985.0, "discounted_cash": 2977.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS LISTON BONE", "code_information": [{"code": "3100100766", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MINILAP ALLI", "code_information": [{"code": "3100100767", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 752.0, "discounted_cash": 1128.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MOSQUITO HAL", "code_information": [{"code": "3100100768", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MOSQUITO HEM", "code_information": [{"code": "3100100769", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MOSQUITO JAC", "code_information": [{"code": "3100100770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.0, "discounted_cash": 339.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MULTIBITE", "code_information": [{"code": "3100100771", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 226.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS NASAL TAKAHA", "code_information": [{"code": "3100100772", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 994.0, "discounted_cash": 1491.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS OSHSNER ART", "code_information": [{"code": "3100100773", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.8, "discounted_cash": 116.7, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS PEAPOD", "code_information": [{"code": "3100100774", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.0, "discounted_cash": 915.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS PEDO UPPER", "code_information": [{"code": "3100100775", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS RAD JAW PULM", "code_information": [{"code": "3100100776", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 154.0, "discounted_cash": 231.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SCREW HOLDIN", "code_information": [{"code": "3100100777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SCREW REMOVA", "code_information": [{"code": "3100100778", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1409.0, "discounted_cash": 2113.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SCREW REMOVA", "code_information": [{"code": "3100100779", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1174.0, "discounted_cash": 1761.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SCREW W PLAT", "code_information": [{"code": "3100100780", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 902.0, "discounted_cash": 1353.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SHAFT INSERT", "code_information": [{"code": "3100100781", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3050.0, "discounted_cash": 4575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SIDE-GRASP T", "code_information": [{"code": "3100100782", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 199.0, "discounted_cash": 298.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS STRAIGHT BIP", "code_information": [{"code": "3100100783", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1474.0, "discounted_cash": 2211.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS TISSUE", "code_information": [{"code": "3100100784", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.2, "discounted_cash": 108.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORENSIC CYTOPATHOLOGY", "code_information": [{"code": "88125", "type": "CPT"}], "standard_charges": [{"minimum": 25.23, "maximum": 43.61, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORESKIN MANIPULATIO", "code_information": [{"code": "54450", "type": "CPT"}, {"code": "3480102061", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 252.2, "maximum": 946.72, "gross_charge": 976.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 829.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 732.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 683.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 946.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 683.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 732.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 829.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORESKIN MANIPULATIO", "code_information": [{"code": "54450", "type": "CPT"}, {"code": "3480103262", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 252.2, "maximum": 902.1, "gross_charge": 930.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 902.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7640", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "FORMOTEROL FUMARATE, INH", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7606", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.57, "maximum": 3.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSAPREPITANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1453", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.13, "maximum": 0.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSCARNET SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1455", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.59, "maximum": 36.59, "discounted_cash": 95.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOSPHENYTOIN INJ PE", "code_information": [{"code": "Q2009", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.6, "maximum": 1.6, "discounted_cash": 7.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FR FRZ PLASMA DONOR RETESTED", "code_information": [{"code": "P9060", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 93.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTIONATION KETOSTEROIDS", "code_information": [{"code": "83593", "type": "CPT"}], "standard_charges": [{"minimum": 28.5, "maximum": 34.27, "discounted_cash": 45.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURE ASSESSMENT VIA DXA", "code_information": [{"code": "77086", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRACTURE NASAL TURBI", "code_information": [{"code": "30930", "type": "CPT"}, {"code": "3480101840", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "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": 5520.59, "maximum": 5520.59, "discounted_cash": 16977.96, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5520.59, "methodology": "fee schedule"}], "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": 3910.34, "maximum": 3910.34, "discounted_cash": 9998.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3910.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITH MCC", "code_information": [{"code": "533", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8687.6, "maximum": 8687.6, "discounted_cash": 18213.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8687.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [{"code": "534", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2742.77, "maximum": 2742.77, "discounted_cash": 9043.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2742.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [{"code": "535", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6041.97, "maximum": 6041.97, "discounted_cash": 14477.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6041.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [{"code": "536", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4962.94, "maximum": 4962.94, "discounted_cash": 8787.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4962.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FRAGMENTING OF KIDNE", "code_information": [{"code": "50590", "type": "CPT"}, {"code": "3480103170", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3557.41, "maximum": 11828.18, "gross_charge": 12194.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11828.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRAGMENTING OF KIDNE", "code_information": [{"code": "50590", "type": "CPT"}, {"code": "3480103215", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 3557.41, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRANCISELLA TULARENSIS", "code_information": [{"code": "86668", "type": "CPT"}], "standard_charges": [{"minimum": 14.16, "maximum": 30.26, "discounted_cash": 22.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRBRIDGE TURB SYS*AR", "code_information": [{"code": "3100207348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2600.0, "discounted_cash": 3900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FREE FASCIAL FLAP MICROVASC", "code_information": [{"code": "15758", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE JEJUNUM FLAP MICROVASC", "code_information": [{"code": "43496", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE MYO/SKIN FLAP MICROVASC", "code_information": [{"code": "15756", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE OMENTAL FLAP MICROVASC", "code_information": [{"code": "49906", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE SKIN FLAP MICROVASC", "code_information": [{"code": "15757", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE THYROXINE", "code_information": [{"code": "84439", "type": "CPT"}, {"code": "3440101000", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.02, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 14.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREE/REMOVE CHEST LINING", "code_information": [{"code": "32320", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FREEING OF BOWEL ADHESION", "code_information": [{"code": "44005", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRENULOPLASTY", "code_information": [{"code": "D7963", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRENULOTOMY OF PENIS", "code_information": [{"code": "54164", "type": "CPT"}, {"code": "3340102435", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5891.78, "gross_charge": 6074.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5162.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4555.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4251.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5891.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4251.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4555.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5162.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4859.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRESH FROZEN PLASMA", "code_information": [{"code": "P9017", "type": "HCPCS"}, {"code": "3470101273", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 85.64, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 128.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 88.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 87.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 88.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 101.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 85.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 85.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 87.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FRESH FRZN PLSMA 8-2", "code_information": [{"code": "P9059", "type": "HCPCS"}, {"code": "3470103009", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 77.72, "maximum": 308.46, "gross_charge": 318.0, "discounted_cash": 116.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 270.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 238.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 222.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 308.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 79.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 222.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 80.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 238.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 77.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 92.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 270.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 77.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 77.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 79.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD FREEZE/THAW", "code_information": [{"code": "86932", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD PREP", "code_information": [{"code": "86930", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN BLOOD THAW", "code_information": [{"code": "86931", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN CELL PREPARATION", "code_information": [{"code": "88241", "type": "CPT"}], "standard_charges": [{"minimum": 12.09, "maximum": 35.16, "discounted_cash": 19.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN IVF CASE RATE", "code_information": [{"code": "S4016", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FROZEN PLASMA POOLED", "code_information": [{"code": "P9023", "type": "HCPCS"}, {"code": "3440103024", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 64.75, "maximum": 443.29, "gross_charge": 457.0, "discounted_cash": 97.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 388.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 342.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 319.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 443.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 319.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 342.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.75, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 77.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 388.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 365.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 64.75, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GR F/C/C/M/N/AX/G/H/F EA", "code_information": [{"code": "15241", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR N/E/E/L EACH ADDL", "code_information": [{"code": "15261", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR S/A/L EACH ADDL", "code_information": [{"code": "15221", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK 20 SQ CM/<", "code_information": [{"code": "15200", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTH GRF FR TRNK EACH ADDL", "code_information": [{"code": "15201", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL ANEUPLOIDY STR ALYS DNA", "code_information": [{"code": "252U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 1219.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR 3 PROTEINS", "code_information": [{"code": "81509", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1487.37, "discounted_cash": 2389.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1487.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FIVE ANAL", "code_information": [{"code": "81512", "type": "CPT"}], "standard_charges": [{"minimum": 69.52, "maximum": 79.66, "discounted_cash": 111.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 69.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR FOUR ANAL", "code_information": [{"code": "81511", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 153.5, "discounted_cash": 246.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 153.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR THREE ANAL", "code_information": [{"code": "81510", "type": "CPT"}], "standard_charges": [{"minimum": 55.54, "maximum": 79.66, "discounted_cash": 89.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FTL CGEN ABNOR TWO PROTEINS", "code_information": [{"code": "81508", "type": "CPT"}], "standard_charges": [{"minimum": 54.3, "maximum": 79.66, "discounted_cash": 87.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 54.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL FIELD ERG W/I&R", "code_information": [{"code": "92273", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH DEBRIDEMENT", "code_information": [{"code": "D4355", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL MOUTH X-RAY OF TEETH", "code_information": [{"code": "70320", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL RING 155MM*7107", "code_information": [{"code": "3100209115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4833.01, "discounted_cash": 7249.52, "setting": "both", "billing_class": "facility"}]}, {"description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [{"code": "793", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3266.61, "maximum": 3266.61, "discounted_cash": 46995.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3266.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICK GRAFT 20", "code_information": [{"code": "15240", "type": "CPT"}, {"code": "3480101369", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC", "code_information": [{"code": "928", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19974.11, "maximum": 19974.11, "discounted_cash": 77255.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19974.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC", "code_information": [{"code": "929", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11965.28, "maximum": 11965.28, "discounted_cash": 35899.65, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11965.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [{"code": "934", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5276.51, "maximum": 5276.51, "discounted_cash": 23361.86, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5276.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUNCTIONAL BRAIN MAPPING", "code_information": [{"code": "96020", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUNDUS PHOTOGRAPHY W/I&R", "code_information": [{"code": "92250", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUNGI IDENTIFICATION MOLD", "code_information": [{"code": "87107", "type": "CPT"}], "standard_charges": [{"minimum": 10.32, "maximum": 24.03, "discounted_cash": 16.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUNGUS AB NES", "code_information": [{"code": "86671", "type": "CPT"}, {"code": "3440101104", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.25, "maximum": 98.94, "gross_charge": 102.0, "discounted_cash": 19.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUNNEL ARTHREX", "code_information": [{"code": "3100102165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUROSEMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1940", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.61, "maximum": 0.61, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47760", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47780", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE BILE DUCTS AND BOWEL", "code_information": [{"code": "47785", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43340", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & INTESTINE", "code_information": [{"code": "43341", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE ESOPHAGUS & STOMACH", "code_information": [{"code": "43320", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47720", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE HAND BONES WITH", "code_information": [{"code": "25825", "type": "CPT"}, {"code": "3480103060", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 22090.78, "gross_charge": 22774.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19357.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17080.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15941.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22090.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15941.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17080.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19357.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18219.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCT & INTESTINE", "code_information": [{"code": "47802", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48520", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS CYST AND BOWEL", "code_information": [{"code": "48540", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE UPPER GI STRUCTURES", "code_information": [{"code": "47721", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSE/GRAFT ADDED JOINT", "code_information": [{"code": "26863", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION 2 OR MORE 3D IMAGES", "code_information": [{"code": "D0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION ANTER SPINE 2", "code_information": [{"code": "22808", "type": "CPT"}, {"code": "3480101512", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3750.6, "maximum": 14462.5, "gross_charge": 5358.0, "discounted_cash": 8037.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4554.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4018.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3750.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5197.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3750.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4018.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4554.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4286.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION ANTER SPINE 8", "code_information": [{"code": "22812", "type": "CPT"}, {"code": "3480101513", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4712.4, "maximum": 14462.5, "gross_charge": 6732.0, "discounted_cash": 10098.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5722.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5049.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6530.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5049.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5722.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5385.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION CUP 10H*FC10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2529.8, "maximum": 3505.58, "gross_charge": 3614.0, "discounted_cash": 5421.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3071.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2710.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2529.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3505.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2529.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2710.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3071.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2891.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION CUP*LFC10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1983.8, "maximum": 2748.98, "gross_charge": 2834.0, "discounted_cash": 4251.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2748.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2267.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF ANKLE JOINT OPEN", "code_information": [{"code": "27870", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF BIG TOE JOINT", "code_information": [{"code": "28760", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF ELBOW JOINT", "code_information": [{"code": "24800", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64866", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FACIAL/OTHER NERVE", "code_information": [{"code": "64868", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER JNT ADD-ON", "code_information": [{"code": "26861", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TEN", "code_information": [{"code": "26474", "type": "CPT"}, {"code": "3480103134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4245.69, "gross_charge": 4377.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4245.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3501.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FINGER TENDONS", "code_information": [{"code": "26471", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28705", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28715", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28725", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF FOOT BONES", "code_information": [{"code": "28730", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND BONES", "code_information": [{"code": "25820", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF HAND JOINT", "code_information": [{"code": "26843", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNEE", "code_information": [{"code": "27580", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE", "code_information": [{"code": "26850", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINT", "code_information": [{"code": "26516", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26517", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26518", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE WITH GRAFT", "code_information": [{"code": "26852", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54900", "type": "CPT"}], "standard_charges": [{"minimum": 1927.74, "maximum": 1927.74, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54901", "type": "CPT"}], "standard_charges": [{"minimum": 2109.3, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43810", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43820", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": "43825", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT", "code_information": [{"code": "25301", "type": "CPT"}, {"code": "3480101596", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TENDONS AT WRIST", "code_information": [{"code": "25300", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF THUMB", "code_information": [{"code": "26841", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TIBIOFIBULAR JOINT", "code_information": [{"code": "27871", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF TOES", "code_information": [{"code": "28280", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & BOWEL", "code_information": [{"code": "50810", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50740", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", "code_information": [{"code": "50750", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETERS", "code_information": [{"code": "50760", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION OF WRIST JNT", "code_information": [{"code": "25800", "type": "CPT"}, {"code": "3480101616", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 23883.34, "gross_charge": 24622.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23883.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19697.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION POSTR SPINE 1", "code_information": [{"code": "22804", "type": "CPT"}, {"code": "3480101511", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5009.2, "maximum": 14462.5, "gross_charge": 7156.0, "discounted_cash": 10734.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6082.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5367.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5009.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6941.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5009.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5367.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6082.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5724.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION POSTR SPINE 7", "code_information": [{"code": "22802", "type": "CPT"}, {"code": "3480101510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3625.3, "maximum": 14462.5, "gross_charge": 5179.0, "discounted_cash": 7768.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4402.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3884.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3625.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5023.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3625.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3884.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4402.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4143.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION POSTR SPINE U", "code_information": [{"code": "22800", "type": "CPT"}, {"code": "3480101509", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2347.1, "maximum": 14462.5, "gross_charge": 3353.0, "discounted_cash": 5029.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2850.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2514.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2347.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3252.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2347.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2514.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2850.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2682.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION RADIOULNAR JNT/ULNA", "code_information": [{"code": "25830", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION REAMER 18MM*R", "code_information": [{"code": "3100207441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1038.0, "discounted_cash": 1557.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION REAMER 22MM*R", "code_information": [{"code": "3100207794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1038.0, "discounted_cash": 1557.0, "setting": "both", "billing_class": "facility"}]}, {"description": "FUSION WRIST JOINT W", "code_information": [{"code": "25810", "type": "CPT"}, {"code": "3480101617", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 23883.34, "gross_charge": 24622.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23883.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19697.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF ELBOW JOINT", "code_information": [{"code": "24802", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF FINGER JOINT", "code_information": [{"code": "26862", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF HAND JOINT", "code_information": [{"code": "26844", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUSION/GRAFT OF WRIST JOINT", "code_information": [{"code": "25805", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUT1 GNOTYP FUT1 EXON 4", "code_information": [{"code": "185U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FUT2 GNOTYP FUT2 EXON 2", "code_information": [{"code": "186U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR 1ST 100 SQ CM", "code_information": [{"code": "479T", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXJL ABL LSR EA ADDL 100SQCM", "code_information": [{"code": "480T", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXN GENE ANALYSIS", "code_information": [{"code": "233U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXN GENE CHARAC ALLELES", "code_information": [{"code": "81285", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXN GENE DETC ABNOR ALLELES", "code_information": [{"code": "81284", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXN GENE FULL GENE SEQUENCE", "code_information": [{"code": "81286", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FXN GENE KNOWN FAMIL VARIANT", "code_information": [{"code": "81289", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "FY GNOTYP ACKR1 EXONS 1-2", "code_information": [{"code": "187U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures, Major", "code_information": [{"code": "92.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40752.98, "maximum": 40752.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40752.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures, Minor", "code_information": [{"code": "92.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20755.17, "maximum": 20755.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20755.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures, Moderate", "code_information": [{"code": "92.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22499.3, "maximum": 22499.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22499.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures, Severe", "code_information": [{"code": "92.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 64633.73, "maximum": 64633.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 64633.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Infections, Major", "code_information": [{"code": "531.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17017.04, "maximum": 17017.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17017.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Infections, Minor", "code_information": [{"code": "531.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6754.79, "maximum": 6754.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6754.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Infections, Moderate", "code_information": [{"code": "531.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8857.73, "maximum": 8857.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8857.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Infections, Severe", "code_information": [{"code": "531.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24459.99, "maximum": 24459.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24459.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Malignancy, Major", "code_information": [{"code": "530.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17817.98, "maximum": 17817.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17817.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Malignancy, Minor", "code_information": [{"code": "530.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10636.45, "maximum": 10636.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10636.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Malignancy, Moderate", "code_information": [{"code": "530.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13327.6, "maximum": 13327.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13327.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Malignancy, Severe", "code_information": [{"code": "530.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23965.33, "maximum": 23965.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23965.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Reconstructive Procedures, Major", "code_information": [{"code": "514.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34556.93, "maximum": 34556.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34556.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Reconstructive Procedures, Minor", "code_information": [{"code": "514.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11692.41, "maximum": 11692.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11692.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Reconstructive Procedures, Moderate", "code_information": [{"code": "514.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16787.65, "maximum": 16787.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16787.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Female Reproductive System Reconstructive Procedures, Severe", "code_information": [{"code": "514.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 57757.21, "maximum": 57757.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 57757.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fever And Inflammatory Conditions, Major", "code_information": [{"code": "722.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16831.22, "maximum": 16831.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16831.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fever And Inflammatory Conditions, Minor", "code_information": [{"code": "722.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7171.27, "maximum": 7171.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7171.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fever And Inflammatory Conditions, Moderate", "code_information": [{"code": "722.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8755.21, "maximum": 8755.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8755.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fever And Inflammatory Conditions, Severe", "code_information": [{"code": "722.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24429.23, "maximum": 24429.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24429.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fish Analysis Of 4 Genes In Prostate Needle Biopsy Specimen", "code_information": [{"code": "53U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Foot And Toe Procedures, Major", "code_information": [{"code": "314.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21499.73, "maximum": 21499.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21499.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Foot And Toe Procedures, Minor", "code_information": [{"code": "314.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13958.1, "maximum": 13958.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13958.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Foot And Toe Procedures, Moderate", "code_information": [{"code": "314.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14858.99, "maximum": 14858.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14858.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Foot And Toe Procedures, Severe", "code_information": [{"code": "314.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36568.88, "maximum": 36568.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36568.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Femur, Major", "code_information": [{"code": "340.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12588.17, "maximum": 12588.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12588.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Femur, Minor", "code_information": [{"code": "340.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5866.71, "maximum": 5866.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5866.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Femur, Moderate", "code_information": [{"code": "340.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6815.02, "maximum": 6815.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6815.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Femur, Severe", "code_information": [{"code": "340.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18515.11, "maximum": 18515.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18515.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Pelvis Or Dislocation Of Hip, Major", "code_information": [{"code": "341.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17337.41, "maximum": 17337.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17337.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Pelvis Or Dislocation Of Hip, Minor", "code_information": [{"code": "341.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5842.36, "maximum": 5842.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5842.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Pelvis Or Dislocation Of Hip, Moderate", "code_information": [{"code": "341.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9247.3, "maximum": 9247.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9247.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fracture Of Pelvis Or Dislocation Of Hip, Severe", "code_information": [{"code": "341.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22250.68, "maximum": 22250.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22250.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fractures And Dislocations Except Femur, Pelvis And Back, Major", "code_information": [{"code": "342.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12007.66, "maximum": 12007.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12007.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fractures And Dislocations Except Femur, Pelvis And Back, Minor", "code_information": [{"code": "342.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8284.9, "maximum": 8284.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8284.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fractures And Dislocations Except Femur, Pelvis And Back, Moderate", "code_information": [{"code": "342.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8707.79, "maximum": 8707.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8707.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Fractures And Dislocations Except Femur, Pelvis And Back, Severe", "code_information": [{"code": "342.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19901.7, "maximum": 19901.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19901.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "G6PC GENE", "code_information": [{"code": "81250", "type": "CPT"}], "standard_charges": [{"minimum": 58.49, "maximum": 79.66, "discounted_cash": 93.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "G6PD FULL GENE SEQUENCE", "code_information": [{"code": "81249", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 600.0, "discounted_cash": 963.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "G6PD GENE ALYS CMN VARIANT", "code_information": [{"code": "81247", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 174.81, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "G6PD KNOWN FAMILIAL VARIANT", "code_information": [{"code": "81248", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 375.25, "discounted_cash": 602.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GA67 GALLIUM", "code_information": [{"code": "A9556", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.28, "maximum": 119.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 119.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GABAPENTIN", "code_information": [{"code": "80171", "type": "CPT"}, {"code": "3440100815", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.67, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 34.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 23.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GABAPENTIN NON-BLOOD", "code_information": [{"code": "80355", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GADOBUTROL INJECTION", "code_information": [{"code": "A9585", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.35, "maximum": 0.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GADOFOSVESET TRISODIUM INJ", "code_information": [{"code": "A9583", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GADOLINIUM BASE MRI", "code_information": [{"code": "A9579", "type": "HCPCS"}, {"code": "3280100153", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.73, "maximum": 1.51, "gross_charge": 1.05, "discounted_cash": 1.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 0.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 0.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 0.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 0.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 0.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GADOXETATE DISODIUM INJ", "code_information": [{"code": "A9581", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.76, "maximum": 14.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAIT TRAINING THERAPY", "code_information": [{"code": "97116", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GALACTOSE TRANSFERASE TEST", "code_information": [{"code": "82776", "type": "CPT"}], "standard_charges": [{"minimum": 11.74, "maximum": 40.05, "discounted_cash": 18.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GALECTIN-3", "code_information": [{"code": "82777", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 53.85, "discounted_cash": 71.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68", "code_information": [{"code": "A9587", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68 PSMA-11 UCSF", "code_information": [{"code": "A9593", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 1295.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM GA-68 PSMA-11, UCLA", "code_information": [{"code": "A9594", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 1268.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM ILLUCCIX 1 MILLICURE", "code_information": [{"code": "A9596", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 1593.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM LOCAMETZ 1 MILLICURI", "code_information": [{"code": "A9800", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 1403.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GALLIUM NITRATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1457", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.83, "maximum": 1.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GALSULFASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1458", "type": "HCPCS"}], "standard_charges": [{"minimum": 466.92, "maximum": 466.92, "discounted_cash": 743.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 466.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAMMA GLOBULIN 1 CC INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1460", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.06, "maximum": 49.06, "discounted_cash": 81.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAMMA GLOBULIN > 10 CC INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1560", "type": "HCPCS"}], "standard_charges": [{"minimum": 490.62, "maximum": 490.62, "discounted_cash": 814.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 490.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAMMAGARD LIQUID INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1569", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.22, "maximum": 43.22, "discounted_cash": 70.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 43.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAMMAGLOBLN IGA IGD", "code_information": [{"code": "82784", "type": "CPT"}, {"code": "3440100908", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.3, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 14.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GAMMAGRAFT", "code_information": [{"code": "Q4111", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.22, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GAMMAPLEX INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1557", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.01, "maximum": 55.01, "discounted_cash": 88.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GAMUNEX-C/GAMMAKED", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1561", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.88, "maximum": 48.88, "discounted_cash": 79.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GANCICLOVIR LONG ACT IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7310", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GANCICLOVIR SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1570", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.1, "maximum": 44.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARAMYCIN GENTAMICIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1580", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.73, "maximum": 2.73, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA AMP PROBE", "code_information": [{"code": "87511", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA DIR PROBE", "code_information": [{"code": "87510", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GARDNER VAG DNA QUANT", "code_information": [{"code": "87512", "type": "CPT"}], "standard_charges": [{"minimum": 41.76, "maximum": 41.83, "discounted_cash": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRGRAFIN / ML", "code_information": [{"code": "Q9963", "type": "HCPCS"}, {"code": "3270102288", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.22, "maximum": 0.35, "gross_charge": 0.37, "discounted_cash": 0.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 0.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 0.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRGRAFIN / ML", "code_information": [{"code": "Q9963", "type": "HCPCS"}, {"code": "3290103013", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.22, "maximum": 0.35, "gross_charge": 0.37, "discounted_cash": 0.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 0.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 0.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 0.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC ANALY W/PH EA SPEC", "code_information": [{"code": "82930", "type": "CPT"}], "standard_charges": [{"minimum": 6.71, "maximum": 20.92, "discounted_cash": 10.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC BAND ADJ VIA", "code_information": [{"code": "S2083", "type": "HCPCS"}, {"code": "3480102245", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 188.3, "maximum": 260.93, "gross_charge": 269.0, "discounted_cash": 403.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 228.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 201.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 188.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 260.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 188.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 201.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 228.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 215.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS FOR OBESITY", "code_information": [{"code": "43846", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC BYPASS INCL SMALL I", "code_information": [{"code": "43847", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78264", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78265", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [{"code": "78266", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC MOTILITY STUDIES", "code_information": [{"code": "91020", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIC MUCOSA IMAGING", "code_information": [{"code": "78261", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIN", "code_information": [{"code": "82941", "type": "CPT"}, {"code": "3440100913", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.63, "maximum": 153.26, "gross_charge": 158.0, "discounted_cash": 28.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 153.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRIN TEST", "code_information": [{"code": "82938", "type": "CPT"}], "standard_charges": [{"minimum": 17.69, "maximum": 34.27, "discounted_cash": 28.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTRO ANCHOR FASTEN", "code_information": [{"code": "3100206645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTRO SURGERY 1ST 3", "code_information": [{"code": "3480103109", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.0, "discounted_cash": 1974.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTRO SURGERY EA AD", "code_information": [{"code": "3480103110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2633.0, "discounted_cash": 3949.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTROC ENDOBLADE*A8", "code_information": [{"code": "3100202747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX EXAM", "code_information": [{"code": "78262", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROESOPHAGEAL REFLUX TEST", "code_information": [{"code": "91034", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROGRAFIN / ML", "code_information": [{"code": "Q9963", "type": "HCPCS"}, {"code": "3100100785", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.22, "maximum": 46.56, "gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROGRAFIN 30ML *0", "code_information": [{"code": "3100204587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.24, "discounted_cash": 43.86, "setting": "both", "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [{"code": "378", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5685.98, "maximum": 5685.98, "discounted_cash": 10983.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5685.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [{"code": "377", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8675.92, "maximum": 8675.92, "discounted_cash": 19987.92, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8675.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "379", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3610.92, "maximum": 3610.92, "discounted_cash": 7069.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3610.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [{"code": "389", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4712.7, "maximum": 4712.7, "discounted_cash": 8891.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4712.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [{"code": "388", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6202.45, "maximum": 6202.45, "discounted_cash": 16227.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6202.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC", "code_information": [{"code": "390", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3224.8, "maximum": 3224.8, "discounted_cash": 6240.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3224.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43361", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL TRA", "code_information": [{"code": "91110", "type": "CPT"}, {"code": "3390100675", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 925.01, "maximum": 2548.19, "gross_charge": 2627.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1970.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2548.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1970.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY DUODENAL SWITCH", "code_information": [{"code": "43845", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GASTROPLASTY W/O V-BAND", "code_information": [{"code": "43843", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SINGLE", "code_information": [{"code": "78472", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GAUGE LOCKDOWN", "code_information": [{"code": "3100104633", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GBA GENE", "code_information": [{"code": "81251", "type": "CPT"}], "standard_charges": [{"minimum": 47.25, "maximum": 79.66, "discounted_cash": 75.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GE GNOTYP GYPC EXONS 1-4", "code_information": [{"code": "188U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GEFITINIB ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8565", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GEL-FLO NT*00009-104", "code_information": [{"code": "3100204722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 668.76, "discounted_cash": 1003.14, "setting": "both", "billing_class": "facility"}]}, {"description": "GEL-ONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7326", "type": "HCPCS"}], "standard_charges": [{"minimum": 522.37, "maximum": 522.37, "discounted_cash": 798.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GELATIN", "code_information": [{"code": "3400300011", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 337.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFILM", "code_information": [{"code": "3100104692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3430.0, "discounted_cash": 5145.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GELFILM", "code_information": [{"code": "3100104693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 583.0, "discounted_cash": 874.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GELPORT HAND ACCESS", "code_information": [{"code": "3100100786", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GELSYN-3 INJECTION 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7328", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.49, "maximum": 0.49, "discounted_cash": 0.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEMINI", "code_information": [{"code": "3100102166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GEMTUZUMAB OZOGAMICIN 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9203", "type": "HCPCS"}], "standard_charges": [{"minimum": 226.28, "maximum": 226.28, "discounted_cash": 363.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 226.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GEN ANES- MYRINGOTOM", "code_information": [{"code": "69421", "type": "CPT"}, {"code": "3480102228", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GEN ANES-CLEAN EXT.", "code_information": [{"code": "69205", "type": "CPT"}, {"code": "3480102225", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GEN SURGERY 1ST 30 M", "code_information": [{"code": "3480103111", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 8892.0, "discounted_cash": 13338.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GEN SURGERY EA ADDL", "code_information": [{"code": "3480103112", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2633.0, "discounted_cash": 3949.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GENE PROFILE PANEL BREAST", "code_information": [{"code": "S3854", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST ALPHA-THALASSEMIA", "code_information": [{"code": "S3845", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST BETA-THALASSEMIA", "code_information": [{"code": "S3846", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST HIPPEL-LINDAU", "code_information": [{"code": "S3842", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST MYO MUSCLR DYST", "code_information": [{"code": "S3853", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST NIEMANN-PICK", "code_information": [{"code": "S3849", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST RETINOBLASTOMA", "code_information": [{"code": "S3841", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENE TEST SICKLE CELL", "code_information": [{"code": "S3850", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENERAL ANESTH EA ADDL 15 MI", "code_information": [{"code": "D9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENERAL HEALTH PANEL", "code_information": [{"code": "80050", "type": "CPT"}, {"code": "3440100793", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 42.72, "maximum": 510.22, "gross_charge": 526.0, "discounted_cash": 789.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENERAL SURGERY 1ST", "code_information": [{"code": "3480103066", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 9270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERAL SURGERY EA A", "code_information": [{"code": "3480103071", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 1545.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR INFINITY 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17325.0, "maximum": 24007.5, "gross_charge": 24750.0, "discounted_cash": 37125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21037.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17325.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24007.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17325.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21037.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR INFINITY 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17325.0, "maximum": 24007.5, "gross_charge": 24750.0, "discounted_cash": 37125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21037.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17325.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24007.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17325.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21037.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR INFINITY 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 24885.0, "maximum": 34483.5, "gross_charge": 35550.0, "discounted_cash": 53325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30217.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26662.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24885.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34483.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24885.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26662.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30217.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR INFINITY 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 24885.0, "maximum": 34483.5, "gross_charge": 35550.0, "discounted_cash": 53325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30217.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26662.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24885.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34483.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24885.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26662.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30217.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR KIT ALPHA*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28000.0, "maximum": 38800.0, "gross_charge": 40000.0, "discounted_cash": 60000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34000.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28000.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38800.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28000.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34000.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR PLUS SCS", "code_information": [{"code": "3100102389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 35200.0, "discounted_cash": 52800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GENERATOR PULSE *324", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25900.0, "maximum": 35890.0, "gross_charge": 37000.0, "discounted_cash": 55500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31450.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25900.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35890.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25900.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31450.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENERATOR PULSE KIT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25900.0, "maximum": 35890.0, "gross_charge": 37000.0, "discounted_cash": 55500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31450.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25900.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35890.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25900.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31450.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENESIS AMNIO MEMBRANE 1SQCM", "code_information": [{"code": "Q4198", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENESIS MALLEABL", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8372.0, "maximum": 11601.2, "gross_charge": 11960.0, "discounted_cash": 17940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11601.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GENET VIRUS ISOLATE HSV", "code_information": [{"code": "87255", "type": "CPT"}], "standard_charges": [{"minimum": 33.86, "maximum": 41.83, "discounted_cash": 54.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENETIC TEST BRUGADA", "code_information": [{"code": "S3861", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENETIC TEST SPEC ANALYSIS", "code_information": [{"code": "D0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENETIC TESTING ALS", "code_information": [{"code": "S3800", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENETIC TSTG SEVERE INH COND", "code_information": [{"code": "81443", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2448.56, "discounted_cash": 3933.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENOME RAPID SEQUENCE ALYS", "code_information": [{"code": "94U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 12180.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENOME RE-EVALUATION", "code_information": [{"code": "81427", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2337.65, "discounted_cash": 3755.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2337.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81425", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 5031.2, "discounted_cash": 8082.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5031.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENOME SEQUENCE ANALYSIS", "code_information": [{"code": "81426", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2709.95, "discounted_cash": 4353.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2709.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN", "code_information": [{"code": "80170", "type": "CPT"}, {"code": "3440100814", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.38, "maximum": 138.71, "gross_charge": 143.0, "discounted_cash": 26.31, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 138.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 107.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 121.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 114.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GENTAMICIN SULFATE", "code_information": [{"code": "3400300263", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.7, "discounted_cash": 17.55, "setting": "both", "billing_class": "facility"}]}, {"description": "GENTAMICIN SULFATE", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300213", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 6.4, "discounted_cash": 9.6, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "GENVISC 850, INJ, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7320", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.16, "maximum": 5.16, "discounted_cash": 9.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GFRG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15774", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GFT FREE W/DIR CLOS", "code_information": [{"code": "15220", "type": "CPT"}, {"code": "3340102329", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4655.03, "gross_charge": 4799.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4079.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3599.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3359.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4655.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3359.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3599.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4079.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3839.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI BARRETT ESOPH 9 PRTN BMRK", "code_information": [{"code": "108U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 7952.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI BARRETTS ESOPH VIM&CCNA1", "code_information": [{"code": "114U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3113.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI ENDOSCOPIC ULTRASOUND", "code_information": [{"code": "76975", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI IBS IA ANTI-CDTB&VINCULIN", "code_information": [{"code": "164U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 179.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI PROC KIT", "code_information": [{"code": "3100104657", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GI PROC KIT*4003782", "code_information": [{"code": "3100206431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GI PROC KIT*CEK-865", "code_information": [{"code": "3100205455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.2, "discounted_cash": 79.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GI PROC KIT*CEK-866-", "code_information": [{"code": "3100208947", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.2, "discounted_cash": 84.3, "setting": "both", "billing_class": "facility"}]}, {"description": "GI PROTEIN LOSS EXAM", "code_information": [{"code": "78282", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL COLON I&R", "code_information": [{"code": "91113", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI TRC IMG INTRAL ESOPHAGUS", "code_information": [{"code": "91111", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GI WIRELESS CAPSULE MEASURE", "code_information": [{"code": "91112", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GIARDIA AG IF", "code_information": [{"code": "87269", "type": "CPT"}], "standard_charges": [{"minimum": 13.61, "maximum": 24.03, "discounted_cash": 21.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GIARDIA LAMBLIA ANTIBODY", "code_information": [{"code": "86674", "type": "CPT"}], "standard_charges": [{"minimum": 14.72, "maximum": 30.26, "discounted_cash": 23.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GILTER GRAFT FOR RIA", "code_information": [{"code": "3100100787", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1061.0, "discounted_cash": 1591.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GINGIVAL IRRIGATION PER QUAD", "code_information": [{"code": "D4921", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE FULL SEQUENCE", "code_information": [{"code": "81252", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 101.12, "discounted_cash": 162.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 101.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GJB2 GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81253", "type": "CPT"}], "standard_charges": [{"minimum": 61.52, "maximum": 79.66, "discounted_cash": 98.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 61.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GJB6 GENE COM VARIANTS", "code_information": [{"code": "81254", "type": "CPT"}], "standard_charges": [{"minimum": 35.0, "maximum": 79.66, "discounted_cash": 56.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLASSIA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.4, "maximum": 5.4, "discounted_cash": 8.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66150", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66155", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66160", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5841.07, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLAUCOMA SURGERY", "code_information": [{"code": "66170", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLENO REV", "code_information": [{"code": "3100104300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENO REV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENO REV UNIV 39 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENO REV UNVI 42*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 22 X 6*0S0CI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 3 PEG SZ1*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 3 PEG SZ2*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 3 PEG SZ2*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 3 PEG SZ3*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 40MM*1100307", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 40MM*1100307", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID 40MM*1100307", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID BASEPLATE 28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1904.21, "maximum": 2638.7, "gross_charge": 2720.31, "discounted_cash": 4080.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2312.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2040.23, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1904.21, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2638.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1904.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2040.23, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2312.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2176.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID BASEPLATE*DW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5982.34, "maximum": 8289.81, "gross_charge": 8546.2, "discounted_cash": 12819.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7264.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6409.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5982.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8289.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5982.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6409.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7264.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6836.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID BASEPLATE*DW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID BASEPLATE*DW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209466", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID CALIBRATOR*V", "code_information": [{"code": "3100205484", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID HEAD 36MM*50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1509.2, "maximum": 2091.32, "gross_charge": 2156.0, "discounted_cash": 3234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2091.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID HEAD 36MM*50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1912.96, "maximum": 2650.81, "gross_charge": 2732.8, "discounted_cash": 4099.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2322.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2049.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1912.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2650.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1912.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2049.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2322.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2186.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID HEAD W/RETAI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1509.2, "maximum": 2091.32, "gross_charge": 2156.0, "discounted_cash": 3234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2091.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID LONG POST*DW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID MODEL 3D*VIP", "code_information": [{"code": "3100203849", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID MODEL 3D*VIP", "code_information": [{"code": "3100206341", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID PE LG PEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2293.2, "maximum": 3177.72, "gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2293.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3177.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2293.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID PEG SZ 4*SAG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID PEG SZ 5*SAG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID PEGGED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2620.8, "maximum": 3631.68, "gross_charge": 3744.0, "discounted_cash": 5616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3631.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2995.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID PEGGED 42MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2156.0, "maximum": 2987.6, "gross_charge": 3080.0, "discounted_cash": 4620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2618.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2310.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2156.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2987.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2156.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2310.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2618.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2464.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID PEGGED 46MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID PIN 2.8*AR-5", "code_information": [{"code": "3100206098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID PIN 3.5 X230", "code_information": [{"code": "3100208034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID POST MODULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1026.9, "maximum": 1422.99, "gross_charge": 1467.0, "discounted_cash": 2200.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1246.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1100.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1026.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1422.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1026.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1100.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1246.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1173.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID POST POLY*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID POST*SAGP000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1079.4, "maximum": 1495.74, "gross_charge": 1542.0, "discounted_cash": 2313.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1310.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1156.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1079.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1495.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1079.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1156.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1310.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1233.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID REAMER*AR541", "code_information": [{"code": "3100208813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID REAMER*AR541", "code_information": [{"code": "3100208827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLENOID REV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4395.3, "maximum": 6090.63, "gross_charge": 6279.0, "discounted_cash": 9418.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5337.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4709.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4395.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6090.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4395.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4709.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5337.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5023.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID UNIVERS LG*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID UNIVERS MED*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID UNIVERS SM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID UNIVERS XLG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID W KEEL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2620.8, "maximum": 3631.68, "gross_charge": 3744.0, "discounted_cash": 5616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3631.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2995.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID W KEEL ART S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2620.8, "maximum": 3631.68, "gross_charge": 3744.0, "discounted_cash": 5616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3631.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2995.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOID XS 21.5*5100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHER 33/24 AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2804.62, "maximum": 3886.4, "gross_charge": 4006.6, "discounted_cash": 6009.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3886.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3205.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 32MM*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 32MM*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 33*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 33*AR956", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 33/24*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 36*5573-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1731.32, "maximum": 2399.12, "gross_charge": 2473.32, "discounted_cash": 3709.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2102.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1854.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1731.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2399.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1731.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1854.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2102.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1978.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 36*AR956", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207159", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2804.62, "maximum": 3886.4, "gross_charge": 4006.6, "discounted_cash": 6009.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3886.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3205.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 36/24*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2804.62, "maximum": 3886.4, "gross_charge": 4006.6, "discounted_cash": 6009.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3886.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3205.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 36MM*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 36MM*TI-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 36MM*TI-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2529.8, "maximum": 3505.58, "gross_charge": 3614.0, "discounted_cash": 5421.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3071.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2710.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2529.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3505.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2529.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2710.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3071.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2891.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 39/24*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2804.62, "maximum": 3886.4, "gross_charge": 4006.6, "discounted_cash": 6009.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3886.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3205.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 39/28*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 39/4*AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2804.62, "maximum": 3886.4, "gross_charge": 4006.6, "discounted_cash": 6009.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3886.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3205.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 42*AR956", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2804.62, "maximum": 3886.4, "gross_charge": 4006.6, "discounted_cash": 6009.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3886.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2804.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3004.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3405.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3205.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 42/24*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3265.08, "maximum": 4524.46, "gross_charge": 4664.4, "discounted_cash": 6996.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4524.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3731.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 42/28*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3265.08, "maximum": 4524.46, "gross_charge": 4664.4, "discounted_cash": 6996.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4524.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3731.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE 42MM*130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE LAT 36M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE LAT 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE LAT 39MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE LAT 42MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE RVRS 36M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1820.0, "maximum": 2522.0, "gross_charge": 2600.0, "discounted_cash": 3900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2210.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2522.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2210.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE STAND 42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5991.44, "maximum": 8302.42, "gross_charge": 8559.2, "discounted_cash": 12838.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7275.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6419.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5991.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8302.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5991.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6419.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7275.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6847.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE VERSA-DI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2580.9, "maximum": 3576.39, "gross_charge": 3687.0, "discounted_cash": 5530.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3133.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2765.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2580.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3576.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2580.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2765.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3133.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2949.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE36/28*AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3265.08, "maximum": 4524.46, "gross_charge": 4664.4, "discounted_cash": 6996.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4524.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3731.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLENOSPHERE39/28*AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3265.08, "maximum": 4524.46, "gross_charge": 4664.4, "discounted_cash": 6996.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4524.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3498.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3964.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3731.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLIDE FLOSS", "code_information": [{"code": "3100102167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDE FLOSS REF", "code_information": [{"code": "3100100794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDECATH 4FR*CG415", "code_information": [{"code": "3100210042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.6, "discounted_cash": 306.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDESCOPE BFLEX 3.8", "code_information": [{"code": "3100207063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 778.5, "discounted_cash": 1167.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDESCOPE BFLEX 5.0", "code_information": [{"code": "3100207064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 778.5, "discounted_cash": 1167.75, "setting": "both", "billing_class": "facility"}]}, {"description": "GLIDEWIRE STIFF ANG*", "code_information": [{"code": "3100205172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.08, "discounted_cash": 331.62, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOBAL ESWL KIDNEY", "code_information": [{"code": "S0400", "type": "HCPCS"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLOSSECTOMY PRTL W/U", "code_information": [{"code": "41135", "type": "CPT"}, {"code": "3480101910", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3899.7, "maximum": 6415.12, "gross_charge": 5571.0, "discounted_cash": 8356.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4735.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4178.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3899.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5403.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3899.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4178.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4735.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4456.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLOVE RADIATION", "code_information": [{"code": "3100102168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE RADIATION", "code_information": [{"code": "3100103698", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLOVE RADIATION", "code_information": [{"code": "3100103699", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GLUCAGON HUMAN", "code_information": [{"code": "3400300001", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 333.0, "discounted_cash": 499.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GLUCAGON HYDROCHLORIDE/1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1610", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.52, "maximum": 191.52, "discounted_cash": 302.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 191.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE PANEL", "code_information": [{"code": "80422", "type": "CPT"}], "standard_charges": [{"minimum": 46.07, "maximum": 68.09, "discounted_cash": 74.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE PANEL", "code_information": [{"code": "80424", "type": "CPT"}], "standard_charges": [{"minimum": 50.5, "maximum": 68.09, "discounted_cash": 81.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCAGON TOLERANCE TEST", "code_information": [{"code": "82946", "type": "CPT"}], "standard_charges": [{"minimum": 17.77, "maximum": 40.05, "discounted_cash": 28.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE 6PD QUANT", "code_information": [{"code": "82955", "type": "CPT"}, {"code": "3440100920", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.7, "maximum": 82.45, "gross_charge": 85.0, "discounted_cash": 15.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 72.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 72.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE BLD MNTR DEV", "code_information": [{"code": "82962", "type": "CPT"}, {"code": "3440100921", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.28, "maximum": 20.92, "gross_charge": 16.0, "discounted_cash": 5.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE BLOOD REAGEN", "code_information": [{"code": "82948", "type": "CPT"}, {"code": "3440100917", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.04, "maximum": 29.1, "gross_charge": 30.0, "discounted_cash": 8.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE BODY FLUID N", "code_information": [{"code": "82945", "type": "CPT"}, {"code": "3440100914", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.93, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE POST GLUCOSE", "code_information": [{"code": "82950", "type": "CPT"}, {"code": "3440100918", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.75, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 7.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE QUANT BLOOD", "code_information": [{"code": "82947", "type": "CPT"}, {"code": "3440100916", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.93, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE QUANTITATIVE", "code_information": [{"code": "82947", "type": "CPT"}, {"code": "3440100915", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.93, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUCOSE TOLERANCE 3", "code_information": [{"code": "82951", "type": "CPT"}, {"code": "3440100919", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 20.67, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUTAMYLTRASE GAMMA", "code_information": [{"code": "82977", "type": "CPT"}, {"code": "3440100922", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.2, "maximum": 64.99, "gross_charge": 67.0, "discounted_cash": 11.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 50.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 50.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 53.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLUTEUS MEDIUS IMP*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2311.4, "maximum": 3202.94, "gross_charge": 3302.0, "discounted_cash": 4953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2806.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2311.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3202.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2311.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2806.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2641.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GLYCA NUC MR SPECTRSC QUAN", "code_information": [{"code": "24U", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 53.85, "discounted_cash": 54.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLYCATED PROTEIN", "code_information": [{"code": "82985", "type": "CPT"}, {"code": "3440100923", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.76, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 26.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GLYCOPYRROLATE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7642", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GLYCOPYRROLATE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7643", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOLD SODIUM THIOMALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1600", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GOLIMUMAB FOR IV USE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1602", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.8, "maximum": 11.8, "discounted_cash": 19.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GONADORELIN HYDROCH/ 100 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1620", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GONADOTROPIN FOLLICL", "code_information": [{"code": "83001", "type": "CPT"}, {"code": "3440100924", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.58, "maximum": 161.99, "gross_charge": 167.0, "discounted_cash": 29.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 125.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 125.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 133.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GONADOTROPIN HORMONE PANEL", "code_information": [{"code": "80426", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 148.41, "discounted_cash": 238.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 148.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GONIOSCOPY", "code_information": [{"code": "92020", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GORE VIABAHN 6MM*VBH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6333.6, "maximum": 8776.56, "gross_charge": 9048.0, "discounted_cash": 13572.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7690.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6786.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6333.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8776.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6333.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6786.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7690.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7238.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GOSERELIN ACETATE IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9202", "type": "HCPCS"}], "standard_charges": [{"minimum": 599.34, "maximum": 599.34, "discounted_cash": 978.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 599.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GOUGE HOLLOW 4 BROKN", "code_information": [{"code": "3100100795", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1294.0, "discounted_cash": 1941.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN", "code_information": [{"code": "3100102169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN", "code_information": [{"code": "3100103700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN", "code_information": [{"code": "3100103701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GOWN REINFORCED XXXL", "code_information": [{"code": "3100207401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.32, "discounted_cash": 31.98, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFIX CORE, GRAFIXPL CORE", "code_information": [{"code": "Q4132", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.44, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 110.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFIX MEMBRANE 2X3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIX MEMBRANE 3X4*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2284.1, "maximum": 3165.11, "gross_charge": 3263.0, "discounted_cash": 4894.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2773.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2447.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2284.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3165.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2284.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2447.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2773.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2610.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIX PL 5X5CM*PS13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4440.8, "maximum": 6153.68, "gross_charge": 6344.0, "discounted_cash": 9516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5392.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4440.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6153.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4440.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5392.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5075.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFIX PLUS, PER SQ CM", "code_information": [{"code": "Q4304", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "GRAFIX STRAVIX PRIME PL SQCM", "code_information": [{"code": "Q4133", "type": "HCPCS"}], "standard_charges": [{"minimum": 143.23, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 143.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT BOLT8.5X30*232", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT BONE PRO-STIM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5500.87, "gross_charge": 5671.0, "discounted_cash": 8506.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4820.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4253.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3969.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5500.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3969.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4253.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4820.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4536.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT COLLAGEN*AG630", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3965.78, "maximum": 5495.43, "gross_charge": 5665.4, "discounted_cash": 8498.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4815.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4249.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3965.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5495.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3965.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4249.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4815.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4532.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT FQL*FQL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5187.0, "maximum": 7187.7, "gross_charge": 7410.0, "discounted_cash": 11115.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6298.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5557.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5187.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7187.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5187.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5557.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6298.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5928.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT HAND OR FINGER TENDON", "code_information": [{"code": "26416", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT MAGNIFUS 2.5X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT MAGNIFUSE II", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 7341.93, "gross_charge": 7569.0, "discounted_cash": 11353.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6433.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5676.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5298.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7341.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5298.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5676.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6433.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6055.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT MAGNIFUSE II 2", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 7342.17, "gross_charge": 7569.25, "discounted_cash": 11353.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6433.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5676.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5298.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7342.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5298.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5676.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6433.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6055.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT NERVE AVANCE*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8135.4, "maximum": 11273.34, "gross_charge": 11622.0, "discounted_cash": 17433.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9878.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8716.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8135.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11273.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8135.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8716.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9878.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9297.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT OTLOGIC 2.5 X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT OTOLOGIC 5.0 X", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.5, "maximum": 1725.27, "gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT REPAIR OF SPINE DEFECT", "code_information": [{"code": "63710", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT SCLERAL PATCH", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100100796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 1725.27, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFT SINUS REPAIR 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 459.9, "maximum": 637.29, "gross_charge": 657.0, "discounted_cash": 985.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 558.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 492.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 459.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 637.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 459.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 492.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 558.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 525.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFT SIZING KIT*AR-", "code_information": [{"code": "3100206863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFT SPREADER*AR-19", "code_information": [{"code": "3100206926", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GRAFTBOLT 8.5X25*232", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTBOLT ARTHREX TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET", "code_information": [{"code": "Q4107", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.0, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFTJACKET XPRESS", "code_information": [{"code": "Q4113", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFTLINK TS*FGLTS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3948.6, "maximum": 5471.63, "gross_charge": 5640.86, "discounted_cash": 8461.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4794.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4230.64, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3948.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5471.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3948.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4230.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4794.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4512.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 12CC*T50", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3731.0, "maximum": 5170.1, "gross_charge": 5330.0, "discounted_cash": 7995.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4530.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3997.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3731.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5170.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3731.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3997.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4530.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 1CC*T501", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 1725.27, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 3CC*T502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 3CC*T503", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1526.17, "maximum": 2114.84, "gross_charge": 2180.25, "discounted_cash": 3270.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1853.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1635.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1526.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2114.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1526.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1635.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1853.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1744.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 6CC*T502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2411.5, "maximum": 3341.65, "gross_charge": 3445.0, "discounted_cash": 5167.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3341.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 6CC*T502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2411.5, "maximum": 3341.65, "gross_charge": 3445.0, "discounted_cash": 5167.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3341.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 9CC*T502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3185.0, "maximum": 4413.5, "gross_charge": 4550.0, "discounted_cash": 6825.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4413.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON DBF 9CC*T503", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3032.12, "maximum": 4201.65, "gross_charge": 4331.6, "discounted_cash": 6497.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3681.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3248.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3032.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4201.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3032.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3248.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3681.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3465.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON ORTHOBLEND D", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100100798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2492.0, "discounted_cash": 3738.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRAFTON PLUG 8X10MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON PUTTY 6CC*T5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRAFTON PUTTY DBF 6C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL 1 MG ORAL", "code_information": [{"code": "Q0166", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.04, "maximum": 1.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANISETRON HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1626", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.33, "maximum": 0.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GRANULOCYTES, PHERESIS UNIT", "code_information": [{"code": "P9050", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRASPING FORCEPS*FG-", "code_information": [{"code": "3100208701", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.92, "discounted_cash": 389.88, "setting": "both", "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 25 CC/<", "code_information": [{"code": "15773", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO 50 CC/<", "code_information": [{"code": "15771", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL FAT LIPO EA ADDL", "code_information": [{"code": "15772", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRFG AUTOL SOFT TISS DIR EXC", "code_information": [{"code": "15769", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRIESHABER FORCEPS 2", "code_information": [{"code": "3100203996", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.04, "discounted_cash": 831.06, "setting": "both", "billing_class": "facility"}]}, {"description": "GRIPPER NEEDLE*21-27", "code_information": [{"code": "3100203118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.84, "discounted_cash": 29.76, "setting": "both", "billing_class": "facility"}]}, {"description": "GRIPPER NEEDLE*21-27", "code_information": [{"code": "3100203119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.84, "discounted_cash": 29.76, "setting": "both", "billing_class": "facility"}]}, {"description": "GROSS EXAM, PREP & REPORT", "code_information": [{"code": "D0472", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROSS PULPAL DEBRIDEMENT", "code_information": [{"code": "D3221", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROUP BEHAVE COUNS 2-10", "code_information": [{"code": "G0473", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.55, "maximum": 84.55, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROUP HEALTH EDUCATION", "code_information": [{"code": "99078", "type": "CPT"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROUP MNT 2 OR MORE 30 MINS", "code_information": [{"code": "G0271", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROUP PSYCHOTHERAPY", "code_information": [{"code": "90853", "type": "CPT"}], "standard_charges": [{"minimum": 84.55, "maximum": 84.55, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROUP THERAPEUTIC PROCEDURES", "code_information": [{"code": "97150", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE ANTIBODY", "code_information": [{"code": "86277", "type": "CPT"}], "standard_charges": [{"minimum": 15.74, "maximum": 30.26, "discounted_cash": 25.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE HGH", "code_information": [{"code": "83003", "type": "CPT"}, {"code": "3440100926", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.67, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 26.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80428", "type": "CPT"}], "standard_charges": [{"minimum": 66.7, "maximum": 68.09, "discounted_cash": 107.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROWTH HORMONE PANEL", "code_information": [{"code": "80430", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 129.33, "discounted_cash": 207.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 129.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GROWTH STIMULATION GENE 2", "code_information": [{"code": "83006", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 75.6, "discounted_cash": 121.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY PHY/QHP", "code_information": [{"code": "97158", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRP ADAPT BHV TX BY TECH", "code_information": [{"code": "97154", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GRP PSYCH PHP/IOP 45-50", "code_information": [{"code": "G0410", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.55, "maximum": 84.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GSTR EMPTG 7 TIMED BRTH SPEC", "code_information": [{"code": "106U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1404.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GSTRIC RSTCV PORT O", "code_information": [{"code": "43886", "type": "CPT"}, {"code": "3340102296", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7674.64, "gross_charge": 7912.0, "discounted_cash": 5491.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3785.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7674.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3770.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4356.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6329.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GTT-ADDED SAMPLES", "code_information": [{"code": "82952", "type": "CPT"}], "standard_charges": [{"minimum": 3.92, "maximum": 20.92, "discounted_cash": 6.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GU SURGERY 1ST 30 MI", "code_information": [{"code": "3480103068", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4120.0, "discounted_cash": 6180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GU SURGERY EA ADDL 1", "code_information": [{"code": "3480103073", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 1545.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDANCE FOR RADJ TX DLVR", "code_information": [{"code": "77387", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUIDE AC", "code_information": [{"code": "3100100799", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE BIOPSY DUAL*UA", "code_information": [{"code": "3100204570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.08, "discounted_cash": 121.62, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE BIOPSY SINGLE*", "code_information": [{"code": "3100204569", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.52, "discounted_cash": 98.28, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE CUP ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1165.5, "maximum": 1615.05, "gross_charge": 1665.0, "discounted_cash": 2497.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1415.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1248.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1165.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1615.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1165.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1248.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1415.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1332.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE DRILL", "code_information": [{"code": "3100104085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE FRONT STRATUS", "code_information": [{"code": "3100100800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1047.0, "discounted_cash": 1570.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE NERV DESTR ELEC STIM", "code_information": [{"code": "95873", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUIDE NERV DESTR NEEDLE EMG", "code_information": [{"code": "95874", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUIDE PIN", "code_information": [{"code": "3100100801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN", "code_information": [{"code": "3100102802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN", "code_information": [{"code": "3100102803", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 204.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 1.5*0109-1", "code_information": [{"code": "3100208247", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 1.5*0120-1", "code_information": [{"code": "3100208248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100104094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2*00-114", "code_information": [{"code": "3100205357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.4, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2*500373", "code_information": [{"code": "3100208043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 3.2MM*804-", "code_information": [{"code": "3100209476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN 350MM*CES-", "code_information": [{"code": "3100205851", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN ARTHREX", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 108.78, "maximum": 150.73, "gross_charge": 155.4, "discounted_cash": 233.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE PIN BIOMET", "code_information": [{"code": "3100104000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 904.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN BREAKAWAY", "code_information": [{"code": "3100100802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN BREAKAWAY", "code_information": [{"code": "3100102804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN NITINOL", "code_information": [{"code": "3100100803", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN NITINOL", "code_information": [{"code": "3100100804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN OST 3.0MM*", "code_information": [{"code": "3100209227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.4, "discounted_cash": 201.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN STRYKER", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100103749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 501.2, "maximum": 694.52, "gross_charge": 716.0, "discounted_cash": 1074.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 608.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 694.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 608.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 572.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE PIN W/SUTURE E", "code_information": [{"code": "3100100805", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE PIN W/SUTURE E", "code_information": [{"code": "3100102805", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE ROD G7*1100188", "code_information": [{"code": "3100208559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE", "code_information": [{"code": "3100100806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 44.1, "maximum": 61.11, "gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 44.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 61.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 44.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 73.5, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE .062 X 6*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.8, "maximum": 100.88, "gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.2 X 70*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 93.85, "maximum": 130.05, "gross_charge": 134.08, "discounted_cash": 201.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 107.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.2 X100*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 61.6, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.25X150M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 69.52, "maximum": 96.34, "gross_charge": 99.32, "discounted_cash": 148.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 84.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 74.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 69.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 96.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 69.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 74.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 84.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 79.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.4 X 150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 219.71, "maximum": 304.46, "gross_charge": 313.88, "discounted_cash": 470.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 266.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 235.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 219.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 304.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 219.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 235.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 266.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 251.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.4*03.33", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 264.06, "maximum": 365.92, "gross_charge": 377.24, "discounted_cash": 565.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 320.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 264.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 365.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 264.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 320.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 301.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.4X150*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 230.18, "maximum": 318.97, "gross_charge": 328.84, "discounted_cash": 493.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 279.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 246.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 230.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 318.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 230.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 246.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 279.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 263.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.6 X 150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 93.85, "maximum": 130.05, "gross_charge": 134.08, "discounted_cash": 201.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 100.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 107.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.6*K100-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 318.5, "maximum": 441.35, "gross_charge": 455.0, "discounted_cash": 682.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 386.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 318.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 441.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 318.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 386.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.6MM*101", "code_information": [{"code": "3100209208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.6MM*292", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 79.26, "maximum": 109.84, "gross_charge": 113.24, "discounted_cash": 169.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 96.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 109.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 79.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 96.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 90.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 1.6X150MM", "code_information": [{"code": "3100206268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 197.64, "discounted_cash": 296.46, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.0X200*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 44.1, "maximum": 61.11, "gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 44.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 61.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 44.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 47.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 53.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.4 X228*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 468.3, "maximum": 648.93, "gross_charge": 669.0, "discounted_cash": 1003.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 501.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 648.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 501.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 535.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.4MM*804", "code_information": [{"code": "3100209477", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.8*02.20", "code_information": [{"code": "3100208236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 409.04, "discounted_cash": 613.56, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE 2.8X300MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 270.9, "maximum": 375.39, "gross_charge": 387.0, "discounted_cash": 580.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 328.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 290.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 270.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 375.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 270.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 290.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 328.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 309.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 3.0 X800*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 373.17, "maximum": 517.1, "gross_charge": 533.1, "discounted_cash": 799.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 453.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 373.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 517.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 373.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 453.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 426.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE 3.2*03.01", "code_information": [{"code": "3100204924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.32, "discounted_cash": 510.48, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE ACUMED", "code_information": [{"code": "3100100807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE ACUMED", "code_information": [{"code": "3100104456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE ACUMED", "code_information": [{"code": "3100104457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE ARTHREX", "code_information": [{"code": "3100103811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE ARTHREX", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE ARTHREX", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE ARTHREX", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 20.58, "maximum": 28.51, "gross_charge": 29.4, "discounted_cash": 44.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 24.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 24.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE ARTHREX", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE BALL TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE BALL TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 499.1, "maximum": 691.61, "gross_charge": 713.0, "discounted_cash": 1069.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 534.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 691.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 534.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 570.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE BALL TIPP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.8, "maximum": 721.68, "gross_charge": 744.0, "discounted_cash": 1116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 632.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 558.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 520.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 721.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 520.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 558.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 632.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 595.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE BLUNT", "code_information": [{"code": "3100100812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE COOK URO", "code_information": [{"code": "3100103882", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE DBL TROCA", "code_information": [{"code": "3100100813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE DEPTH/COU", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE FIXED STR", "code_information": [{"code": "3100204261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.6, "discounted_cash": 90.9, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE FLEXIBLE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 61.6, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE INTR DISC", "code_information": [{"code": "3100202303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE PACK*5101", "code_information": [{"code": "3100209748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE PACK*5101", "code_information": [{"code": "3100209752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE SMOOTH TI", "code_information": [{"code": "3100100816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE SMOOTH TI", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 375.9, "maximum": 520.89, "gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SPADE POI", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 153.3, "maximum": 212.43, "gross_charge": 219.0, "discounted_cash": 328.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 186.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 153.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 212.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 153.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 186.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 175.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "3100102420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 259.0, "discounted_cash": 388.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 93.8, "maximum": 129.98, "gross_charge": 134.0, "discounted_cash": 201.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 100.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 129.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 100.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 107.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 95.9, "maximum": 132.89, "gross_charge": 137.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 106.4, "maximum": 147.44, "gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 147.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.5, "maximum": 198.85, "gross_charge": 205.0, "discounted_cash": 307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 198.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.2, "maximum": 413.22, "gross_charge": 426.0, "discounted_cash": 639.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 319.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 413.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 319.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 340.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 407.4, "maximum": 564.54, "gross_charge": 582.0, "discounted_cash": 873.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 436.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 564.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 436.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE SYNTHES", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100104432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 73.72, "maximum": 102.16, "gross_charge": 105.32, "discounted_cash": 157.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 102.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE THREAD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE THREAD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 123.2, "maximum": 170.72, "gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 170.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE THREAD TR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 260.4, "maximum": 360.84, "gross_charge": 372.0, "discounted_cash": 558.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 297.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE TRAY PEG", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 245.0, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR", "code_information": [{"code": "3100100822", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 64.68, "maximum": 89.62, "gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 89.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR 0.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR*AR", "code_information": [{"code": "3100202249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE TROCAR*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 84.0, "maximum": 116.4, "gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDE WIRE*DWD017", "code_information": [{"code": "3100209901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*G08733", "code_information": [{"code": "3100206578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*IQ35F80B", "code_information": [{"code": "3100206574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.36, "discounted_cash": 53.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*IQA521", "code_information": [{"code": "3100206575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*IQA523", "code_information": [{"code": "3100206580", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.36, "discounted_cash": 128.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*IQA525", "code_information": [{"code": "3100206579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.08, "discounted_cash": 190.62, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*IQA526", "code_information": [{"code": "3100206581", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.08, "discounted_cash": 190.62, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*MSWSTA358", "code_information": [{"code": "3100206572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.64, "discounted_cash": 156.96, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*MSWSTDA35", "code_information": [{"code": "3100206576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.64, "discounted_cash": 156.96, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*MSWSTDS18", "code_information": [{"code": "3100206571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.28, "discounted_cash": 297.42, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*MSWSTFA35", "code_information": [{"code": "3100206573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.92, "discounted_cash": 194.88, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*MSWSTFA35", "code_information": [{"code": "3100206577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.64, "discounted_cash": 156.96, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE WIRE*S-MAK401N", "code_information": [{"code": "3100206582", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.24, "discounted_cash": 162.36, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDE/BONE MODEL*804", "code_information": [{"code": "3100209189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2674.0, "discounted_cash": 4011.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDED TISS REGEN NONRESORB", "code_information": [{"code": "D4267", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUIDED TISS REGEN RESORBLE", "code_information": [{"code": "D4266", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUIDED TISSUE REGENERATION", "code_information": [{"code": "D3432", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE", "code_information": [{"code": "3100104020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE", "code_information": [{"code": "3100104147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 212.8, "maximum": 294.88, "gross_charge": 304.0, "discounted_cash": 456.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 294.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100104225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 510.3, "maximum": 707.13, "gross_charge": 729.0, "discounted_cash": 1093.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 707.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 583.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100104743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.8, "maximum": 100.88, "gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE .034\"*AR-8", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100207447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 42.0, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE .035X150*M", "code_information": [{"code": "3100203256", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.8, "discounted_cash": 352.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .062 X 9.2", "code_information": [{"code": "3100204729", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .062 X9.25", "code_information": [{"code": "3100205334", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .062*AR-18", "code_information": [{"code": "3100206729", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE .078*AR-42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 61.6, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 132.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 0.7MM*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 58.8, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 0.9*101-00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 36.4, "maximum": 50.44, "gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.1 X 150*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 189.67, "maximum": 262.83, "gross_charge": 270.96, "discounted_cash": 406.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.67, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.1*AR1870", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 58.8, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.1MM*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 58.8, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.35MM*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 120.54, "maximum": 167.03, "gross_charge": 172.2, "discounted_cash": 258.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 146.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 120.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 167.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 120.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 137.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.35MM*AR8", "code_information": [{"code": "3100204889", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.4*AR-874", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 137.2, "maximum": 190.12, "gross_charge": 196.0, "discounted_cash": 294.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.4X150MM", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100104241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 260.4, "maximum": 360.84, "gross_charge": 372.0, "discounted_cash": 558.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 297.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6*AR-187", "code_information": [{"code": "3100207117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6*AR-188", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6*AR-874", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 144.06, "maximum": 199.62, "gross_charge": 205.8, "discounted_cash": 308.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 154.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 144.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 144.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 154.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6*AR-874", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 137.2, "maximum": 190.12, "gross_charge": 196.0, "discounted_cash": 294.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 1.6*AR-896", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 64.68, "maximum": 89.62, "gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 89.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 64.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 69.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 78.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 73.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.0 X150*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.0MM*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.4X9.25*A", "code_information": [{"code": "3100205258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.4X9.25*A", "code_information": [{"code": "3100205335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 2.8 X 150*", "code_information": [{"code": "3100204929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE 350MM*8670", "code_information": [{"code": "3100205073", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE BARRX ENDO", "code_information": [{"code": "3100204288", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.9, "discounted_cash": 757.35, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE BIO-COMPRE", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19.6, "maximum": 27.16, "gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 27.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 22.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BLUN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100103971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.8, "maximum": 469.48, "gross_charge": 484.0, "discounted_cash": 726.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 469.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 363.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 411.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 387.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BLUNT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 347.2, "maximum": 481.12, "gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 347.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 481.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 347.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BLUNT*DRUJ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BOSTON", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 124.6, "maximum": 172.66, "gross_charge": 178.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 133.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 124.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 172.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 124.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 133.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BOSTON", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100103702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 80.5, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 172.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BOSTON", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100103703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 117.6, "maximum": 162.96, "gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE BOSTON", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100103704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 164.5, "maximum": 227.95, "gross_charge": 235.0, "discounted_cash": 352.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 199.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 176.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 227.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 176.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 199.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE INTUITION*", "code_information": [{"code": "3100202961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE INTUITION*", "code_information": [{"code": "3100204387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE INTUITION*", "code_information": [{"code": "3100205241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NITINO .03", "code_information": [{"code": "3100204162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.28, "discounted_cash": 24.42, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NITINO .03", "code_information": [{"code": "3100204163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.28, "discounted_cash": 24.42, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NITINO .03", "code_information": [{"code": "3100204164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.36, "discounted_cash": 15.54, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NITINO .03", "code_information": [{"code": "3100204956", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 778.8, "discounted_cash": 1168.2, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE NITINOL*27", "code_information": [{"code": "3100204525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 558.0, "discounted_cash": 837.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE PTFE .035*", "code_information": [{"code": "3100203235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.16, "discounted_cash": 75.24, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE SINUS NAV*", "code_information": [{"code": "3100204240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE SMOOTH TIP", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 485.8, "maximum": 673.18, "gross_charge": 694.0, "discounted_cash": 1041.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 589.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 520.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 485.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 673.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 485.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 520.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 589.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 555.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE ST", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 42.0, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE STAND STRG", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 156.29, "maximum": 216.58, "gross_charge": 223.28, "discounted_cash": 334.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 189.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 156.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 216.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 156.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 167.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 189.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 178.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE STIFF CRVD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 179.9, "maximum": 249.29, "gross_charge": 257.0, "discounted_cash": 385.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 192.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 179.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 249.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 179.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 192.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 218.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 205.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE STIFF*AGWS", "code_information": [{"code": "3100209675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE TEARDROP*4", "code_information": [{"code": "3100203368", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE THRD", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 190.4, "maximum": 263.84, "gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 263.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUIDEWIRE TROC .045*", "code_information": [{"code": "3100205361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.4, "discounted_cash": 138.6, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ZIP ANG*M0", "code_information": [{"code": "3100206423", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.24, "discounted_cash": 288.36, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE ZIP ST*M00", "code_information": [{"code": "3100206422", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.24, "discounted_cash": 288.36, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDEWIRE*M006670308", "code_information": [{"code": "3100206240", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.52, "discounted_cash": 332.28, "setting": "both", "billing_class": "facility"}]}, {"description": "GUIDWIRE THREAD 1.6*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 127.03, "maximum": 176.03, "gross_charge": 181.48, "discounted_cash": 272.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 154.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 136.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 127.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 176.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 127.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 136.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 154.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 145.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GUM GRAFT", "code_information": [{"code": "41870", "type": "CPT"}], "standard_charges": [{"minimum": 361.79, "maximum": 522.5, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GUPPY", "code_information": [{"code": "3100102172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GUPPY*5036-30", "code_information": [{"code": "3100206893", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.64, "discounted_cash": 57.96, "setting": "both", "billing_class": "facility"}]}, {"description": "GWIRE SENSOR ANG*M00", "code_information": [{"code": "3100205716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.52, "discounted_cash": 332.28, "setting": "both", "billing_class": "facility"}]}, {"description": "GWIRE XTR STF ANG*M0", "code_information": [{"code": "3100205715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.04, "discounted_cash": 420.06, "setting": "both", "billing_class": "facility"}]}, {"description": "GWIRE XTR STF STR*M0", "code_information": [{"code": "3100205714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.04, "discounted_cash": 420.06, "setting": "both", "billing_class": "facility"}]}, {"description": "GYN SURGERY 1ST 30 M", "code_information": [{"code": "3480103113", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7906.0, "discounted_cash": 11859.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GYN SURGERY EA ADDL", "code_information": [{"code": "3480103114", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1977.0, "discounted_cash": 2965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "GYPA GNOTYP NTRNS 1 5 EXON 2", "code_information": [{"code": "189U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "GYPB GNOTYP NTRNS 1 5 SEUX 3", "code_information": [{"code": "190U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastric Fundoplication, Major", "code_information": [{"code": "232.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26152.85, "maximum": 26152.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26152.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastric Fundoplication, Minor", "code_information": [{"code": "232.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15618.92, "maximum": 15618.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15618.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastric Fundoplication, Moderate", "code_information": [{"code": "232.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21007.63, "maximum": 21007.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21007.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastric Fundoplication, Severe", "code_information": [{"code": "232.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 61683.72, "maximum": 61683.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61683.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastrointestinal Vascular Insufficiency, Major", "code_information": [{"code": "246.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11668.06, "maximum": 11668.06, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11668.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastrointestinal Vascular Insufficiency, Minor", "code_information": [{"code": "246.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6955.98, "maximum": 6955.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6955.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastrointestinal Vascular Insufficiency, Moderate", "code_information": [{"code": "246.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9006.38, "maximum": 9006.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9006.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gastrointestinal Vascular Insufficiency, Severe", "code_information": [{"code": "246.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21800.88, "maximum": 21800.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21800.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gene Analysis (Thyroid Cancer)", "code_information": [{"code": "81545", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gene Analysis For Germline Disorder", "code_information": [{"code": "12U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Gene Analysis Of Solid Organ Tumor Tissue", "code_information": [{"code": "13U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BLOOD", "code_information": [{"code": "83009", "type": "CPT"}], "standard_charges": [{"minimum": 67.36, "maximum": 181.56, "discounted_cash": 108.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "H PYLORI (C-13) BREATH", "code_information": [{"code": "83013", "type": "CPT"}], "standard_charges": [{"minimum": 67.36, "maximum": 181.56, "discounted_cash": 108.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 181.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "H PYLORI AG IA", "code_information": [{"code": "87339", "type": "CPT"}], "standard_charges": [{"minimum": 16.0, "maximum": 24.03, "discounted_cash": 25.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "H PYLORI DRUG ADMIN", "code_information": [{"code": "83014", "type": "CPT"}], "standard_charges": [{"minimum": 7.86, "maximum": 20.92, "discounted_cash": 12.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR ANALYSIS", "code_information": [{"code": "P2031", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 7.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL 1-15 PUNCH GRFTS", "code_information": [{"code": "15775", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAIR TRNSPL >15 PUNCH GRAFTS", "code_information": [{"code": "15776", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HALF RING 155MM*7107", "code_information": [{"code": "3100209114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4790.24, "discounted_cash": 7185.36, "setting": "both", "billing_class": "facility"}]}, {"description": "HALLUX RIGIDUS CORRE", "code_information": [{"code": "28289", "type": "CPT"}, {"code": "3480101763", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HALO RING MED*1211-1", "code_information": [{"code": "3100204498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HALO VEST SMALL*1233", "code_information": [{"code": "3100204499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HALOPERIDOL", "code_information": [{"code": "80173", "type": "CPT"}, {"code": "3440100816", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.78, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 25.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL DECANOATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1631", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.75, "maximum": 6.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HALOPERIDOL LACTATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1630", "type": "HCPCS"}, {"code": "3400300208", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.26, "maximum": 16.19, "gross_charge": 16.7, "discounted_cash": 25.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "513", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7090.88, "maximum": 7090.88, "discounted_cash": 18097.76, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7090.88, "methodology": "fee schedule"}], "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": 5317.7, "maximum": 5317.7, "discounted_cash": 11627.9, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5317.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND PROCEDURES FOR INJURIES", "code_information": [{"code": "906", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11094.68, "maximum": 11094.68, "discounted_cash": 21007.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11094.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26500", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON RECONSTRUCTION", "code_information": [{"code": "26502", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAND TENDON/MUSCLE TRANSFER", "code_information": [{"code": "26494", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HANDLE ASSEMBLY", "code_information": [{"code": "3100100831", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 361.0, "discounted_cash": 541.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE INFLATION ALL", "code_information": [{"code": "3100100832", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1334.0, "discounted_cash": 2001.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE INSECTION ZUK", "code_information": [{"code": "3100100833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1890.0, "discounted_cash": 2835.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MICROFILL", "code_information": [{"code": "3100100834", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 226.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE PITUITARY RIN", "code_information": [{"code": "3100100835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2738.0, "discounted_cash": 4107.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE POSITION GLEN", "code_information": [{"code": "3100103937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE RATCHET", "code_information": [{"code": "3100100836", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 1552.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE RATCHET", "code_information": [{"code": "3100102822", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SCREW TENDON", "code_information": [{"code": "3100104619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 448.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SIZER*7205-30", "code_information": [{"code": "3100208036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE TENDON HARVES", "code_information": [{"code": "3100104620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 944.0, "discounted_cash": 1416.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE THUNDE5X45", "code_information": [{"code": "3100204753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE THUNDE5X45", "code_information": [{"code": "3100204754", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1053.0, "discounted_cash": 1579.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE THUNDER", "code_information": [{"code": "3100104335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 1822.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE THUNDERBEA", "code_information": [{"code": "3100102173", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HAPTOGLOBIN QUANTITA", "code_information": [{"code": "83010", "type": "CPT"}, {"code": "3440100927", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.58, "maximum": 109.61, "gross_charge": 113.0, "discounted_cash": 20.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 79.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 109.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 79.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 96.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 90.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARMONIC ACE", "code_information": [{"code": "3100100837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1355.0, "discounted_cash": 2032.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HARMONIC ACE", "code_information": [{"code": "3100102823", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1529.0, "discounted_cash": 2293.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HARMONIC ACE", "code_information": [{"code": "3100102824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1724.0, "discounted_cash": 2586.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HARMONIC SCALPEL", "code_information": [{"code": "3100100838", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HARMONIC SCALPEL CRV", "code_information": [{"code": "3100100839", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1167.0, "discounted_cash": 1750.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HARMONIC SCISSOR LAP", "code_information": [{"code": "3100100840", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1879.0, "discounted_cash": 2818.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1695.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CE", "code_information": [{"code": "38206", "type": "CPT"}, {"code": "3480103301", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4908.2, "gross_charge": 5060.0, "discounted_cash": 2348.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4301.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1618.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3795.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3542.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4908.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1596.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3542.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1612.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3795.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1565.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1863.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4301.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1565.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4048.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1565.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1596.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST EYE TISSUE ALOGRAFT", "code_information": [{"code": "68371", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST FEMOROPOPLITEAL VEIN", "code_information": [{"code": "35572", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST STEM CELL CONCENTRTE", "code_information": [{"code": "38215", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVEST VEIN FOR BYPASS", "code_information": [{"code": "35500", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HARVESTING OF DONOR MULTIVIS", "code_information": [{"code": "S2055", "type": "HCPCS"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAST W/OXYGEN TITRATE", "code_information": [{"code": "94453", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HAST W/REPORT", "code_information": [{"code": "94452", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HB GLYCOSYLATED A1C HOME DEV", "code_information": [{"code": "83037", "type": "CPT"}], "standard_charges": [{"minimum": 9.71, "maximum": 20.92, "discounted_cash": 15.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 FULL GENE SEQUENCE", "code_information": [{"code": "81259", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 600.0, "discounted_cash": 963.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE", "code_information": [{"code": "81257", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 102.26, "discounted_cash": 164.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 102.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE DUP/DEL VRNTS", "code_information": [{"code": "81269", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 202.4, "discounted_cash": 325.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 202.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBA1/HBA2 GENE FAM VRNT", "code_information": [{"code": "81258", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 375.25, "discounted_cash": 602.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBA1C IN OFFICE TESTING", "code_information": [{"code": "D0411", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.92, "maximum": 20.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBB FULL GENE SEQUENCE", "code_information": [{"code": "81364", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 324.58, "discounted_cash": 521.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 324.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBB GENE COM VARIANTS", "code_information": [{"code": "81361", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 174.81, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBB GENE DUP/DEL VARIANTS", "code_information": [{"code": "81363", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 202.4, "discounted_cash": 325.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 202.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBB GENE KNOWN FAM VARIANT", "code_information": [{"code": "81362", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 375.25, "discounted_cash": 602.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 375.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HBOT, FULL BODY CHAMBER, 30M", "code_information": [{"code": "G0277", "type": "HCPCS"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "discounted_cash": 212.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HCG FREE BETACHAIN TEST", "code_information": [{"code": "84704", "type": "CPT"}], "standard_charges": [{"minimum": 15.29, "maximum": 40.05, "discounted_cash": 24.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HCG GONADOTROPIN QUA", "code_information": [{"code": "84702", "type": "CPT"}, {"code": "3440101020", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.05, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 24.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HCG GONADOTROPIN QUA", "code_information": [{"code": "84703", "type": "CPT"}, {"code": "3440101021", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.52, "maximum": 66.93, "gross_charge": 69.0, "discounted_cash": 12.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 51.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 48.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 66.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 48.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 51.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 55.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HCG GONADOTROPIN QUA", "code_information": [{"code": "84703", "type": "CPT"}, {"code": "3440101022", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 7.52, "maximum": 66.93, "gross_charge": 69.0, "discounted_cash": 12.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 51.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 48.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 66.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 48.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 51.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 58.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 55.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HCG URINE VISUAL COL", "code_information": [{"code": "81025", "type": "CPT"}, {"code": "3440100838", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 8.61, "maximum": 54.32, "gross_charge": 56.0, "discounted_cash": 13.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 54.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 47.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HCV GENOTYPE NUCLEIC", "code_information": [{"code": "87902", "type": "CPT"}, {"code": "3440101213", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 2243.61, "gross_charge": 2313.0, "discounted_cash": 413.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1966.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 285.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1734.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1619.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2243.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 281.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1619.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 284.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1734.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 328.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1966.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1850.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 281.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "395T", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 1097.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR ELCTR NTRST/NTRCV BRCHTX", "code_information": [{"code": "400U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "394T", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR ELCTRNC SKN SURF BRCHYTX", "code_information": [{"code": "395U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77770", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 1097.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77771", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 1097.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL NTRSTL/ICAV BRCHTX", "code_information": [{"code": "77772", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 1097.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77767", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HDR RDNCL SKN SURF BRACHYTX", "code_information": [{"code": "77768", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEAD COMPONENT*11-36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1075.2, "maximum": 1489.92, "gross_charge": 1536.0, "discounted_cash": 2304.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1305.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1075.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1489.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1075.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1152.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1305.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM 28*00-8775-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM 28+0MM*0087", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1872.78, "maximum": 2595.13, "gross_charge": 2675.4, "discounted_cash": 4013.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2274.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2006.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1872.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2595.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1872.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2006.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2274.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2140.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM 28MM*008777", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM 32*00-8777-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM 36-3.5MM*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2051.14, "maximum": 2842.29, "gross_charge": 2930.2, "discounted_cash": 4395.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2490.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2197.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2051.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2842.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2051.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2197.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2490.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2344.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM CER 32*0087", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5454.54, "maximum": 7558.43, "gross_charge": 7792.2, "discounted_cash": 11688.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6623.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5844.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5454.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7558.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5454.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5844.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6623.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6233.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM CER 36*0087", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6224.4, "maximum": 8625.24, "gross_charge": 8892.0, "discounted_cash": 13338.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7558.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6669.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6224.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8625.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6224.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6669.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7558.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7113.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM CER 40*0087", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6224.4, "maximum": 8625.24, "gross_charge": 8892.0, "discounted_cash": 13338.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7558.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6669.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6224.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8625.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6224.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6669.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7558.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7113.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM CER28/3.5*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5454.54, "maximum": 7558.43, "gross_charge": 7792.2, "discounted_cash": 11688.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6623.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5844.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5454.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7558.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5454.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5844.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6623.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6233.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEM CER36/3.5*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 32MM*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1427.58, "maximum": 1978.21, "gross_charge": 2039.4, "discounted_cash": 3059.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1733.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1529.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1427.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1427.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1529.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1733.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1631.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3266.9, "maximum": 4526.99, "gross_charge": 4667.0, "discounted_cash": 7000.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3966.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3500.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3266.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4526.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3266.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3500.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3966.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3733.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ALUMINA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2336.6, "maximum": 3237.86, "gross_charge": 3338.0, "discounted_cash": 5007.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2837.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2503.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2336.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3237.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2336.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2503.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2837.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL C-TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3250.8, "maximum": 4504.68, "gross_charge": 4644.0, "discounted_cash": 6966.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3947.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3483.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3250.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4504.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3250.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3483.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3947.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3715.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL C-TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL C-TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL V40 STR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL V40 STR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.0, "maximum": 3492.0, "gross_charge": 3600.0, "discounted_cash": 5400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6439.3, "maximum": 8923.03, "gross_charge": 9199.0, "discounted_cash": 13798.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7819.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6899.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6439.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8923.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6439.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6899.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7819.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7359.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD HIP W/INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 40/17*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD HUMERAL 50X27X5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD HUMERAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3203.2, "maximum": 4438.72, "gross_charge": 4576.0, "discounted_cash": 6864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4438.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3660.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD HUMERAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3203.2, "maximum": 4438.72, "gross_charge": 4576.0, "discounted_cash": 6864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4438.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3660.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD LFIT 28MM*06-28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1151.5, "maximum": 1595.65, "gross_charge": 1645.0, "discounted_cash": 2467.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1398.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1151.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1595.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1151.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1398.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1316.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD MORSE W LFIT*01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1498.42, "maximum": 2076.38, "gross_charge": 2140.6, "discounted_cash": 3210.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1819.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1605.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1498.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2076.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1498.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1605.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1819.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1712.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAD PIN 2.5 X 60*KI", "code_information": [{"code": "3100204327", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEADACHES WITH MCC", "code_information": [{"code": "102", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7297.46, "maximum": 7297.46, "discounted_cash": 13471.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7297.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEADACHES WITHOUT MCC", "code_information": [{"code": "103", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3873.45, "maximum": 3873.45, "discounted_cash": 9405.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID CHECK BOTH EARS", "code_information": [{"code": "92593", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID CHECK ONE EAR", "code_information": [{"code": "92592", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID DISPENSING FEE", "code_information": [{"code": "V5090", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID DISPENSING FEE", "code_information": [{"code": "V5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM BOTH EARS", "code_information": [{"code": "92591", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM ONE EAR", "code_information": [{"code": "92590", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID FITTING/CHECKING", "code_information": [{"code": "V5011", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING AID REPAIR/MODIFYING", "code_information": [{"code": "V5014", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS DUP/DEL ANALYS", "code_information": [{"code": "81431", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 679.57, "discounted_cash": 1091.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 679.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS SEQUENCE ANALYS", "code_information": [{"code": "81430", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1625.0, "discounted_cash": 2610.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1625.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEARING SCREENING", "code_information": [{"code": "V5008", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [{"code": "292", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5623.89, "maximum": 5623.89, "discounted_cash": 9562.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5623.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [{"code": "291", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7250.12, "maximum": 7250.12, "discounted_cash": 14334.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7250.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FAILURE AND SHOCK WITHOUT CC/MCC", "code_information": [{"code": "293", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3953.38, "maximum": 3953.38, "discounted_cash": 6268.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3953.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS MULTIPLE", "code_information": [{"code": "78483", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93571", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93572", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART REVASCULARIZE (TMR)", "code_information": [{"code": "33140", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART RHYTHM PACING", "code_information": [{"code": "93618", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 1821.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR", "code_information": [{"code": "331T", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART SYMP IMAGE PLNR SPECT", "code_information": [{"code": "332T", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [{"code": "1", "type": "MS-DRG"}], "standard_charges": [{"minimum": 180413.81, "maximum": 180413.81, "discounted_cash": 302544.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 180413.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [{"code": "2", "type": "MS-DRG"}], "standard_charges": [{"minimum": 89682.76, "maximum": 89682.76, "discounted_cash": 136700.04, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 89682.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEAT QUANT SENSORY TEST", "code_information": [{"code": "109T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUAL ANY ANAL", "code_information": [{"code": "83015", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 20.94, "discounted_cash": 33.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEAVY METAL QUANT EACH NES", "code_information": [{"code": "83018", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 21.96, "discounted_cash": 35.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES DIRECT", "code_information": [{"code": "85441", "type": "CPT"}], "standard_charges": [{"minimum": 4.2, "maximum": 20.92, "discounted_cash": 6.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEINZ BODIES INDUCED", "code_information": [{"code": "85445", "type": "CPT"}], "standard_charges": [{"minimum": 6.82, "maximum": 20.92, "discounted_cash": 10.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HELICOBACTER PYLORI", "code_information": [{"code": "86677", "type": "CPT"}, {"code": "3440101105", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.85, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 27.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HELICOLL, PER SQUARE CM", "code_information": [{"code": "Q4164", "type": "HCPCS"}], "standard_charges": [{"minimum": 1571.96, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1571.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM AHUS GEN SEQ ALYS 15 GEN", "code_information": [{"code": "268U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM AUT DM CGEN TRMBCTPNA 22", "code_information": [{"code": "269U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM CGEN COAGJ DO 20 GENES", "code_information": [{"code": "270U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM CGEN NEUTROPENIA 24 GEN", "code_information": [{"code": "271U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM GEN HYPRFIBRNLYSIS 8 GEN", "code_information": [{"code": "273U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT DO 62 GENES", "code_information": [{"code": "274U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM GEN PLTLT FUNCJ DO 40", "code_information": [{"code": "277U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM GEN THROMBOSIS 14 GENES", "code_information": [{"code": "278U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM GENETIC BLD DO 60 GENES", "code_information": [{"code": "272U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 977.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM HEPRN NDUC TRMBCTPNA SRM", "code_information": [{"code": "275U", "type": "CPT"}], "standard_charges": [{"minimum": 20.47, "maximum": 20.47, "discounted_cash": 29.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM INH THROMBOCYTOPENIA 42", "code_information": [{"code": "276U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 3933.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD HYPOXIC", "code_information": [{"code": "303U", "type": "CPT"}], "standard_charges": [{"minimum": 20.92, "maximum": 20.92, "discounted_cash": 3536.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM RBC ADS WHL BLD NORMOXIC", "code_information": [{"code": "304U", "type": "CPT"}], "standard_charges": [{"minimum": 20.92, "maximum": 20.92, "discounted_cash": 3334.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM RBC FNCLTY&DFRM SHR STRS", "code_information": [{"code": "305U", "type": "CPT"}], "standard_charges": [{"minimum": 20.92, "maximum": 20.92, "discounted_cash": 1064.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN III BNDG", "code_information": [{"code": "279U", "type": "CPT"}], "standard_charges": [{"minimum": 20.47, "maximum": 20.47, "discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM VW FACTOR&CLGN IV BNDG", "code_information": [{"code": "280U", "type": "CPT"}], "standard_charges": [{"minimum": 20.47, "maximum": 20.47, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEM VWD PROPEPTIDE AG LVL", "code_information": [{"code": "281U", "type": "CPT"}], "standard_charges": [{"minimum": 20.47, "maximum": 20.47, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMAGGLUTINATION INHIBITION", "code_information": [{"code": "86280", "type": "CPT"}], "standard_charges": [{"minimum": 8.19, "maximum": 30.26, "discounted_cash": 13.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMATOPOIETIC NUCLEAR TX", "code_information": [{"code": "79403", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMICRT INTRCLRY ALGRFT PRTL", "code_information": [{"code": "20933", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1640", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.35, "maximum": 31.35, "discounted_cash": 50.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEMOCLIP TITANIUM", "code_information": [{"code": "3100100848", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMOCLIP TITANIUM", "code_information": [{"code": "3100102827", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ACCESS STUDY", "code_information": [{"code": "90940", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS CATH*59", "code_information": [{"code": "3100205591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMODIALYSIS CATH*59", "code_information": [{"code": "3100205719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEMODIALYSIS ONE EVALUATION", "code_information": [{"code": "90935", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "discounted_cash": 1069.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMODIALYSIS REPEATED EVAL", "code_information": [{"code": "90937", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN", "code_information": [{"code": "85018", "type": "CPT"}, {"code": "3440103029", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 2.37, "maximum": 23.28, "gross_charge": 24.0, "discounted_cash": 3.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN COPPER SULFATE", "code_information": [{"code": "83026", "type": "CPT"}], "standard_charges": [{"minimum": 4.01, "maximum": 20.92, "discounted_cash": 6.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN F FETAL CHEMICAL", "code_information": [{"code": "83030", "type": "CPT"}], "standard_charges": [{"minimum": 10.74, "maximum": 20.92, "discounted_cash": 17.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85460", "type": "CPT"}], "standard_charges": [{"minimum": 7.73, "maximum": 20.92, "discounted_cash": 12.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FETAL", "code_information": [{"code": "85461", "type": "CPT"}], "standard_charges": [{"minimum": 9.36, "maximum": 20.92, "discounted_cash": 15.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FRCT/QNT", "code_information": [{"code": "83020", "type": "CPT"}, {"code": "3440100928", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.87, "maximum": 40.05, "gross_charge": 37.0, "discounted_cash": 20.67, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FRCT/QNT", "code_information": [{"code": "83021", "type": "CPT"}, {"code": "3440100929", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.06, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 29.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN FTL F ASSAY QUAL", "code_information": [{"code": "83033", "type": "CPT"}], "standard_charges": [{"minimum": 8.0, "maximum": 20.92, "discounted_cash": 12.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN GLYCOSYLA", "code_information": [{"code": "83036", "type": "CPT"}, {"code": "3440100930", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.71, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 15.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN PLASMA", "code_information": [{"code": "83051", "type": "CPT"}], "standard_charges": [{"minimum": 7.31, "maximum": 20.92, "discounted_cash": 11.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN THERMOLABILE", "code_information": [{"code": "83065", "type": "CPT"}], "standard_charges": [{"minimum": 9.0, "maximum": 20.92, "discounted_cash": 14.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN UNSTABLE", "code_information": [{"code": "83068", "type": "CPT"}, {"code": "3440100931", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 9.47, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 15.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN URINE", "code_information": [{"code": "83069", "type": "CPT"}], "standard_charges": [{"minimum": 3.95, "maximum": 20.92, "discounted_cash": 6.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN,GLYCOSYLA", "code_information": [{"code": "83036", "type": "CPT"}, {"code": "3440103065", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.71, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 15.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOGLOBIN-OXYGEN AFFINITY", "code_information": [{"code": "82820", "type": "CPT"}], "standard_charges": [{"minimum": 13.34, "maximum": 20.92, "discounted_cash": 21.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOLYSIN ACID", "code_information": [{"code": "85475", "type": "CPT"}], "standard_charges": [{"minimum": 8.87, "maximum": 20.47, "discounted_cash": 14.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS", "code_information": [{"code": "86941", "type": "CPT"}], "standard_charges": [{"minimum": 12.11, "maximum": 35.6, "discounted_cash": 19.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOLYSINS/AGGLUTININS AUTO", "code_information": [{"code": "86940", "type": "CPT"}], "standard_charges": [{"minimum": 8.77, "maximum": 35.6, "discounted_cash": 14.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOPERFUSION", "code_information": [{"code": "90997", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOPHILIA CLOT FACTOR NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7199", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEMOPHILUS INFLUENZA ANTIBDY", "code_information": [{"code": "86684", "type": "CPT"}], "standard_charges": [{"minimum": 15.84, "maximum": 30.26, "discounted_cash": 25.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY, BY", "code_information": [{"code": "46221", "type": "CPT"}, {"code": "3480101974", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "gross_charge": 1845.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1568.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1383.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1789.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1291.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1383.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1568.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY, EX", "code_information": [{"code": "46250", "type": "CPT"}, {"code": "3480101976", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6210.91, "gross_charge": 6403.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6210.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY, IN", "code_information": [{"code": "46255", "type": "CPT"}, {"code": "3480101977", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7453.48, "gross_charge": 7684.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6531.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5763.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5378.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7453.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5378.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5763.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6531.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6147.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY, IN", "code_information": [{"code": "46260", "type": "CPT"}, {"code": "3480101978", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6210.91, "gross_charge": 6403.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6210.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDECTOMY, IN", "code_information": [{"code": "46262", "type": "CPT"}, {"code": "3480101979", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7453.48, "gross_charge": 7684.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6531.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5763.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5378.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7453.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5378.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5763.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6531.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6147.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMORRHOIDOPEXY", "code_information": [{"code": "46947", "type": "CPT"}, {"code": "3480101987", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8032.57, "gross_charge": 8281.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8032.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5796.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6210.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7038.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6624.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEMOSIDERIN QUALITAT", "code_information": [{"code": "83070", "type": "CPT"}, {"code": "3440100932", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.75, "maximum": 33.95, "gross_charge": 35.0, "discounted_cash": 7.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 33.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEP A/HEP B VACC ADULT IM", "code_information": [{"code": "90636", "type": "CPT"}], "standard_charges": [{"minimum": 109.68, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 109.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEP B SURFACE AG NEUTRLZJ IA", "code_information": [{"code": "87341", "type": "CPT"}], "standard_charges": [{"minimum": 10.33, "maximum": 24.03, "discounted_cash": 16.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEP B VAC 3AG 10MCG 3 DOS IM", "code_information": [{"code": "90759", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 73.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 73.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEP C SCREEN HIGH RISK/OTHER", "code_information": [{"code": "G0472", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 74.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPA VACC PED/ADOL 2 DOSE IM", "code_information": [{"code": "90633", "type": "CPT"}], "standard_charges": [{"minimum": 36.31, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPA VACC PED/ADOL 3 DOSE", "code_information": [{"code": "90634", "type": "CPT"}], "standard_charges": [{"minimum": 48.46, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPA VACCINE ADULT IM", "code_information": [{"code": "90632", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 70.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPAGAM B IM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1571", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.77, "maximum": 60.77, "discounted_cash": 95.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 60.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPAGAM B INTRAVENOUS, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1573", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.85, "maximum": 69.85, "discounted_cash": 95.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 69.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN ASSAY", "code_information": [{"code": "85520", "type": "CPT"}, {"code": "3440101047", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 13.09, "maximum": 113.49, "gross_charge": 117.0, "discounted_cash": 21.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.02, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.02, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPARIN NEUTRALIZATION", "code_information": [{"code": "85525", "type": "CPT"}], "standard_charges": [{"minimum": 11.84, "maximum": 20.47, "discounted_cash": 19.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPARIN SOD PORCINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1644", "type": "HCPCS"}, {"code": "3400300294", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.27, "maximum": 7.46, "gross_charge": 7.7, "discounted_cash": 11.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN SOD PORCINE/", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1644", "type": "HCPCS"}, {"code": "3400300069", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.27, "maximum": 22.69, "gross_charge": 23.4, "discounted_cash": 35.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN SOD PORCINE/", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1644", "type": "HCPCS"}, {"code": "3400300139", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.27, "maximum": 11.73, "gross_charge": 12.1, "discounted_cash": 18.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPARIN-PROTAMINE TOLERANCE", "code_information": [{"code": "85530", "type": "CPT"}], "standard_charges": [{"minimum": 13.09, "maximum": 20.47, "discounted_cash": 21.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATIC FUNCTION PAN", "code_information": [{"code": "80076", "type": "CPT"}, {"code": "3440100800", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 71.78, "gross_charge": 74.0, "discounted_cash": 13.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS A AB TOTAL", "code_information": [{"code": "86708", "type": "CPT"}, {"code": "3440101111", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.39, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 19.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B ANTIBODY", "code_information": [{"code": "86705", "type": "CPT"}, {"code": "3440103030", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.77, "maximum": 102.82, "gross_charge": 106.0, "discounted_cash": 18.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 90.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 90.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B CORE AB", "code_information": [{"code": "86704", "type": "CPT"}, {"code": "3440101108", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.05, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 19.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B QN NAP", "code_information": [{"code": "87517", "type": "CPT"}, {"code": "3440103054", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 41.83, "maximum": 348.23, "gross_charge": 359.0, "discounted_cash": 68.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 348.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 287.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURF ANT", "code_information": [{"code": "86706", "type": "CPT"}, {"code": "3440101109", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 10.74, "maximum": 93.12, "gross_charge": 96.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B SURFACE AG QUAN", "code_information": [{"code": "87467", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B VAC RECO", "code_information": [{"code": "90371", "type": "CPT"}, {"code": "3400300323", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 141.12, "maximum": 380.24, "gross_charge": 392.0, "discounted_cash": 221.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 380.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 141.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS B VAC RECO", "code_information": [{"code": "90746", "type": "CPT"}, {"code": "3400300327", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 55.18, "maximum": 169.75, "gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 169.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS BE AGN IA", "code_information": [{"code": "87350", "type": "CPT"}, {"code": "3440103053", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 94.09, "gross_charge": 97.0, "discounted_cash": 18.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 94.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 82.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS BE ANTIBOD", "code_information": [{"code": "86707", "type": "CPT"}, {"code": "3440101110", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.57, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 18.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C AB", "code_information": [{"code": "86803", "type": "CPT"}, {"code": "3440101132", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.27, "maximum": 123.19, "gross_charge": 127.0, "discounted_cash": 22.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 123.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C AB CONFI", "code_information": [{"code": "86804", "type": "CPT"}, {"code": "3440101133", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.49, "maximum": 134.83, "gross_charge": 139.0, "discounted_cash": 24.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS C RNA DIR PROBE", "code_information": [{"code": "87520", "type": "CPT"}], "standard_charges": [{"minimum": 31.22, "maximum": 41.83, "discounted_cash": 50.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS D QUANTIFICATION", "code_information": [{"code": "87523", "type": "CPT"}], "standard_charges": [{"minimum": 42.84, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS DELTA AGENT AG IA", "code_information": [{"code": "87380", "type": "CPT"}], "standard_charges": [{"minimum": 18.36, "maximum": 24.03, "discounted_cash": 29.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS DELTA AGENT ANTBDY", "code_information": [{"code": "86692", "type": "CPT"}], "standard_charges": [{"minimum": 17.16, "maximum": 30.26, "discounted_cash": 27.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA AMP PROBE", "code_information": [{"code": "87526", "type": "CPT"}], "standard_charges": [{"minimum": 39.26, "maximum": 41.83, "discounted_cash": 63.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA DIR PROBE", "code_information": [{"code": "87525", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 29.8, "discounted_cash": 47.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS G DNA QUANT", "code_information": [{"code": "87527", "type": "CPT"}], "standard_charges": [{"minimum": 41.76, "maximum": 41.83, "discounted_cash": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATITIS HAAB AB IG", "code_information": [{"code": "86709", "type": "CPT"}, {"code": "3440101112", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.26, "maximum": 117.37, "gross_charge": 121.0, "discounted_cash": 18.09, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.06, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBIL SYST IMAGE W/DRUG", "code_information": [{"code": "78227", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [{"code": "421", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11739.64, "maximum": 11739.64, "discounted_cash": 19086.95, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11739.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [{"code": "420", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21611.42, "maximum": 21611.42, "discounted_cash": 35735.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21611.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "422", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6345.09, "maximum": 6345.09, "discounted_cash": 15753.2, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6345.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATOBILIARY SYSTEM IMAGING", "code_information": [{"code": "78226", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPB SCREEN HIGH RISK INDIV", "code_information": [{"code": "G0499", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 45.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 2 DOSE ADOLESC IM", "code_information": [{"code": "90743", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 75.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 75.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 2/4 DOSE ADULT IM", "code_information": [{"code": "90739", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 160.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 160.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 3 DOSE IMMUNSUP IM", "code_information": [{"code": "90740", "type": "CPT"}], "standard_charges": [{"minimum": 158.15, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 158.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 3 DOSE PED/ADOL IM", "code_information": [{"code": "90744", "type": "CPT"}], "standard_charges": [{"minimum": 30.77, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPB VACC 4 DOSE IMMUNSUP IM", "code_information": [{"code": "90747", "type": "CPT"}], "standard_charges": [{"minimum": 140.75, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 140.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEPCIDIN-25 ELISA SERUM/PLSM", "code_information": [{"code": "251U", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO 17 GEN", "code_information": [{"code": "102U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 2094.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO PANEL", "code_information": [{"code": "129U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 2094.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED BRST CA RLTD DO PNL 13", "code_information": [{"code": "131U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1140.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA DO 15 GENES", "code_information": [{"code": "101U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 2801.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA DO MRNA PNL", "code_information": [{"code": "130U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED COLON CA TRGT MRNA PNL", "code_information": [{"code": "162U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 781.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED GYN CA MRNA PNL 12 GEN", "code_information": [{"code": "135U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1125.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED OVA CA PNL 24 GENES", "code_information": [{"code": "103U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 2801.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED OVA CA RLTD DO PNL 17", "code_information": [{"code": "132U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1191.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED PAN CA MRNA PNL 18 GEN", "code_information": [{"code": "134U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1202.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERED PRST8 CA RLTD DO 11", "code_information": [{"code": "133U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1108.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEREDITARY COLON CA DSORDRS", "code_information": [{"code": "81435", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.9, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEREDITARY COLON CA DSORDRS", "code_information": [{"code": "81436", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.9, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEREDITARY RETINAL DISORDERS", "code_information": [{"code": "81434", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 597.91, "discounted_cash": 960.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 597.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEREDTRY NURONDCRN TUM DSRDR", "code_information": [{"code": "81437", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 438.93, "discounted_cash": 705.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 438.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEREDTRY NURONDCRN TUM DSRDR", "code_information": [{"code": "81438", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 438.93, "discounted_cash": 705.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 438.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERNIA MESH/PATCH BA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100100851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERNIA MESH/PATCH BA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100100852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2453.5, "maximum": 3399.85, "gross_charge": 3505.0, "discounted_cash": 5257.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2979.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2628.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2453.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3399.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2453.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2628.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2979.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERNIA MESH/PATCH BA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100100853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1512.0, "maximum": 2095.2, "gross_charge": 2160.0, "discounted_cash": 3240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2095.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1728.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [{"code": "354", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9312.89, "maximum": 9312.89, "discounted_cash": 19178.49, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9312.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [{"code": "353", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12383.99, "maximum": 12383.99, "discounted_cash": 32648.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12383.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC", "code_information": [{"code": "355", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8296.57, "maximum": 8296.57, "discounted_cash": 15212.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8296.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEROIN METABOLITE", "code_information": [{"code": "80356", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 1 AG IF", "code_information": [{"code": "87274", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX 2 AG IF", "code_information": [{"code": "87273", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX NES ANTBDY", "code_information": [{"code": "86694", "type": "CPT"}], "standard_charges": [{"minimum": 14.39, "maximum": 30.26, "discounted_cash": 23.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX TYPE", "code_information": [{"code": "86695", "type": "CPT"}, {"code": "3440103114", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.19, "maximum": 46.56, "gross_charge": 48.0, "discounted_cash": 21.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX TYPE", "code_information": [{"code": "86696", "type": "CPT"}, {"code": "3440103115", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 19.35, "maximum": 69.84, "gross_charge": 72.0, "discounted_cash": 31.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 69.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 61.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 57.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HERPES SIMPLEX VIRUS", "code_information": [{"code": "87530", "type": "CPT"}, {"code": "3440103055", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 41.83, "maximum": 348.23, "gross_charge": 359.0, "discounted_cash": 68.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 348.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 287.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HET BIPOLAR SYSTEM*1", "code_information": [{"code": "3100205812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HETASTARCH/0.9% NACL", "code_information": [{"code": "3400300138", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.3, "discounted_cash": 55.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY ABSRBJ", "code_information": [{"code": "86310", "type": "CPT"}], "standard_charges": [{"minimum": 7.37, "maximum": 30.26, "discounted_cash": 11.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HETEROPHILE ANTIBODY TITER", "code_information": [{"code": "86309", "type": "CPT"}], "standard_charges": [{"minimum": 6.47, "maximum": 30.26, "discounted_cash": 10.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HETEROPHILE MONO AB", "code_information": [{"code": "86308", "type": "CPT"}, {"code": "3440101077", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEX DRIVER 1.5*DVHX-", "code_information": [{"code": "3100207442", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX DRIVER 2.5*DVHX-", "code_information": [{"code": "3100208955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX DRIVER 3.5MM*AR8", "code_information": [{"code": "3100202297", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX DRIVER TIP 1.5MM", "code_information": [{"code": "3100209895", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 643.14, "discounted_cash": 964.71, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX PIN 2.5 X 100*SB", "code_information": [{"code": "3100207930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.0, "discounted_cash": 841.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX PIN 2.5 X 70*SBH", "code_information": [{"code": "3100207929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.0, "discounted_cash": 841.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEX SCREW 1.5X10MM*3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 267.06, "maximum": 370.07, "gross_charge": 381.52, "discounted_cash": 572.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 370.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 305.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEX SCREW 1.5X11MM*3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210240", "type": "CDM"}, {"code": "275", "type": "RC"}], "standard_charges": [{"minimum": 267.06, "maximum": 370.07, "gross_charge": 381.52, "discounted_cash": 572.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 370.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 305.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEX SCREW 2.3X10MM*3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 267.06, "maximum": 370.07, "gross_charge": 381.52, "discounted_cash": 572.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 370.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 305.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEX SCREW 2.3X13MM*3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 267.06, "maximum": 370.07, "gross_charge": 381.52, "discounted_cash": 572.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 370.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 267.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 286.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 324.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 305.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEX WRENCH*SC-4276", "code_information": [{"code": "3100207504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEXA GENE", "code_information": [{"code": "81255", "type": "CPT"}], "standard_charges": [{"minimum": 51.45, "maximum": 79.66, "discounted_cash": 82.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEXAGNAL PHOSPH PLTLT NEUTRL", "code_information": [{"code": "85598", "type": "CPT"}], "standard_charges": [{"minimum": 17.98, "maximum": 20.47, "discounted_cash": 28.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HEXALOBE DRIVER T20-", "code_information": [{"code": "3100206782", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HFE GENE", "code_information": [{"code": "81256", "type": "CPT"}], "standard_charges": [{"minimum": 65.36, "maximum": 79.66, "discounted_cash": 105.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAL", "code_information": [{"code": "83045", "type": "CPT"}], "standard_charges": [{"minimum": 6.49, "maximum": 20.92, "discounted_cash": 10.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HGB METHEMOGLOBIN QUAN", "code_information": [{"code": "83050", "type": "CPT"}], "standard_charges": [{"minimum": 8.2, "maximum": 20.92, "discounted_cash": 13.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HGB QUANT TRANSCUTANEOUS", "code_information": [{"code": "88738", "type": "CPT"}], "standard_charges": [{"minimum": 5.02, "maximum": 20.92, "discounted_cash": 8.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HGB SULFHEMOGLOBIN QUAN", "code_information": [{"code": "83060", "type": "CPT"}], "standard_charges": [{"minimum": 8.8, "maximum": 20.92, "discounted_cash": 14.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HH RESPIRATORY THRPY IN EVAL", "code_information": [{"code": "S5180", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HH RESPIRATORY THRPY NOS/DAY", "code_information": [{"code": "S5181", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHC OCCUP THERAPY EA 15", "code_information": [{"code": "G0160", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHC OT ASSISTANT EA 15", "code_information": [{"code": "G0158", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHC PT ASSISTANT EA 15", "code_information": [{"code": "G0157", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHC PT MAINT EA 15 MIN", "code_information": [{"code": "G0159", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHC RN E&M PLAN SVS, 15 MIN", "code_information": [{"code": "G0162", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHC SLP EA 15 MIN", "code_information": [{"code": "G0161", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHCP-SERV OF OT,EA 15 MIN", "code_information": [{"code": "G0152", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHCP-SERV OF PT,EA 15 MIN", "code_information": [{"code": "G0151", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF CSW,EA 15 MIN", "code_information": [{"code": "G0155", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHCP-SVS OF S/L PATH,EA 15MN", "code_information": [{"code": "G0153", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHF10-P PER SQ CM", "code_information": [{"code": "Q4224", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA AMP PROBE", "code_information": [{"code": "87532", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA DIR PROBE", "code_information": [{"code": "87531", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 58.0, "discounted_cash": 93.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HHV-6 DNA QUANT", "code_information": [{"code": "87533", "type": "CPT"}], "standard_charges": [{"minimum": 41.76, "maximum": 41.83, "discounted_cash": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HI ENRGY ESWT PLANTAR FASCIA", "code_information": [{"code": "28890", "type": "CPT"}], "standard_charges": [{"minimum": 3498.15, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HI INTEN SERV FOR SIP MODEL", "code_information": [{"code": "G2020", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIB PRP-OMP VACC 3 DOSE IM", "code_information": [{"code": "90647", "type": "CPT"}], "standard_charges": [{"minimum": 36.68, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIB PRP-T VACCINE 4 DOSE IM", "code_information": [{"code": "90648", "type": "CPT"}], "standard_charges": [{"minimum": 20.27, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIB-HEPB VACCINE IM", "code_information": [{"code": "90748", "type": "CPT"}], "standard_charges": [{"minimum": 37.26, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIB-MENCY VACC 6WK-18M0 IM", "code_information": [{"code": "90644", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIGH INTEN BEH COUNS STD 30M", "code_information": [{"code": "G0445", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIN LPS UNV TIB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8514.1, "maximum": 11798.11, "gross_charge": 12163.0, "discounted_cash": 18244.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10338.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9122.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8514.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11798.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8514.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9122.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10338.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9730.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE BUMPER*5612-4-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1705.2, "maximum": 2362.92, "gross_charge": 2436.0, "discounted_cash": 3654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2070.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2362.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2070.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1948.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE BUMPER*5612-4-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1705.2, "maximum": 2362.92, "gross_charge": 2436.0, "discounted_cash": 3654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2070.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2362.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2070.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1948.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE FEM COMP*5612-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10680.6, "maximum": 14800.26, "gross_charge": 15258.0, "discounted_cash": 22887.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12969.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11443.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10680.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14800.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10680.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11443.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12969.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE FEM COMP*5612-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10680.6, "maximum": 14800.26, "gross_charge": 15258.0, "discounted_cash": 22887.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12969.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11443.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10680.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14800.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10680.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11443.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12969.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE FEM ROT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8512.14, "maximum": 11795.39, "gross_charge": 12160.2, "discounted_cash": 18240.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10336.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9120.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8512.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11795.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8512.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9120.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10336.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9728.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE FEM ROT LT XSM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8512.14, "maximum": 11795.39, "gross_charge": 12160.2, "discounted_cash": 18240.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10336.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9120.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8512.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11795.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8512.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9120.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10336.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9728.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE FEM ROT RT SM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8512.14, "maximum": 11795.39, "gross_charge": 12160.2, "discounted_cash": 18240.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10336.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9120.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8512.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11795.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8512.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9120.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10336.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9728.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE INSERT*5612-P-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 42733.09, "maximum": 59215.86, "gross_charge": 61047.28, "discounted_cash": 91570.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51890.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45785.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42733.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 59215.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42733.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45785.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51890.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48837.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE INSERT*5612-P-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4272.99, "maximum": 5921.15, "gross_charge": 6104.28, "discounted_cash": 9156.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5188.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4578.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4272.99, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5921.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4272.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4578.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5188.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4883.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGE KNEE-AXLE*6481", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1735.58, "maximum": 2405.01, "gross_charge": 2479.4, "discounted_cash": 3719.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2107.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1859.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1735.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2405.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1735.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1859.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2107.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1983.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HINGED ROD 3.5X3.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1169.7, "maximum": 1620.87, "gross_charge": 1671.0, "discounted_cash": 2506.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1420.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1253.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1169.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1620.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1169.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1253.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1420.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1336.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [{"code": "481", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12558.6, "maximum": 12558.6, "discounted_cash": 23165.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12558.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [{"code": "480", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17156.94, "maximum": 17156.94, "discounted_cash": 32923.19, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17156.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC", "code_information": [{"code": "482", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8849.31, "maximum": 8849.31, "discounted_cash": 17733.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8849.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP ARTHR0 W/SYNOVECTOMY", "code_information": [{"code": "29863", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO ACETABULO", "code_information": [{"code": "29915", "type": "CPT"}, {"code": "3340102461", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7300.29, "maximum": 14459.79, "gross_charge": 14907.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14459.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11925.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO ACETABULO", "code_information": [{"code": "46922", "type": "CPT"}, {"code": "3340102462", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5130.33, "gross_charge": 5289.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4495.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3966.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3702.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5130.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3702.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3966.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4495.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/DEBRIDE", "code_information": [{"code": "29862", "type": "CPT"}, {"code": "3340102441", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7300.29, "maximum": 14459.79, "gross_charge": 14907.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14459.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11925.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHRO W/FB REMOVAL", "code_information": [{"code": "29861", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3461.21, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP ARTHROSCOPY DX", "code_information": [{"code": "29860", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP MIDLINE CATH INSERT KIT", "code_information": [{"code": "S5523", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIP MODULAR 155X14M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5178.17, "maximum": 7175.46, "gross_charge": 7397.39, "discounted_cash": 11096.09, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6287.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5548.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5178.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7175.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5178.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5548.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6287.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5917.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP MODULAR NECK R2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1646.4, "maximum": 2281.44, "gross_charge": 2352.0, "discounted_cash": 3528.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2281.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP MODULAR STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7236.9, "maximum": 10028.27, "gross_charge": 10338.43, "discounted_cash": 15507.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10028.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8270.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP MODULAR STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5527.9, "maximum": 7660.09, "gross_charge": 7897.0, "discounted_cash": 11845.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6712.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5922.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5527.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7660.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5527.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5922.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6712.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP MODULAR STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5184.81, "maximum": 7184.67, "gross_charge": 7406.88, "discounted_cash": 11110.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6295.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5555.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5184.81, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7184.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5184.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5555.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6295.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5925.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP MODULAR STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6178.2, "maximum": 8561.22, "gross_charge": 8826.0, "discounted_cash": 13239.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7502.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6619.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6178.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8561.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6178.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6619.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7502.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7060.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP NEUTRAL PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2842.0, "maximum": 3938.2, "gross_charge": 4060.0, "discounted_cash": 6090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3451.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2842.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3938.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2842.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3451.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP NEUTRAL PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2952.6, "maximum": 4091.46, "gross_charge": 4218.0, "discounted_cash": 6327.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3585.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3163.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2952.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4091.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2952.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3163.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3585.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3374.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP NEUTRAL PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3201.1, "maximum": 4435.81, "gross_charge": 4573.0, "discounted_cash": 6859.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3887.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3429.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3201.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4435.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3201.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3429.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3887.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3658.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP NEUTRAL PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3385.2, "maximum": 4690.92, "gross_charge": 4836.0, "discounted_cash": 7254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4110.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3627.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4690.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3627.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4110.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [{"code": "521", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18132.07, "maximum": 18132.07, "discounted_cash": 33428.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18132.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [{"code": "522", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14180.53, "maximum": 14180.53, "discounted_cash": 23581.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14180.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM 132 *6051-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM 132 *6051-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM 35X137*6057", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM 37X158*6057", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 0*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 0*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 1*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 1*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 10*7000-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 10*7000-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 2*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 2*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 3*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 3*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 4*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 4*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 5*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 5*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 6*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 6*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 7*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 7*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 8*7000-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 8*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP STEM SZ 9*7000-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYS MODLR 155X25", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5184.81, "maximum": 7184.67, "gross_charge": 7406.88, "discounted_cash": 11110.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6295.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5555.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5184.81, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7184.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5184.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5555.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6295.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5925.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5649.0, "maximum": 7827.9, "gross_charge": 8070.0, "discounted_cash": 12105.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6859.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6052.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5649.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7827.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5649.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6052.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6859.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 115X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5251.35, "maximum": 7276.88, "gross_charge": 7501.94, "discounted_cash": 11252.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7276.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6001.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 115X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5251.35, "maximum": 7276.88, "gross_charge": 7501.94, "discounted_cash": 11252.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7276.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6001.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 115X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5251.35, "maximum": 7276.88, "gross_charge": 7501.94, "discounted_cash": 11252.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7276.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6001.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 155X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5178.17, "maximum": 7175.46, "gross_charge": 7397.39, "discounted_cash": 11096.09, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6287.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5548.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5178.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7175.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5178.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5548.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6287.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5917.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 18X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5251.35, "maximum": 7276.88, "gross_charge": 7501.94, "discounted_cash": 11252.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7276.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6001.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 18X19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5491.45, "maximum": 7609.58, "gross_charge": 7844.93, "discounted_cash": 11767.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6668.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5883.69, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5491.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7609.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5491.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5883.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6668.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6275.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 195X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8199.83, "maximum": 11362.62, "gross_charge": 11714.05, "discounted_cash": 17571.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9956.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8785.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8199.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11362.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8199.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8785.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9956.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9371.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 195X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5795.46, "maximum": 8030.85, "gross_charge": 8279.23, "discounted_cash": 12418.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7037.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6209.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5795.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8030.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5795.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6209.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7037.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6623.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 195X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6566.19, "maximum": 9098.87, "gross_charge": 9380.28, "discounted_cash": 14070.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7973.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7035.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6566.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9098.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6566.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7035.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7973.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7504.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 195X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5787.78, "maximum": 8020.21, "gross_charge": 8268.26, "discounted_cash": 12402.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7028.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6201.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5787.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8020.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5787.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6201.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7028.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6614.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 195X2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5795.46, "maximum": 8030.85, "gross_charge": 8279.23, "discounted_cash": 12418.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7037.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6209.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5795.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8030.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5795.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6209.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7037.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6623.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 19X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5251.35, "maximum": 7276.88, "gross_charge": 7501.94, "discounted_cash": 11252.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7276.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5251.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5626.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6376.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6001.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYST MODLR 19X19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5491.45, "maximum": 7609.58, "gross_charge": 7844.93, "discounted_cash": 11767.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6668.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5883.69, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5491.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7609.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5491.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5883.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6668.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6275.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYSTEM MOD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7236.9, "maximum": 10028.27, "gross_charge": 10338.43, "discounted_cash": 15507.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10028.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8270.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYSTEM MOD 27MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7236.9, "maximum": 10028.27, "gross_charge": 10338.43, "discounted_cash": 15507.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10028.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8270.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYSTEM MODLR 19M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7227.22, "maximum": 10014.86, "gross_charge": 10324.6, "discounted_cash": 15486.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8775.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7743.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7227.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10014.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7227.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7743.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8775.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8259.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYSTEM MODLR 25M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7227.22, "maximum": 10014.86, "gross_charge": 10324.6, "discounted_cash": 15486.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8775.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7743.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7227.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10014.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7227.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7743.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8775.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8259.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYSTEM MODLR 29M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7227.22, "maximum": 10014.86, "gross_charge": 10324.6, "discounted_cash": 15486.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8775.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7743.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7227.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10014.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7227.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7743.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8775.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8259.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP SYSTEM MODLR 31M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7236.9, "maximum": 10028.27, "gross_charge": 10338.43, "discounted_cash": 15507.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10028.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7236.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7753.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8787.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8270.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP TOTAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7791.0, "maximum": 10796.1, "gross_charge": 11130.0, "discounted_cash": 16695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9460.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8347.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10796.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8347.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9460.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIP TRACKING KIT*107", "code_information": [{"code": "3100208040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 711.75, "discounted_cash": 1067.63, "setting": "both", "billing_class": "facility"}]}, {"description": "HIPPOTHERAPY PER SESSION", "code_information": [{"code": "S8940", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMA ANTIBODY", "code_information": [{"code": "86698", "type": "CPT"}], "standard_charges": [{"minimum": 13.79, "maximum": 30.26, "discounted_cash": 22.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HISTOPLASMOSIS SKIN TEST", "code_information": [{"code": "86510", "type": "CPT"}], "standard_charges": [{"minimum": 9.45, "maximum": 68.53, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HISTOTRIPSY MAL HEPATCEL TIS", "code_information": [{"code": "686T", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 28114.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HISTRELIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1675", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIT ALPHA-1-PROTEINAS DIEM", "code_information": [{"code": "S9346", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-HEMOPHIL DIEM", "code_information": [{"code": "S9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-SPASMOTIC DIEM", "code_information": [{"code": "S9363", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-TNF PER DIEM", "code_information": [{"code": "S9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q12H DIEM", "code_information": [{"code": "S9501", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q24H DIEM", "code_information": [{"code": "S9500", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q3H DIEM", "code_information": [{"code": "S9497", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q4H DIEM", "code_information": [{"code": "S9504", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q6H DIEM", "code_information": [{"code": "S9503", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q8H DIEM", "code_information": [{"code": "S9502", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC TOTAL DIEM", "code_information": [{"code": "S9494", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT BLOOD PRODUCTS DIEM", "code_information": [{"code": "S9538", "type": "HCPCS"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CATH CARE NOC", "code_information": [{"code": "S5497", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CATH REPAIR KIT", "code_information": [{"code": "S5518", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CHELATION DIEM", "code_information": [{"code": "S9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CHEMO PER DIEM", "code_information": [{"code": "S9329", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT COMPLEX CATH CARE", "code_information": [{"code": "S5501", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTICOAG DIEM", "code_information": [{"code": "S9336", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTIEMETIC DIEM", "code_information": [{"code": "S9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CONT CHEM DIEM", "code_information": [{"code": "S9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CONT INSULIN DIEM", "code_information": [{"code": "S9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CONT PAIN PER DIEM", "code_information": [{"code": "S9326", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT CORTICOSTEROID/DIEM", "code_information": [{"code": "S9490", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT DECLOTTING KIT", "code_information": [{"code": "S5517", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT DEVICE REPAIR", "code_information": [{"code": "S5036", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT DIURETIC INFUS DIEM", "code_information": [{"code": "S9361", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL BOLUS NURS", "code_information": [{"code": "S9343", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL GRAV DIEM", "code_information": [{"code": "S9341", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PER DIEM", "code_information": [{"code": "S9340", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PUMP DIEM", "code_information": [{"code": "S9342", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ENZYME REPLACE DIEM", "code_information": [{"code": "S9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 1 LITER DIEM", "code_information": [{"code": "S9374", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 2 LITER DIEM", "code_information": [{"code": "S9375", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 3 LITER DIEM", "code_information": [{"code": "S9376", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA OVER 3L DIEM", "code_information": [{"code": "S9377", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA TOTAL DIEM", "code_information": [{"code": "S9373", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT IMMUNOTHERAPY DIEM", "code_information": [{"code": "S9338", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT INJ INTERFERON DIEM", "code_information": [{"code": "S9559", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT INT PAIN PER DIEM", "code_information": [{"code": "S9327", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT INTERIM CATH CARE", "code_information": [{"code": "S5502", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT INTERMIT CHEMO DIEM", "code_information": [{"code": "S9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT LONGTERM INFUSION DIEM", "code_information": [{"code": "S9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT MIDLINE CATH INSERT KIT", "code_information": [{"code": "S5521", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT NOC PER DIEM", "code_information": [{"code": "S9379", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT PAIN IMP PUMP DIEM", "code_information": [{"code": "S9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT PAIN MGMT PER DIEM", "code_information": [{"code": "S9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT PERITON DIALYSIS DIEM", "code_information": [{"code": "S9339", "type": "HCPCS"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT KIT", "code_information": [{"code": "S5520", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT NO SUPP", "code_information": [{"code": "S5522", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT ROUTINE DEVICE MAINT", "code_information": [{"code": "S5035", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT SIMPLE CATH CARE", "code_information": [{"code": "S5498", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT SYMPATHOMIM DIEM", "code_information": [{"code": "S9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT TOCOLYSIS DIEM", "code_information": [{"code": "S9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT TPN 1 LITER DIEM", "code_information": [{"code": "S9365", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT TPN 2 LITER DIEM", "code_information": [{"code": "S9366", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT TPN 3 LITER DIEM", "code_information": [{"code": "S9367", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT TPN OVER 3L DIEM", "code_information": [{"code": "S9368", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIT TPN TOTAL DIEM", "code_information": [{"code": "S9364", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV 1 ANTIBODY", "code_information": [{"code": "86701", "type": "CPT"}, {"code": "3440101106", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 8.89, "maximum": 76.63, "gross_charge": 79.0, "discounted_cash": 14.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 67.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 59.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 76.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 59.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.33, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 67.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.52, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV AG W/HIV1&2 ANTB W/OPTIC", "code_information": [{"code": "87806", "type": "CPT"}], "standard_charges": [{"minimum": 32.77, "maximum": 41.83, "discounted_cash": 52.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV ANTIGEN/ANTIBODY", "code_information": [{"code": "G0475", "type": "HCPCS"}, {"code": "3440103072", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 24.08, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 38.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.79, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 30.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 25.79, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV GENOTYPE HIV REV", "code_information": [{"code": "87901", "type": "CPT"}, {"code": "3440101212", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 2366.8, "gross_charge": 2440.0, "discounted_cash": 413.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2074.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 285.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1830.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1708.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2366.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 281.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1708.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 284.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1830.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 328.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2074.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1952.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 275.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 281.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV PREP, FDA APPROVED, NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0799", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, FTC/TAF 200/25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0751", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, FTC/TDF 200/300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0750", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV PREP, INJ, CABOTEGRAVIR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0739", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "969", "type": "MS-DRG"}], "standard_charges": [{"minimum": 35592.13, "maximum": 35592.13, "discounted_cash": 76729.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35592.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [{"code": "970", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18107.48, "maximum": 18107.48, "discounted_cash": 26844.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18107.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [{"code": "975", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5393.32, "maximum": 5393.32, "discounted_cash": 15220.65, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5393.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [{"code": "974", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12390.13, "maximum": 12390.13, "discounted_cash": 32561.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12390.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC", "code_information": [{"code": "976", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5393.32, "maximum": 5393.32, "discounted_cash": 9437.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5393.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [{"code": "977", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6209.82, "maximum": 6209.82, "discounted_cash": 15810.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6209.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIV-1 AG IA", "code_information": [{"code": "87390", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.06, "discounted_cash": 38.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-1 AG W/HIV-1&-2 AB AG IA", "code_information": [{"code": "87389", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.08, "discounted_cash": 38.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-1 ANTIBODY TESTING OF OR", "code_information": [{"code": "S3645", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-1 DNA DIR PROBE", "code_information": [{"code": "87534", "type": "CPT"}], "standard_charges": [{"minimum": 21.92, "maximum": 24.03, "discounted_cash": 35.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-1&HIV-2 SINGL AN", "code_information": [{"code": "86703", "type": "CPT"}, {"code": "3440101107", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.71, "maximum": 85.36, "gross_charge": 88.0, "discounted_cash": 22.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 66.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-2 AG IA", "code_information": [{"code": "87391", "type": "CPT"}], "standard_charges": [{"minimum": 21.9, "maximum": 24.03, "discounted_cash": 35.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-2 ANTIBODY", "code_information": [{"code": "86702", "type": "CPT"}], "standard_charges": [{"minimum": 13.52, "maximum": 30.26, "discounted_cash": 21.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-2 DNA DIR PROBE", "code_information": [{"code": "87537", "type": "CPT"}], "standard_charges": [{"minimum": 21.92, "maximum": 24.03, "discounted_cash": 35.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-2 PROBE&REVRSE TRNSCRIPJ", "code_information": [{"code": "87538", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIV-2 QUANT&REVRSE TRNSCRIPJ", "code_information": [{"code": "87539", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 58.62, "discounted_cash": 94.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HIZENTRA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1559", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.91, "maximum": 12.91, "discounted_cash": 20.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HL NEO GSAP 5-50 RNA ALYS", "code_information": [{"code": "81451", "type": "CPT"}], "standard_charges": [{"minimum": 759.53, "maximum": 759.53, "discounted_cash": 1220.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 759.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HL NEO GSAP 5-50DNA/DNA&RNA", "code_information": [{"code": "81450", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 759.53, "discounted_cash": 1220.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 759.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CL II TYPING, 1", "code_information": [{"code": "81382", "type": "CPT"}, {"code": "3440103081", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 79.66, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 198.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 136.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 135.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 136.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 157.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 123.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 132.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 135.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I HIGH DEFIN QUAL", "code_information": [{"code": "86832", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 323.75, "discounted_cash": 520.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 323.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I PHENOTYPE QUAL", "code_information": [{"code": "86830", "type": "CPT"}], "standard_charges": [{"minimum": 88.56, "maximum": 95.52, "discounted_cash": 153.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 95.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I SEMIQUANT PANEL", "code_information": [{"code": "86834", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 357.56, "discounted_cash": 574.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 357.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I&II ANTIBODY QUAL", "code_information": [{"code": "86828", "type": "CPT"}], "standard_charges": [{"minimum": 64.19, "maximum": 88.56, "discounted_cash": 103.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS I/II ANTIBODY QUAL", "code_information": [{"code": "86829", "type": "CPT"}], "standard_charges": [{"minimum": 64.19, "maximum": 88.56, "discounted_cash": 103.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II HIGH DEFIN QUAL", "code_information": [{"code": "86833", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 325.8, "discounted_cash": 523.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 325.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II PHENOTYPE QUAL", "code_information": [{"code": "86831", "type": "CPT"}], "standard_charges": [{"minimum": 81.88, "maximum": 88.56, "discounted_cash": 131.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 81.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II SEMIQUANT PANEL", "code_information": [{"code": "86835", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 322.96, "discounted_cash": 518.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 322.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA CLASS II TYPING", "code_information": [{"code": "81376", "type": "CPT"}, {"code": "3440103076", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 79.66, "maximum": 847.78, "gross_charge": 874.0, "discounted_cash": 196.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 742.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 135.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 655.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 611.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 847.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 133.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 611.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 655.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 742.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 699.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 133.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPE VERIFY LR", "code_information": [{"code": "81371", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 404.52, "discounted_cash": 649.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 404.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPING HR", "code_information": [{"code": "81378", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 345.57, "discounted_cash": 555.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 345.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I & II TYPING LR", "code_information": [{"code": "81370", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 402.12, "discounted_cash": 646.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 402.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 ALLELE HR", "code_information": [{"code": "81381", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 169.9, "discounted_cash": 272.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 169.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 ANTIGEN LR", "code_information": [{"code": "81374", "type": "CPT"}], "standard_charges": [{"minimum": 74.33, "maximum": 79.66, "discounted_cash": 119.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 74.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 LOCUS HR", "code_information": [{"code": "81380", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 177.25, "discounted_cash": 284.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 177.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING 1 LOCUS LR", "code_information": [{"code": "81373", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 127.43, "discounted_cash": 204.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 127.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING COMPLETE HR", "code_information": [{"code": "81379", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 335.38, "discounted_cash": 538.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 335.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA I TYPING COMPLETE LR", "code_information": [{"code": "81372", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 403.59, "discounted_cash": 648.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 403.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA II TYPE 1 AG EQUIV LR", "code_information": [{"code": "81377", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 94.74, "discounted_cash": 152.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 94.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING 1 ALLELE HR", "code_information": [{"code": "81383", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 109.13, "discounted_cash": 175.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 109.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA II TYPING AG EQUIV LR", "code_information": [{"code": "81375", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 220.74, "discounted_cash": 354.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 220.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA TYPING A B OR C", "code_information": [{"code": "86813", "type": "CPT"}], "standard_charges": [{"minimum": 58.0, "maximum": 88.56, "discounted_cash": 93.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA TYPING A/B/C SIN", "code_information": [{"code": "86812", "type": "CPT"}, {"code": "3440101134", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 25.81, "maximum": 225.04, "gross_charge": 232.0, "discounted_cash": 41.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 197.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 225.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 197.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 185.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA TYPING DR/DQ", "code_information": [{"code": "86816", "type": "CPT"}], "standard_charges": [{"minimum": 30.17, "maximum": 35.6, "discounted_cash": 48.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA TYPING DR/DQ MUL", "code_information": [{"code": "86817", "type": "CPT"}, {"code": "3440101135", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 88.56, "maximum": 561.63, "gross_charge": 579.0, "discounted_cash": 170.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 492.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 117.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 434.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 405.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 561.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 405.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 117.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 434.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 135.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 492.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 463.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 106.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA X-MATCH NONCYTOTOXC ADDL", "code_information": [{"code": "86826", "type": "CPT"}], "standard_charges": [{"minimum": 88.56, "maximum": 88.56, "discounted_cash": 58.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLA X-MATH NON-CYTOTOXIC", "code_information": [{"code": "86825", "type": "CPT"}], "standard_charges": [{"minimum": 88.56, "maximum": 88.56, "discounted_cash": 175.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLTH BHV ASSMT/REASSESSMENT", "code_information": [{"code": "96156", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING GROUP", "code_information": [{"code": "593T", "type": "CPT"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING INDIV 1ST", "code_information": [{"code": "591T", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HLTH&WB COACHING INDIV F-UP", "code_information": [{"code": "592T", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HM GEST DM PER DIEM", "code_information": [{"code": "S9214", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HM PREECLAMP PER DIEM", "code_information": [{"code": "S9213", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HMATRIX", "code_information": [{"code": "Q4134", "type": "HCPCS"}], "standard_charges": [{"minimum": 162.08, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 162.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOCM 150-199MG/ML IODINE,1ML", "code_information": [{"code": "Q9959", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HOCM 200-249MG/ML IODINE,1ML", "code_information": [{"code": "Q9960", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.2, "maximum": 0.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM 250-299MG/ML IODINE,1ML", "code_information": [{"code": "Q9961", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.28, "maximum": 0.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM 300-349MG/ML IODINE,1ML", "code_information": [{"code": "Q9962", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.2, "maximum": 0.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM <=149 MG/ML IODINE, 1ML", "code_information": [{"code": "Q9958", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOCM>= 400MG/ML IODINE, 1ML", "code_information": [{"code": "Q9964", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.34, "maximum": 0.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOLDER LABEL", "code_information": [{"code": "3100104702", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLDER TUBE ENDOTRAC", "code_information": [{"code": "3100206492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.12, "discounted_cash": 52.68, "setting": "both", "billing_class": "facility"}]}, {"description": "HOLDING SLEEVE SYNTH", "code_information": [{"code": "3100100858", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1673.0, "discounted_cash": 2509.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HOME EPISODIC CASE 30 DAYS", "code_information": [{"code": "S0272", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99374", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "99375", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME HEALTH CARE SUPERVISION", "code_information": [{"code": "G0181", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME HOSPICE CASE 30 DAYS", "code_information": [{"code": "S0271", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME MGMT GEST HYPERTENSION", "code_information": [{"code": "S9211", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME MGMT PPROM", "code_information": [{"code": "S9209", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME MGMT PRETERM LABOR", "code_information": [{"code": "S9208", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME NFS VISIT <2 HRS", "code_information": [{"code": "99601", "type": "CPT"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME NFS VISIT EACH ADDL HR", "code_information": [{"code": "99602", "type": "CPT"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME PHOTOTHERAPY VISIT", "code_information": [{"code": "S9098", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 2 PORTA", "code_information": [{"code": "G0398", "type": "HCPCS"}], "standard_charges": [{"minimum": 400.06, "maximum": 400.06, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 400.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 3 PORTA", "code_information": [{"code": "G0399", "type": "HCPCS"}], "standard_charges": [{"minimum": 400.06, "maximum": 400.06, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 400.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME SLEEP TEST/TYPE 4 PORTA", "code_information": [{"code": "G0400", "type": "HCPCS"}], "standard_charges": [{"minimum": 400.06, "maximum": 400.06, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 400.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME STD CASE RATE 30 DAYS", "code_information": [{"code": "S0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME VENT MGMT SUPERVISION", "code_information": [{"code": "94005", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME VISIT MECH VENTILATOR", "code_information": [{"code": "99504", "type": "CPT"}], "standard_charges": [{"minimum": 1634.49, "maximum": 1634.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1634.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME VISIT PRENATAL", "code_information": [{"code": "99500", "type": "CPT"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 176.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOME VISIT RESP THERAPY", "code_information": [{"code": "99503", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOMECARE TRAIN PT 15 MIN", "code_information": [{"code": "S5108", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOMECARE TRAIN PT SESSION", "code_information": [{"code": "S5109", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOMOCYSTEINE", "code_information": [{"code": "83090", "type": "CPT"}, {"code": "3440100933", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.92, "maximum": 143.56, "gross_charge": 148.0, "discounted_cash": 28.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 143.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 118.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOMOGENIZATION TISSU", "code_information": [{"code": "87176", "type": "CPT"}, {"code": "3440101177", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 5.88, "maximum": 48.5, "gross_charge": 50.0, "discounted_cash": 9.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 42.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 48.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 42.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOOD FACE SHLD", "code_information": [{"code": "3100100859", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, "discounted_cash": 202.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOD FLYTE SURGICAL", "code_information": [{"code": "3100103919", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.16, "discounted_cash": 183.24, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOD T4", "code_information": [{"code": "3100100860", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 129.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK", "code_information": [{"code": "3100104070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2193.0, "discounted_cash": 3289.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK BLADE MED*55411", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOOK CRAEFE MUSCLE", "code_information": [{"code": "3100103885", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 148.0, "discounted_cash": 222.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK PLATE*WHV-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1813.0, "maximum": 2512.3, "gross_charge": 2590.0, "discounted_cash": 3885.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1942.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1813.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2512.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1813.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1942.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOOK PLATE*WHV-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1929.2, "maximum": 2673.32, "gross_charge": 2756.0, "discounted_cash": 4134.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2342.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2067.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1929.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2673.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1929.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2067.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2342.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2204.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOOK SKIN*291201", "code_information": [{"code": "3100104233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 567.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK STEERABLE", "code_information": [{"code": "3100102174", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK SUTURE ASSEMBLY", "code_information": [{"code": "3100104575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOK SUTURE SM", "code_information": [{"code": "3100104101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 554.0, "discounted_cash": 831.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOOP SHIN MAS TLIF", "code_information": [{"code": "3100100861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2499.0, "discounted_cash": 3748.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HORIZON WASHER 25MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSE/TEMP SENSOR BAI", "code_information": [{"code": "3100100862", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 249.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOSP DISCHRG DAY MNG", "code_information": [{"code": "99238", "type": "CPT"}, {"code": "3500102277", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 138.4, "maximum": 265.78, "gross_charge": 274.0, "discounted_cash": 411.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 205.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 265.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 205.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 219.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOSP DISCHRG DAY MNG", "code_information": [{"code": "99239", "type": "CPT"}, {"code": "3500102278", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 138.4, "maximum": 391.88, "gross_charge": 404.0, "discounted_cash": 606.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 343.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 303.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 282.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 391.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 282.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 303.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 343.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 323.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOSP MANAGE CONT DRUG ADMIN", "code_information": [{"code": "1996", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOSP OP CLINIC VISIT", "code_information": [{"code": "G0463", "type": "HCPCS"}, {"code": "3500102260", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 134.89, "maximum": 340.47, "gross_charge": 351.0, "discounted_cash": 202.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 298.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 139.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 263.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 340.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 263.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 160.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 298.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 134.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 137.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99377", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "99378", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOSPICE CARE SUPERVISION", "code_information": [{"code": "G0182", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOSPITAL OP SPECIMEN", "code_information": [{"code": "C9803", "type": "HCPCS"}, {"code": "3440103095", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.57, "maximum": 95.06, "gross_charge": 98.0, "discounted_cash": 147.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 95.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HOT OR COLD PACKS THERAPY", "code_information": [{"code": "97010", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-1 GENOTYPING", "code_information": [{"code": "81105", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-15 GENOTYPING", "code_information": [{"code": "81112", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-2 GENOTYPING", "code_information": [{"code": "81106", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-3 GENOTYPING", "code_information": [{"code": "81107", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-4 GENOTYPING", "code_information": [{"code": "81108", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-5 GENOTYPING", "code_information": [{"code": "81109", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-6 GENOTYPING", "code_information": [{"code": "81110", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPA-9 GENOTYPING", "code_information": [{"code": "81111", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 122.22, "discounted_cash": 196.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPV 5+ HI RISK HPV TYPES", "code_information": [{"code": "500T", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPV COMBO ASSAY CA SCREEN", "code_information": [{"code": "G0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPV HI RISK TYPES MALE URINE", "code_information": [{"code": "96U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPV HIGH-RISK TYPES", "code_information": [{"code": "87624", "type": "CPT"}, {"code": "3440103102", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPV LOW-RISK TYPES", "code_information": [{"code": "87623", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPV TYPES 16 & 18 ONLY", "code_information": [{"code": "87625", "type": "CPT"}], "standard_charges": [{"minimum": 40.55, "maximum": 41.83, "discounted_cash": 65.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPYLORI DETCJ ABX RSTNC DNA", "code_information": [{"code": "8U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 960.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HPYLORI STOOL AG IA", "code_information": [{"code": "87338", "type": "CPT"}], "standard_charges": [{"minimum": 14.38, "maximum": 24.03, "discounted_cash": 23.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HRDTRY BRST CA-RLATD DSORDRS", "code_information": [{"code": "81432", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 679.05, "discounted_cash": 1090.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 679.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HRDTRY BRST CA-RLATD DSORDRS", "code_information": [{"code": "81433", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 438.93, "discounted_cash": 705.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 438.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HRDTRY CARDMYPY GENE PANEL", "code_information": [{"code": "81439", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.9, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HRDTRY PERPH NEURPHY PANEL", "code_information": [{"code": "81448", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 584.9, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 584.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HRS DISTAL STEM 15MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9450.0, "maximum": 13095.0, "gross_charge": 13500.0, "discounted_cash": 20250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11475.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13095.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11475.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HRS PROXIMAL BODY*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7818.72, "maximum": 10834.51, "gross_charge": 11169.6, "discounted_cash": 16754.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9494.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8377.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7818.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10834.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7818.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8377.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9494.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8935.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HSV DNA AMP PROBE", "code_information": [{"code": "87529", "type": "CPT"}, {"code": "3440103105", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HSV DNA DIR PROBE", "code_information": [{"code": "87528", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT HEM HORM INJ DIEM", "code_information": [{"code": "S9537", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT HEMODIALYSIS DIEM", "code_information": [{"code": "S9335", "type": "HCPCS"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT INJ ANTICOAG DIEM", "code_information": [{"code": "S9372", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT INJ ANTIEMETIC DIEM", "code_information": [{"code": "S9370", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT INJ GROWTH HORM DIEM", "code_information": [{"code": "S9558", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT INJ HORMONE DIEM", "code_information": [{"code": "S9560", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT INJ NOC PER DIEM", "code_information": [{"code": "S9542", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT INJ PALIVIZUMAB/AB DIEM", "code_information": [{"code": "S9562", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT IRRIGATION DIEM", "code_information": [{"code": "S9590", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT MUSC IMAGE PLANAR MULT", "code_information": [{"code": "78454", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE PLANAR SING", "code_information": [{"code": "78453", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE SPECT MULT", "code_information": [{"code": "78452", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT MUSCLE IMAGE SPECT SING", "code_information": [{"code": "78451", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HT PHARM PER HOUR", "code_information": [{"code": "S9810", "type": "HCPCS"}], "standard_charges": [{"minimum": 314.62, "maximum": 314.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 314.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HTLV-I ANTIBODY", "code_information": [{"code": "86687", "type": "CPT"}], "standard_charges": [{"minimum": 9.09, "maximum": 30.26, "discounted_cash": 14.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HTLV-II ANTIBODY", "code_information": [{"code": "86688", "type": "CPT"}], "standard_charges": [{"minimum": 14.0, "maximum": 30.26, "discounted_cash": 22.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HTLV/HIV CONFIRMJ ANTIBODY", "code_information": [{"code": "86689", "type": "CPT"}], "standard_charges": [{"minimum": 19.35, "maximum": 30.26, "discounted_cash": 31.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 20*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 24*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 28*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 30*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 32*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 36*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CANC 46*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 32*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 34*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 38*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 40*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 42*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 44*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO ANCHOR CORT 52*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT LG*AR-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4941.3, "maximum": 6847.23, "gross_charge": 7059.0, "discounted_cash": 10588.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6000.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5294.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4941.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6847.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4941.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5294.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6000.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5647.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT LG*AR-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT MD*AR-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT MD*AR-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3630.9, "maximum": 5031.39, "gross_charge": 5187.0, "discounted_cash": 7780.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4408.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3890.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3630.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5031.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3630.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3890.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4408.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT SM*AR-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT SM*AR-13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO IMPLANT XLG*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO PLT LT 67MM*AR13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTO PLT RT 71MM*AR13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2600.78, "maximum": 3603.93, "gross_charge": 3715.4, "discounted_cash": 5573.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3158.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2786.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2600.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3603.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2600.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2786.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3158.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2972.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HTR2A HTR2C GENES", "code_information": [{"code": "33U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 561.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HTT GENE CHARAC ALLELES", "code_information": [{"code": "81274", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HTT GENE DETC ABNOR ALLELES", "code_information": [{"code": "81271", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HUM HEAD ADAPTER*AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUM HEAD ADAPTER*SAH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUM HEAD FLEX 51X20*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5855.85, "maximum": 8114.53, "gross_charge": 8365.5, "discounted_cash": 12548.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7110.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6274.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5855.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8114.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5855.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6274.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7110.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6692.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUM STEM ADAPTER*SAH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUM STEM/NK KIT SZ1*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6606.6, "maximum": 9154.86, "gross_charge": 9438.0, "discounted_cash": 14157.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8022.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7078.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6606.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9154.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6606.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7078.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8022.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7550.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN EPIDIDYMIS PROTEIN 4", "code_information": [{"code": "86305", "type": "CPT"}], "standard_charges": [{"minimum": 20.81, "maximum": 30.26, "discounted_cash": 33.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IM", "code_information": [{"code": "90281", "type": "CPT"}], "standard_charges": [{"minimum": 22.77, "maximum": 22.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMAN IG IV", "code_information": [{"code": "90283", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMAN IG SC", "code_information": [{"code": "90284", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HUMATE-P, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7187", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.4, "maximum": 1.4, "discounted_cash": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUME HD UNV II 56/24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUME HD USP II 52/22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL 28MM*2G2SC21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7462.0, "maximum": 10340.2, "gross_charge": 10660.0, "discounted_cash": 15990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9061.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7462.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10340.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7462.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9061.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8528.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL ADAPT*AR9502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL ANCHOR*01.04", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9227.4, "maximum": 12786.54, "gross_charge": 13182.0, "discounted_cash": 19773.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11204.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9886.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9227.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12786.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9227.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9886.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11204.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10545.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL ANCHOR*01.04", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9227.4, "maximum": 12786.54, "gross_charge": 13182.0, "discounted_cash": 19773.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11204.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9886.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9227.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12786.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9227.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9886.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11204.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10545.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL BEARING 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2229.5, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL BEARING 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1916.88, "maximum": 2656.24, "gross_charge": 2738.4, "discounted_cash": 4107.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2656.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2190.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL BEARING 36MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2411.5, "maximum": 3341.65, "gross_charge": 3445.0, "discounted_cash": 5167.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3341.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL BEARING 40MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1916.88, "maximum": 2656.24, "gross_charge": 2738.4, "discounted_cash": 4107.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2656.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1916.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2053.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2327.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2190.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL BEARING 40MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2229.5, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL BEARING 40MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2229.5, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL CUP 36MM*557", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1731.32, "maximum": 2399.12, "gross_charge": 2473.32, "discounted_cash": 3709.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2102.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1854.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1731.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2399.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1731.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1854.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2102.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1978.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL CUP 36MM*557", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2161.25, "maximum": 2994.87, "gross_charge": 3087.5, "discounted_cash": 4631.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2624.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2315.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2161.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2994.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2161.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2315.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2624.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2470.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL CUP ADAPTOR*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 729.77, "maximum": 1011.25, "gross_charge": 1042.53, "discounted_cash": 1563.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 886.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 781.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 729.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1011.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 729.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 781.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 886.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 834.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL DJO SOCKET I", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1855.0, "maximum": 2570.5, "gross_charge": 2650.0, "discounted_cash": 3975.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2252.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1987.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1855.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2570.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1855.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1987.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2252.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL FX STEM 10M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL FX STEM 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL FX STEM 7MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204959", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8262.83, "maximum": 11449.92, "gross_charge": 11804.05, "discounted_cash": 17706.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10033.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8853.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8262.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11449.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8262.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8853.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10033.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9443.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL FX STEM 8MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5856.27, "maximum": 8115.11, "gross_charge": 8366.1, "discounted_cash": 12549.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7111.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6274.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5856.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8115.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5856.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6274.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7111.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6692.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2992.5, "maximum": 4146.75, "gross_charge": 4275.0, "discounted_cash": 6412.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3633.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3206.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2992.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4146.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2992.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3206.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3633.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 27X52*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 37/16*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2631.72, "maximum": 3646.81, "gross_charge": 3759.6, "discounted_cash": 5639.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3195.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2819.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2631.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3646.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2631.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2819.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3195.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3007.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 38*1130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 41/16*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 41/18*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 42*5200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 42MM*52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 44*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4277.0, "maximum": 5926.7, "gross_charge": 6110.0, "discounted_cash": 9165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5926.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 44X18MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2214.03, "maximum": 3068.01, "gross_charge": 3162.9, "discounted_cash": 4744.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2688.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2372.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3068.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2372.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2688.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2530.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 45/17*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 45/17*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206690", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 45X19*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 46MM*52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 46MM*DW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4462.64, "maximum": 6183.94, "gross_charge": 6375.2, "discounted_cash": 9562.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5418.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4781.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4462.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6183.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4462.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4781.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5418.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5100.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 47/18*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 50/21*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 50X19*D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 51/21*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 54MM*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD 54X58M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2908.36, "maximum": 4030.15, "gross_charge": 4154.8, "discounted_cash": 6232.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3531.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3116.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2908.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4030.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2908.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3116.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3531.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3323.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ARTHREX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2707.6, "maximum": 3751.96, "gross_charge": 3868.0, "discounted_cash": 5802.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3287.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2901.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2707.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3751.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2707.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2901.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3287.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3094.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ARTHREX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3185.0, "maximum": 4413.5, "gross_charge": 4550.0, "discounted_cash": 6825.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4413.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD BIO VER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD FLEX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7196.0, "maximum": 9971.6, "gross_charge": 10280.0, "discounted_cash": 15420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8738.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7710.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9971.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7710.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8738.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1925.7, "maximum": 2668.47, "gross_charge": 2751.0, "discounted_cash": 4126.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2668.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2105.6, "maximum": 2917.76, "gross_charge": 3008.0, "discounted_cash": 4512.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2556.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2256.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2105.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2917.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2105.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2256.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2556.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2406.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD TORNIER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3609.9, "maximum": 5002.29, "gross_charge": 5157.0, "discounted_cash": 7735.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4383.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3867.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3609.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5002.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3609.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3867.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4383.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4125.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3203.2, "maximum": 4438.72, "gross_charge": 4576.0, "discounted_cash": 6864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4438.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3660.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3203.2, "maximum": 4438.72, "gross_charge": 4576.0, "discounted_cash": 6864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4438.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3660.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3203.2, "maximum": 4438.72, "gross_charge": 4576.0, "discounted_cash": 6864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4438.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3660.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*01.0455", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*01.4555", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*2N2HE15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*5552-S-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*AR-9550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4277.0, "maximum": 5926.7, "gross_charge": 6110.0, "discounted_cash": 9165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5926.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*AR-9556", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4277.0, "maximum": 5926.7, "gross_charge": 6110.0, "discounted_cash": 9165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5926.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*DWF041", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209689", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL HEAD*DWF048", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3374.0, "maximum": 4675.4, "gross_charge": 4820.0, "discounted_cash": 7230.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4097.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3615.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3374.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4675.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3374.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3615.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4097.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3856.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 32MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 32MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 32MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 36M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1483.86, "maximum": 2056.2, "gross_charge": 2119.8, "discounted_cash": 3179.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1801.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1589.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1483.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2056.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1483.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1589.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1801.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1695.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 36MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1560.3, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 36MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1825.54, "maximum": 2529.68, "gross_charge": 2607.92, "discounted_cash": 3911.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2216.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1825.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2529.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1825.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2216.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2086.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 36MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL INSERT 36MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL LAT INSERT 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1609.74, "maximum": 2230.65, "gross_charge": 2299.64, "discounted_cash": 3449.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1954.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1724.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1609.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2230.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1609.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1724.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1954.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1839.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL LINER/IMP*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL PE CUP*1307-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL PIN 3.5X130*", "code_information": [{"code": "3100208035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL SHELL M 36M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SHELL S 32M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2475.2, "maximum": 3429.92, "gross_charge": 3536.0, "discounted_cash": 5304.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3429.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2828.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SHELL S 32M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SHELL XS 28M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SOCKET 32MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SPACER*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SPACER*AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SPOOL GRAND*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3836.23, "maximum": 5315.92, "gross_charge": 5480.33, "discounted_cash": 8220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4658.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4110.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3836.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5315.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3836.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4110.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4658.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4384.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL SPOOL*DKY216", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3170.44, "maximum": 4393.32, "gross_charge": 4529.2, "discounted_cash": 6793.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3849.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3396.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3170.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4393.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3170.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3396.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3849.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3623.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7598.5, "maximum": 10529.35, "gross_charge": 10855.0, "discounted_cash": 16282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9226.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8141.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10529.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8141.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9226.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6078.8, "maximum": 8423.48, "gross_charge": 8684.0, "discounted_cash": 13026.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8423.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6947.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 10MM *1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5348.98, "maximum": 7412.15, "gross_charge": 7641.4, "discounted_cash": 11462.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6495.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5731.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5348.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7412.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5348.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5731.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6495.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6113.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 10MM*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6304.48, "maximum": 8736.2, "gross_charge": 9006.4, "discounted_cash": 13509.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8736.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7205.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 10X108*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8404.2, "maximum": 11645.82, "gross_charge": 12006.0, "discounted_cash": 18009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11645.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 12X108*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7639.8, "maximum": 10586.58, "gross_charge": 10914.0, "discounted_cash": 16371.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9276.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8185.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7639.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10586.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7639.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8185.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9276.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8731.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 14X108*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8137.08, "maximum": 11275.66, "gross_charge": 11624.4, "discounted_cash": 17436.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9880.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8718.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8137.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11275.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8137.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8718.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9880.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9299.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 16X108*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8404.2, "maximum": 11645.82, "gross_charge": 12006.0, "discounted_cash": 18009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11645.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 21MM*52", "code_information": [{"code": "3100209474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL STEM 8 X108*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8137.08, "maximum": 11275.66, "gross_charge": 11624.4, "discounted_cash": 17436.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9880.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8718.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8137.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11275.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8137.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8718.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9880.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9299.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 83MM*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9337.32, "maximum": 12938.86, "gross_charge": 13339.04, "discounted_cash": 20008.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11338.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10004.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9337.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12938.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9337.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10004.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11338.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10671.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 8MM*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5350.8, "maximum": 7414.68, "gross_charge": 7644.0, "discounted_cash": 11466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7414.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM 9MM*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5350.8, "maximum": 7414.68, "gross_charge": 7644.0, "discounted_cash": 11466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7414.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM MINI 19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7172.62, "maximum": 9939.2, "gross_charge": 10246.6, "discounted_cash": 15369.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8709.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7684.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7172.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9939.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7172.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7684.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8709.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8197.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM RSP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8283.8, "maximum": 11478.98, "gross_charge": 11834.0, "discounted_cash": 17751.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10058.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8875.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8283.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11478.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8283.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8875.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10058.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9467.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SM*533-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8404.2, "maximum": 11645.82, "gross_charge": 12006.0, "discounted_cash": 18009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11645.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SM*533-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8404.2, "maximum": 11645.82, "gross_charge": 12006.0, "discounted_cash": 18009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11645.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SM*533-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8404.2, "maximum": 11645.82, "gross_charge": 12006.0, "discounted_cash": 18009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11645.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SM*533-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7639.8, "maximum": 10586.58, "gross_charge": 10914.0, "discounted_cash": 16371.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9276.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8185.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7639.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10586.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7639.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8185.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9276.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8731.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 10*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 11*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 12*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 13*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 14*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 14*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 15*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 16*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 16*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 4*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 5*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 6*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 7*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 8*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 8*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM SZ 9*SA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM UN 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6078.8, "maximum": 8423.48, "gross_charge": 8684.0, "discounted_cash": 13026.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8423.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6947.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM UN 12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5350.8, "maximum": 7414.68, "gross_charge": 7644.0, "discounted_cash": 11466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7414.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM UN 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6078.8, "maximum": 8423.48, "gross_charge": 8684.0, "discounted_cash": 13026.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8423.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6947.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6078.8, "maximum": 8423.48, "gross_charge": 8684.0, "discounted_cash": 13026.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8423.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6947.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM*0030503", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7716.8, "maximum": 10693.28, "gross_charge": 11024.0, "discounted_cash": 16536.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9370.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8268.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7716.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10693.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7716.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8268.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9370.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8819.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM*5569-C-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM*DWR2360", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM*DWX2PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM-MINI 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM-MINI 6M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL STEM-MINI 8M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204952", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TEFLON TUBE*", "code_information": [{"code": "3100202959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 728.52, "discounted_cash": 1092.78, "setting": "both", "billing_class": "facility"}]}, {"description": "HUMERAL TORNIER AEQU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TORNIER AEQU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TORNIER STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4271.4, "maximum": 5918.94, "gross_charge": 6102.0, "discounted_cash": 9153.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5186.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4576.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4271.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5918.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4271.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4576.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5186.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4881.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY +0*1100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY +10*110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY +3+5*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY +6*1100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY +6*1100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY +6+5*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY 0MM*SAH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY 0MM*SAH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY 6MM*SAH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY 6MM*SAH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY STD*110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY STD*110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY STD*110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERAL TRAY STD*110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERUS METAPHYSIS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2253.3, "maximum": 3122.43, "gross_charge": 3219.0, "discounted_cash": 4828.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2736.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2414.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2253.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3122.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2253.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2414.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2736.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2575.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERUS METAPHYSIS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7689.5, "maximum": 10655.45, "gross_charge": 10985.0, "discounted_cash": 16477.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9337.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8238.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7689.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10655.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7689.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8238.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9337.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8788.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERUS STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2863.0, "maximum": 3967.3, "gross_charge": 4090.0, "discounted_cash": 6135.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3476.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3067.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2863.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3967.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2863.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3067.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3476.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERUS STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2238.6, "maximum": 3102.06, "gross_charge": 3198.0, "discounted_cash": 4797.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2718.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2398.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2238.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3102.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2238.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2398.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2718.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2558.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERUS STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8908.9, "maximum": 12345.19, "gross_charge": 12727.0, "discounted_cash": 19090.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10817.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9545.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8908.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12345.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8908.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9545.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10817.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10181.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HUMERUS TORNIER LONG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 632.1, "maximum": 875.91, "gross_charge": 903.0, "discounted_cash": 1354.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 767.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 677.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 632.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 875.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 632.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 677.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 767.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 722.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYALGAN SUPARTZ VISCO-3 DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7321", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.12, "maximum": 73.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 73.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYALOMATRIX", "code_information": [{"code": "Q4117", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.91, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYALURONIDASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3470", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.2, "maximum": 39.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYALURONIDASE RECOMBINANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3473", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.36, "maximum": 0.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDRALAZINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0360", "type": "HCPCS"}, {"code": "3400300296", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.56, "maximum": 11.34, "gross_charge": 11.7, "discounted_cash": 17.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROCOD/ACETAMIN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300049", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.5, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "HYDROCORTISONE ACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1700", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROCORTISONE SODIUM PH INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1710", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "HYDROCORTISONE SODIUM SUCC I", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1720", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.46, "maximum": 18.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROMORPHONE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1170", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.76, "maximum": 4.76, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYINDOLACETIC A", "code_information": [{"code": "83497", "type": "CPT"}, {"code": "3440100934", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.9, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3410", "type": "HCPCS"}, {"code": "3400300158", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.25, "maximum": 13.87, "gross_charge": 7.5, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYDROXYZINE PAMOATE 25MG", "code_information": [{"code": "Q0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYMOVIS INJECTION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7322", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.51, "maximum": 17.51, "discounted_cash": 27.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1980", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.46, "maximum": 35.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITH MCC", "code_information": [{"code": "304", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5055.78, "maximum": 5055.78, "discounted_cash": 12828.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5055.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSION WITHOUT MCC", "code_information": [{"code": "305", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3895.59, "maximum": 3895.59, "discounted_cash": 8412.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3895.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH CC", "code_information": [{"code": "78", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4723.15, "maximum": 4723.15, "discounted_cash": 11353.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4723.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [{"code": "77", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7362.02, "maximum": 7362.02, "discounted_cash": 16868.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7362.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC", "code_information": [{"code": "79", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4723.15, "maximum": 4723.15, "discounted_cash": 8270.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4723.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 1097.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYQVIA 100MG IMMUNEGLOBULIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1575", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.94, "maximum": 16.94, "discounted_cash": 27.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTMY VAG W TU", "code_information": [{"code": "58263", "type": "CPT"}, {"code": "3340102349", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5075.58, "maximum": 8564.13, "gross_charge": 8829.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7504.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6180.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8564.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6180.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7504.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7063.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58275", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY BI TUBE", "code_information": [{"code": "58565", "type": "CPT"}, {"code": "3480102111", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4828.25, "maximum": 11561.43, "gross_charge": 11919.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10131.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8939.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8343.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11561.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8343.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8939.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10131.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9535.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY DX SEP PROC", "code_information": [{"code": "58555", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY LYSIS", "code_information": [{"code": "58559", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY RESECT SEPTUM", "code_information": [{"code": "58560", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY W/BIOPS", "code_information": [{"code": "58558", "type": "CPT"}, {"code": "3480102107", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5710.39, "gross_charge": 5887.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5003.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4415.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4120.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5710.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4120.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4415.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5003.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4709.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY, SURGIC", "code_information": [{"code": "58561", "type": "CPT"}, {"code": "3480102108", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9085.02, "gross_charge": 9366.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7961.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7024.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6556.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9085.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6556.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7024.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7961.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7492.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY, SURGIC", "code_information": [{"code": "58562", "type": "CPT"}, {"code": "3480102109", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5710.39, "gross_charge": 5887.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5003.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4415.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4120.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5710.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4120.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4415.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5003.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4709.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HYSTEROSCOPY,ABLATIO", "code_information": [{"code": "58563", "type": "CPT"}, {"code": "3480102110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3553.77, "maximum": 9085.02, "gross_charge": 9366.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7961.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7024.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6556.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9085.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6556.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7024.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7961.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7492.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HZV VACC RECOMBINANT IM", "code_information": [{"code": "90750", "type": "CPT"}], "standard_charges": [{"minimum": 164.66, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 164.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "HZV VACCINE LIVE SUBQ", "code_information": [{"code": "90736", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 252.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hand And Wrist Procedures, Major", "code_information": [{"code": "316.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21515.1, "maximum": 21515.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21515.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hand And Wrist Procedures, Minor", "code_information": [{"code": "316.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11492.49, "maximum": 11492.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11492.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hand And Wrist Procedures, Moderate", "code_information": [{"code": "316.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13523.67, "maximum": 13523.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13523.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hand And Wrist Procedures, Severe", "code_information": [{"code": "316.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 41291.21, "maximum": 41291.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41291.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Head Trauma With Coma > 1 Hour Or Hemorrhage, Major", "code_information": [{"code": "55.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17500.16, "maximum": 17500.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17500.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Head Trauma With Coma > 1 Hour Or Hemorrhage, Minor", "code_information": [{"code": "55.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6822.71, "maximum": 6822.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6822.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Head Trauma With Coma > 1 Hour Or Hemorrhage, Moderate", "code_information": [{"code": "55.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9366.48, "maximum": 9366.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9366.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Head Trauma With Coma > 1 Hour Or Hemorrhage, Severe", "code_information": [{"code": "55.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 47268.13, "maximum": 47268.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47268.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hearing Test Using Earphones, (Sisi) Sensitivity Index", "code_information": [{"code": "92564", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart And/Or Lung Transplant, Major", "code_information": [{"code": "2.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 216014.77, "maximum": 216014.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 216014.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart And/Or Lung Transplant, Minor", "code_information": [{"code": "2.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 137425.5, "maximum": 137425.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 137425.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart And/Or Lung Transplant, Moderate", "code_information": [{"code": "2.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 160306.68, "maximum": 160306.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 160306.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart And/Or Lung Transplant, Severe", "code_information": [{"code": "2.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 358034.44, "maximum": 358034.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358034.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart Failure, Major", "code_information": [{"code": "194.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14942.29, "maximum": 14942.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14942.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart Failure, Minor", "code_information": [{"code": "194.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8268.24, "maximum": 8268.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8268.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart Failure, Moderate", "code_information": [{"code": "194.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10093.09, "maximum": 10093.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10093.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Heart Failure, Severe", "code_information": [{"code": "194.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27420.26, "maximum": 27420.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27420.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hemorrhage Or Hematoma Due To Complication, Major", "code_information": [{"code": "810.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12108.89, "maximum": 12108.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12108.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hemorrhage Or Hematoma Due To Complication, Minor", "code_information": [{"code": "810.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7322.49, "maximum": 7322.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7322.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hemorrhage Or Hematoma Due To Complication, Moderate", "code_information": [{"code": "810.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8634.75, "maximum": 8634.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8634.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hemorrhage Or Hematoma Due To Complication, Severe", "code_information": [{"code": "810.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26113.13, "maximum": 26113.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26113.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hepatic Coma And Other Major Acute Liver Disorders, Major", "code_information": [{"code": "279.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16264.8, "maximum": 16264.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16264.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hepatic Coma And Other Major Acute Liver Disorders, Minor", "code_information": [{"code": "279.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6025.61, "maximum": 6025.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6025.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hepatic Coma And Other Major Acute Liver Disorders, Moderate", "code_information": [{"code": "279.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9984.17, "maximum": 9984.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9984.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hepatic Coma And Other Major Acute Liver Disorders, Severe", "code_information": [{"code": "279.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50114.34, "maximum": 50114.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50114.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hernia Procedures Except Inguinal, Femoral And Umbilical, Major", "code_information": [{"code": "227.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29141.31, "maximum": 29141.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29141.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hernia Procedures Except Inguinal, Femoral And Umbilical, Minor", "code_information": [{"code": "227.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16113.58, "maximum": 16113.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16113.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hernia Procedures Except Inguinal, Femoral And Umbilical, Moderate", "code_information": [{"code": "227.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19635.14, "maximum": 19635.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19635.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hernia Procedures Except Inguinal, Femoral And Umbilical, Severe", "code_information": [{"code": "227.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 59658.95, "maximum": 59658.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59658.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hhc lis nurse train ea 15", "code_information": [{"code": "G0164", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hip And Femur Fracture Repair, Major", "code_information": [{"code": "308.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34974.7, "maximum": 34974.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34974.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hip And Femur Fracture Repair, Minor", "code_information": [{"code": "308.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16254.55, "maximum": 16254.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16254.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hip And Femur Fracture Repair, Moderate", "code_information": [{"code": "308.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23550.13, "maximum": 23550.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23550.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hip And Femur Fracture Repair, Severe", "code_information": [{"code": "308.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53287.33, "maximum": 53287.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53287.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Major Hiv Related Condition, Major", "code_information": [{"code": "892.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16217.38, "maximum": 16217.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16217.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Major Hiv Related Condition, Minor", "code_information": [{"code": "892.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10436.54, "maximum": 10436.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10436.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Major Hiv Related Condition, Moderate", "code_information": [{"code": "892.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11343.84, "maximum": 11343.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11343.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Major Hiv Related Condition, Severe", "code_information": [{"code": "892.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22094.34, "maximum": 22094.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22094.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Major Hiv Related Conditions, Major", "code_information": [{"code": "890.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28970.87, "maximum": 28970.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28970.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Major Hiv Related Conditions, Minor", "code_information": [{"code": "890.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12443.37, "maximum": 12443.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12443.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Major Hiv Related Conditions, Moderate", "code_information": [{"code": "890.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13178.95, "maximum": 13178.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13178.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Major Hiv Related Conditions, Severe", "code_information": [{"code": "890.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 79656.76, "maximum": 79656.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79656.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Significant Hiv Related Conditions, Major", "code_information": [{"code": "893.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17382.27, "maximum": 17382.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17382.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Significant Hiv Related Conditions, Minor", "code_information": [{"code": "893.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11496.34, "maximum": 11496.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11496.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Significant Hiv Related Conditions, Moderate", "code_information": [{"code": "893.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12288.3, "maximum": 12288.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12288.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With Multiple Significant Hiv Related Conditions, Severe", "code_information": [{"code": "893.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26534.74, "maximum": 26534.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26534.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With One Significant Hiv Condition Or Without Significant Related Conditions, Major", "code_information": [{"code": "894.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15345.96, "maximum": 15345.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15345.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With One Significant Hiv Condition Or Without Significant Related Conditions, Minor", "code_information": [{"code": "894.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8475.84, "maximum": 8475.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8475.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With One Significant Hiv Condition Or Without Significant Related Conditions, Moderate", "code_information": [{"code": "894.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10606.98, "maximum": 10606.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10606.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hiv With One Significant Hiv Condition Or Without Significant Related Conditions, Severe", "code_information": [{"code": "894.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23718.0, "maximum": 23718.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23718.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypertension, Major", "code_information": [{"code": "199.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13112.31, "maximum": 13112.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13112.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypertension, Minor", "code_information": [{"code": "199.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6436.97, "maximum": 6436.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6436.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypertension, Moderate", "code_information": [{"code": "199.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8855.17, "maximum": 8855.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8855.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypertension, Severe", "code_information": [{"code": "199.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27893.13, "maximum": 27893.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27893.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypovolemia And Related Electrolyte Disorders, Major", "code_information": [{"code": "422.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12089.67, "maximum": 12089.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12089.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypovolemia And Related Electrolyte Disorders, Minor", "code_information": [{"code": "422.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5323.35, "maximum": 5323.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5323.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypovolemia And Related Electrolyte Disorders, Moderate", "code_information": [{"code": "422.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7159.74, "maximum": 7159.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7159.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Hypovolemia And Related Electrolyte Disorders, Severe", "code_information": [{"code": "422.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21176.79, "maximum": 21176.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21176.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D HEMATOMA/FLUID", "code_information": [{"code": "10140", "type": "CPT"}, {"code": "3480101292", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2463.8, "gross_charge": 2540.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2159.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1905.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1778.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2463.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1778.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1905.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2159.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2032.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D VAG HEMATOMA NON-OB", "code_information": [{"code": "57023", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2564.54, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I & D VAGINAL HEMATOMA PP", "code_information": [{"code": "57022", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2385.2, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSC INTRAORAL SOFT TISS", "code_information": [{"code": "D7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS COMP/MULTIPLE", "code_information": [{"code": "10061", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS EXTRAORAL", "code_information": [{"code": "D7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS POSTERIO", "code_information": [{"code": "22015", "type": "CPT"}, {"code": "3480101481", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1554.0, "maximum": 7959.27, "gross_charge": 2220.0, "discounted_cash": 3330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1665.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2153.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1665.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1776.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D ABSCESS SIMPLE", "code_information": [{"code": "10060", "type": "CPT"}, {"code": "3480101289", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 425.83, "gross_charge": 439.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 373.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 329.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 307.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 425.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 307.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 329.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 373.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 351.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I&D P-SPINE C/T/CERV-THOR", "code_information": [{"code": "22010", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D PILONIDAL CYST COMP", "code_information": [{"code": "10081", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1185.04, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E BURSA", "code_information": [{"code": "23931", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I&D UPR A/E DP ABSC/HMTMA", "code_information": [{"code": "23930", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "I125 IOTHALAMATE, DX", "code_information": [{"code": "A9554", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.31, "maximum": 40.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I125 SERUM ALBUMIN, DX", "code_information": [{"code": "A9532", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE CAP, RX", "code_information": [{"code": "A9517", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.44, "maximum": 76.44, "discounted_cash": 34.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 76.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE SOL, DX", "code_information": [{"code": "A9529", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 IODIDE SOL, RX", "code_information": [{"code": "A9530", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.12, "maximum": 10.12, "discounted_cash": 32.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "I131 IODOBENGUATE, DX", "code_information": [{"code": "A9508", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 MAX 100UCI", "code_information": [{"code": "A9531", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "I131 SERUM ALBUMIN, DX", "code_information": [{"code": "A9524", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IA INFECTIOUS AGENT ANTIBODY", "code_information": [{"code": "86318", "type": "CPT"}], "standard_charges": [{"minimum": 18.09, "maximum": 30.26, "discounted_cash": 29.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IA NFCT AB SARSCOV2 COVID19", "code_information": [{"code": "86328", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 45.28, "discounted_cash": 72.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 45.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA CLOSTRIDIUM", "code_information": [{"code": "87324", "type": "CPT"}, {"code": "3440103006", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA CRYPTOCOCCU", "code_information": [{"code": "87327", "type": "CPT"}, {"code": "3440101192", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.42, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 21.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA CRYPTOSPORI", "code_information": [{"code": "87328", "type": "CPT"}, {"code": "3440101193", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.82, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 22.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA GIARDIA", "code_information": [{"code": "87329", "type": "CPT"}, {"code": "3440101194", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA HEPATITIS B", "code_information": [{"code": "87340", "type": "CPT"}, {"code": "3440101165", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 10.33, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 16.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.06, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA HISTOPLASM", "code_information": [{"code": "87385", "type": "CPT"}, {"code": "3440101196", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA MULT STEP M", "code_information": [{"code": "87449", "type": "CPT"}, {"code": "3440101198", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAAD EIA ROTAVIRUS", "code_information": [{"code": "87425", "type": "CPT"}, {"code": "3440101197", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 11.98, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAADI VARICELLA ZOST", "code_information": [{"code": "87290", "type": "CPT"}, {"code": "3440101190", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.42, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 21.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.37, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IAADIADOO NOS", "code_information": [{"code": "87899", "type": "CPT"}, {"code": "3440101211", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.07, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 25.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADI 16S&18S RRNA GENES", "code_information": [{"code": "112U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 82.77, "discounted_cash": 572.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA BARTONELLA DDPCR", "code_information": [{"code": "301U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 422.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA BRTNLA DDPCR FLWG LIQ", "code_information": [{"code": "302U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 580.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA CHLAMYDIA TRAC", "code_information": [{"code": "87491", "type": "CPT"}, {"code": "3440101199", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 367.63, "gross_charge": 379.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 284.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 367.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 284.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 303.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA HEPATITIS B AM", "code_information": [{"code": "87516", "type": "CPT"}, {"code": "3440101201", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA HEPATITIS C AM", "code_information": [{"code": "87521", "type": "CPT"}, {"code": "3440101202", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA HEPATITIS C QU", "code_information": [{"code": "87522", "type": "CPT"}, {"code": "3440101203", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 41.83, "maximum": 373.45, "gross_charge": 385.0, "discounted_cash": 68.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 327.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 269.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 373.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 269.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 327.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA HIV-1 AMP PROB", "code_information": [{"code": "87535", "type": "CPT"}, {"code": "3440103047", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 285.18, "gross_charge": 294.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 285.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA HIV-1 QUANT &", "code_information": [{"code": "87536", "type": "CPT"}, {"code": "3440101204", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 41.83, "maximum": 741.08, "gross_charge": 764.0, "discounted_cash": 136.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 649.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 534.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 741.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 534.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 93.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 91.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 108.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 649.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 91.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 611.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 85.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 91.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA NEISSERIA GONO", "code_information": [{"code": "87591", "type": "CPT"}, {"code": "3440101205", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 365.69, "gross_charge": 377.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 320.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 365.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 320.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 301.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA NOS AMP PROBE", "code_information": [{"code": "87798", "type": "CPT"}, {"code": "3440101208", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA NOS DIRECT PRO", "code_information": [{"code": "87797", "type": "CPT"}, {"code": "3440101207", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 30.03, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 48.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 38.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA S AURS AMP PRO", "code_information": [{"code": "87641", "type": "CPT"}, {"code": "3440101206", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 12-25", "code_information": [{"code": "87507", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 416.78, "discounted_cash": 669.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IADNA-DNA/RNA PROBE TQ 6-11", "code_information": [{"code": "87506", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 262.99, "discounted_cash": 422.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 262.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IBANDRONATE SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1740", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.71, "maximum": 31.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBMFS SEQ ALYS PNL 30 GENES", "code_information": [{"code": "81441", "type": "CPT"}], "standard_charges": [{"minimum": 2448.56, "maximum": 2448.56, "discounted_cash": 3933.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2448.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUPROFEN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1741", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.87, "maximum": 1.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IBUTILIDE FUMARATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1742", "type": "HCPCS"}], "standard_charges": [{"minimum": 247.59, "maximum": 247.59, "discounted_cash": 305.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 247.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICAR CATH ABLTJ DSCRT ARRHYT", "code_information": [{"code": "93655", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ICATIBANT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1744", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.11, "maximum": 187.11, "discounted_cash": 274.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 187.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICG ANGIOGRAPHY I&R UNI/BI", "code_information": [{"code": "92240", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ICONIX ANCHOR 1.4*39", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICONIX ANCHOR 1.4*39", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST DRUG/BUG", "code_information": [{"code": "95024", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TEST-DELAYED", "code_information": [{"code": "95028", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ICUT ALLERGY TITRATE-AIRBORN", "code_information": [{"code": "95027", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ID ASPERGILLUS DNA 4 SPECIES", "code_information": [{"code": "109U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 82.77, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ID BAND/CAPS*7107504", "code_information": [{"code": "3100209141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 992.64, "discounted_cash": 1488.96, "setting": "both", "billing_class": "facility"}]}, {"description": "ID CA IMMNTX EACH ADDL NJX", "code_information": [{"code": "709T", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ID CA IMMNTX PREP & 1ST NJX", "code_information": [{"code": "708T", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDARUBICIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9211", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.94, "maximum": 38.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDECABTAGENE VICLEUCEL CAR", "code_information": [{"code": "Q2055", "type": "HCPCS"}], "standard_charges": [{"minimum": 484690.3, "maximum": 484690.3, "discounted_cash": 778654.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 484690.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IDENTIFY SPERM TISSUE", "code_information": [{"code": "89264", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDET 1 OR MORE LEVELS", "code_information": [{"code": "22527", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDET SINGLE LEVEL", "code_information": [{"code": "22526", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDH1 COMMON VARIANTS", "code_information": [{"code": "81120", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 193.25, "discounted_cash": 310.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDH2 COMMON VARIANTS", "code_information": [{"code": "81121", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 295.79, "discounted_cash": 475.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IDURSULFASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1743", "type": "HCPCS"}], "standard_charges": [{"minimum": 542.89, "maximum": 542.89, "discounted_cash": 872.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 542.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFNL3 GENE", "code_information": [{"code": "81283", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 117.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IFOSFAMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9208", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.45, "maximum": 26.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE 7.0 X 35*7035M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE 7.0 X 40*7040M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE 7.0 X 45*7045M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE 7.0 X 55*7055M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE 70 X 50*7050M-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE TORQ 10 X 35*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE TORQ 10 X 40*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE TORQ 10 X 45*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE TORQ 10 X 50*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IFUSE TORQ 10 X 55*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IG LIGHT CHAINS FREE EACH", "code_information": [{"code": "83521", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 40.05, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IG PARAPROTEIN QUAL BLD/UR", "code_information": [{"code": "77U", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 69.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IGH @ GENE ANAL, EVA", "code_information": [{"code": "81261", "type": "CPT"}, {"code": "3440103057", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 1573.34, "gross_charge": 1622.0, "discounted_cash": 318.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1378.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 219.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1216.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1135.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1573.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 216.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1135.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1216.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 212.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 252.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1378.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 212.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1297.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 197.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 212.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 216.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IGH GENE REARRANG DIR PROBE", "code_information": [{"code": "81262", "type": "CPT"}], "standard_charges": [{"minimum": 68.55, "maximum": 79.66, "discounted_cash": 110.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IGH VARI REGIONAL MUTATION", "code_information": [{"code": "81263", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 294.52, "discounted_cash": 473.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 294.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IGH@/BCL2 TRANSLOCATION ALYS", "code_information": [{"code": "81278", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IGK @ GENE ANAL, EVA", "code_information": [{"code": "81264", "type": "CPT"}, {"code": "3440103058", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 1188.25, "gross_charge": 1225.0, "discounted_cash": 277.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1041.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 918.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 857.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1188.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 188.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 857.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 190.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 918.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 184.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 220.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1041.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 184.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 980.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 172.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 184.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 188.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IHC/ICC EACH ADD AB", "code_information": [{"code": "G0462", "type": "HCPCS"}, {"code": "3440103010", "type": "CDM"}, {"code": "312", "type": "RC"}], "standard_charges": [{"minimum": 166.6, "maximum": 230.86, "gross_charge": 238.0, "discounted_cash": 357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 202.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 230.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 202.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IIV ADJUVANT VACCINE IM", "code_information": [{"code": "90653", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 66.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV NO PRSV INCREASED AG IM", "code_information": [{"code": "90662", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 73.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 73.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV VACC PANDEMIC ADJUVT IM", "code_information": [{"code": "90667", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV VACCINE PANDEMIC IM", "code_information": [{"code": "90668", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV3 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90655", "type": "CPT"}], "standard_charges": [{"minimum": 21.33, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV3 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90657", "type": "CPT"}], "standard_charges": [{"minimum": 6.85, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.25 ML IM", "code_information": [{"code": "90685", "type": "CPT"}], "standard_charges": [{"minimum": 22.72, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV4 VACC NO PRSV 0.5 ML IM", "code_information": [{"code": "90686", "type": "CPT"}], "standard_charges": [{"minimum": 22.35, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.25 ML IM", "code_information": [{"code": "90687", "type": "CPT"}], "standard_charges": [{"minimum": 10.44, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IIV4 VACCINE SPLT 0.5 ML IM", "code_information": [{"code": "90688", "type": "CPT"}], "standard_charges": [{"minimum": 20.88, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IKBKAP GENE", "code_information": [{"code": "81260", "type": "CPT"}], "standard_charges": [{"minimum": 39.31, "maximum": 79.66, "discounted_cash": 63.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILEOSTOMY/JEJUNOSTOMY", "code_information": [{"code": "44310", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC ART ANGIO,CARDIAC CATH", "code_information": [{"code": "G0278", "type": "HCPCS"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC BONE GRAFT MICROVASC", "code_information": [{"code": "20956", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC CONNECTOR 20MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC CONNECTOR 30MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC", "code_information": [{"code": "37220", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC ADD-ON", "code_information": [{"code": "37222", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT", "code_information": [{"code": "37221", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ILIZAROV SPONGE*1021", "code_information": [{"code": "3100209138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.32, "discounted_cash": 55.98, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATION SYSTEM*", "code_information": [{"code": "3100203978", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1207.5, "discounted_cash": 1811.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR SUR", "code_information": [{"code": "3100104156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1739.0, "discounted_cash": 2608.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ILLUMINATOR*AC01-900", "code_information": [{"code": "3100209753", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1311.0, "discounted_cash": 1966.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "discounted_cash": 7083.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "discounted_cash": 7083.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COL", "code_information": [{"code": "49405", "type": "CPT"}, {"code": "3480103323", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1083.58, "maximum": 3729.65, "gross_charge": 3845.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3268.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2691.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3729.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2691.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3268.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID TRNS/VGNL", "code_information": [{"code": "49407", "type": "CPT"}], "standard_charges": [{"minimum": 1083.58, "maximum": 1083.58, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMAGE GUIDED PLACEME", "code_information": [{"code": "19295", "type": "CPT"}, {"code": "3480101395", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 121.8, "maximum": 168.78, "gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS PHY/QHP", "code_information": [{"code": "92228", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETC/MNTR DS POC ALY", "code_information": [{"code": "92229", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMG RTA DETCJ/MNTR DS STAFF", "code_information": [{"code": "92227", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMIPENEM/CILASTATIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0743", "type": "HCPCS"}, {"code": "3400300006", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.56, "maximum": 50.34, "gross_charge": 51.9, "discounted_cash": 77.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 38.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 38.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMIPENEM/CILASTATIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0743", "type": "HCPCS"}, {"code": "3400300007", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 7.56, "maximum": 85.16, "gross_charge": 87.8, "discounted_cash": 131.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 74.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 65.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 85.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 61.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 65.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 74.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 70.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMASSAY FOR INFECT", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "3440103046", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.99, "maximum": 121.25, "gross_charge": 125.0, "discounted_cash": 24.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 106.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 93.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 121.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 87.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 93.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 106.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMED MAN PART DENTURE RESIN", "code_information": [{"code": "D5222", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMED MAND PART DENT METAL", "code_information": [{"code": "D5224", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMED MAND PART DENTURE", "code_information": [{"code": "D5228", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMED MAX PART DENT METAL", "code_information": [{"code": "D5223", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMED MAX PART DENTURE", "code_information": [{"code": "D5227", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMED MAX PART DENTURE RESIN", "code_information": [{"code": "D5221", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMNFLRSCNT EA AB IN", "code_information": [{"code": "88347", "type": "CPT"}, {"code": "3440101245", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 130.2, "maximum": 180.42, "gross_charge": 186.0, "discounted_cash": 279.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 180.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 139.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 148.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMNTX 1 STING INSECT", "code_information": [{"code": "95130", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMNTX 2 STING INSECTS", "code_information": [{"code": "95131", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMNTX 3 STING INSECTS", "code_information": [{"code": "95132", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMNTX 4 STING INSECTS", "code_information": [{"code": "95133", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMNTX 5 STING INSECTS", "code_information": [{"code": "95134", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMONOGLOBULIN IGE", "code_information": [{"code": "82785", "type": "CPT"}, {"code": "3440100909", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.46, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 26.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNE ADMIN ORAL/NASAL", "code_information": [{"code": "90473", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNE ADMIN ORAL/NASAL ADDL", "code_information": [{"code": "90474", "type": "CPT"}], "standard_charges": [{"minimum": 11.37, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNE COMPLEX ASSAY", "code_information": [{"code": "86332", "type": "CPT"}], "standard_charges": [{"minimum": 24.37, "maximum": 30.26, "discounted_cash": 39.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNE GLOBULIN, POWDER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1566", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.46, "maximum": 78.46, "discounted_cash": 126.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNIZATION ADMIN EACH ADD", "code_information": [{"code": "90472", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNO CHEM PER SPEC", "code_information": [{"code": "88344", "type": "CPT"}, {"code": "3440103069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 181.81, "maximum": 1065.06, "gross_charge": 1098.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 933.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 823.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 768.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1065.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 768.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 823.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 933.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 878.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 181.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNO ELETROPHERS S", "code_information": [{"code": "86334", "type": "CPT"}, {"code": "3440101079", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 22.34, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 35.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 23.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY DIPSTICK", "code_information": [{"code": "83518", "type": "CPT"}], "standard_charges": [{"minimum": 9.64, "maximum": 20.92, "discounted_cash": 15.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY NOS", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "3440100937", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.27, "maximum": 134.83, "gross_charge": 139.0, "discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY QUAL/SEM", "code_information": [{"code": "83516", "type": "CPT"}, {"code": "3440100935", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.53, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 18.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY QUANT NO", "code_information": [{"code": "83520", "type": "CPT"}, {"code": "3440103104", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.27, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 27.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY QUANT RI", "code_information": [{"code": "83519", "type": "CPT"}, {"code": "3440100936", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.4, "maximum": 117.37, "gross_charge": 121.0, "discounted_cash": 29.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSAY TUMOR QUAL", "code_information": [{"code": "86294", "type": "CPT"}], "standard_charges": [{"minimum": 25.57, "maximum": 30.26, "discounted_cash": 41.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOASSEY TUMOR AN", "code_information": [{"code": "86301", "type": "CPT"}, {"code": "3440103082", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 20.81, "maximum": 144.53, "gross_charge": 149.0, "discounted_cash": 33.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 144.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOCYTOCHEMISTRY", "code_information": [{"code": "88342", "type": "CPT"}, {"code": "3440101243", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 57.12, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 57.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOCYTOCHEMISTRY", "code_information": [{"code": "88343", "type": "CPT"}, {"code": "3440101244", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 138.6, "maximum": 192.06, "gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 192.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 158.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMMUNODIFFUSION NES", "code_information": [{"code": "86329", "type": "CPT"}], "standard_charges": [{"minimum": 14.05, "maximum": 30.26, "discounted_cash": 22.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNODIFFUSION OUCHTERLONY", "code_information": [{"code": "86331", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 30.26, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOELECTROPHORESIS ASSAY", "code_information": [{"code": "86327", "type": "CPT"}], "standard_charges": [{"minimum": 29.92, "maximum": 68.53, "discounted_cash": 48.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOFLUOR ANTB 1ST", "code_information": [{"code": "88346", "type": "CPT"}, {"code": "3440103099", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 106.45, "maximum": 405.46, "gross_charge": 418.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 355.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 313.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 313.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 355.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 334.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 106.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOFLUOR ANTB ADD", "code_information": [{"code": "88350", "type": "CPT"}, {"code": "3440103100", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 79.28, "maximum": 301.67, "gross_charge": 311.0, "discounted_cash": 466.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 264.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 233.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 217.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 301.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 217.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 233.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 264.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 248.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 79.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN ASSAY", "code_information": [{"code": "86023", "type": "CPT"}], "standard_charges": [{"minimum": 12.46, "maximum": 30.26, "discounted_cash": 20.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOGLOBULIN SUBCL", "code_information": [{"code": "82787", "type": "CPT"}, {"code": "3440100910", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.02, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 12.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOHISTOCHEMICAL STAINS", "code_information": [{"code": "D0478", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOHISTOCHEMISTRY", "code_information": [{"code": "88341", "type": "CPT"}, {"code": "3440103028", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 74.51, "maximum": 182.01, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 74.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOLOGY PROCEDURE", "code_information": [{"code": "86849", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOSUPPRESSIVE DRUG NOC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7599", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY 2/> INJECTIONS", "code_information": [{"code": "95125", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY INJECTIONS", "code_information": [{"code": "95117", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95115", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMMUNOTHERAPY ONE INJECTION", "code_information": [{"code": "95120", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP CROWN BASE ALLOYS", "code_information": [{"code": "D6086", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP CROWN PORC TO BASE ALLOY", "code_information": [{"code": "D6082", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP CROWN PORC TO NOBLE ALLO", "code_information": [{"code": "D6083", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP CROWN PORC TO TITANIUM", "code_information": [{"code": "D6084", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP CROWN TITANIUM ALLOYS", "code_information": [{"code": "D6088", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP RETAIN PORC TO BASE ALLO", "code_information": [{"code": "D6098", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP RETAIN PORC TO TITANIUM", "code_information": [{"code": "D6120", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP RETAINER FOR FPD", "code_information": [{"code": "D6099", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP TESTICULAR LG*52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3882.06, "maximum": 5379.42, "gross_charge": 5545.8, "discounted_cash": 8318.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4713.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4159.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3882.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5379.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3882.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4159.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4713.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4436.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT FIXED DENT PART MAN", "code_information": [{"code": "D6117", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT FIXED DENT PART MAX", "code_information": [{"code": "D6116", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT INT FIXED DENT MAN", "code_information": [{"code": "D6118", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT REM DENT PART MAND", "code_information": [{"code": "D6113", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP/ABUT REM DENT PART MAX", "code_information": [{"code": "D6112", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMP/REV TUNNEL INTRA", "code_information": [{"code": "62350", "type": "CPT"}, {"code": "3430100738", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 11037.63, "gross_charge": 11379.0, "discounted_cash": 10196.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9672.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7028.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8534.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7965.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11037.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7965.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7001.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8534.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8089.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9672.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REM BONY W/COMP", "code_information": [{"code": "D7241", "type": "HCPCS"}], "standard_charges": [{"minimum": 3777.61, "maximum": 3777.61, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV COMP BONY", "code_information": [{"code": "D7240", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV PART BONY", "code_information": [{"code": "D7230", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPACT TOOTH REMOV SOFT TISS", "code_information": [{"code": "D7220", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL OI IMPLT SK TC ESP<100", "code_information": [{"code": "69716", "type": "CPT"}], "standard_charges": [{"minimum": 13981.9, "maximum": 13981.9, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13981.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPL SIZING GUIDE", "code_information": [{"code": "3100103814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL SMOOTH", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100104208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH 500CC*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH 500CC*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH 700CC*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 535CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 560CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 585CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 595CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2234.96, "maximum": 3097.01, "gross_charge": 3192.8, "discounted_cash": 4789.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3097.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2554.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 635CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 650CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2234.96, "maximum": 3097.01, "gross_charge": 3192.8, "discounted_cash": 4789.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3097.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2554.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 685CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 700CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2234.96, "maximum": 3097.01, "gross_charge": 3192.8, "discounted_cash": 4789.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3097.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2554.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 740CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 755CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2234.96, "maximum": 3097.01, "gross_charge": 3192.8, "discounted_cash": 4789.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3097.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2234.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2394.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2713.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2554.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 775CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 790CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HI 790CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HIGH 335", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HIGH 355", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HIGH 380", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH HIGH 415", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 330C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 350C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 375C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 400C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 430C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 470C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 490C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 500C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 525C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 545C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 560C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 605C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MOD 630C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1838.2, "maximum": 2547.22, "gross_charge": 2626.0, "discounted_cash": 3939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2547.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1838.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1969.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2232.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH MODERATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SMOOTH RND250CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SYS BIO-COMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1863.22, "maximum": 2581.89, "gross_charge": 2661.75, "discounted_cash": 3992.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2262.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1996.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1863.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2581.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1863.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1996.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2262.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2129.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SYS DISTAL BICE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL SYS PEC REPAIR*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL/REDO ELECTRD ANTRUM", "code_information": [{"code": "43881", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT AUDITORY BRAIN IMP", "code_information": [{"code": "S2235", "type": "HCPCS"}], "standard_charges": [{"minimum": 37793.41, "maximum": 37793.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37793.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61531", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61533", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRAIN ELECTRODES", "code_information": [{"code": "61760", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100104059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3712.8, "maximum": 5144.88, "gross_charge": 5304.0, "discounted_cash": 7956.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5144.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 330CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 345CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.14, "maximum": 2590.09, "gross_charge": 2670.2, "discounted_cash": 4005.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2590.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 375CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 375CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.14, "maximum": 2590.09, "gross_charge": 2670.2, "discounted_cash": 4005.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2590.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 380CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 995.4, "maximum": 1379.34, "gross_charge": 1422.0, "discounted_cash": 2133.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1379.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 995.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1066.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1208.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 405CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.14, "maximum": 2590.09, "gross_charge": 2670.2, "discounted_cash": 4005.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2590.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 445CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.14, "maximum": 2590.09, "gross_charge": 2670.2, "discounted_cash": 4005.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2590.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 445CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 485CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.14, "maximum": 2590.09, "gross_charge": 2670.2, "discounted_cash": 4005.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2590.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 545CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 550CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 560CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 580CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 580CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 595CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 615CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 615CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 615CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 620CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 620CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 640CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 655CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 685CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 685CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 690CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 740CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 750CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BREAST 800CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRST SZR 225", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT BRST SZR 475", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT COCHLEAR DEVICE", "code_information": [{"code": "69930", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 37793.41, "discounted_cash": 51329.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37793.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT CONNECTING BAR", "code_information": [{"code": "D6055", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT CROWN NOBLE ALLOYS", "code_information": [{"code": "D6087", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT EXPAN 225CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3712.8, "maximum": 5144.88, "gross_charge": 5304.0, "discounted_cash": 7956.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5144.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT EYE DRUG SYSTEM", "code_information": [{"code": "67027", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 24159.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT GEL SIZER", "code_information": [{"code": "3100104214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT GEL SZER 545", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT LEAD 50*MN10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT LEAD 50*MN10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5041.4, "maximum": 6985.94, "gross_charge": 7202.0, "discounted_cash": 10803.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6121.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5401.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5041.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6985.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5041.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5401.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6121.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5761.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT LEAD 50*MN10", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100203516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5041.4, "maximum": 6985.94, "gross_charge": 7202.0, "discounted_cash": 10803.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6121.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5401.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5041.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6985.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5041.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5401.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6121.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5761.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT LEAD 50CM*MN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT MAINTENANCE", "code_information": [{"code": "D6080", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT MANDIBLE FOR AUGMENT", "code_information": [{"code": "D7996", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NERVE END TO", "code_information": [{"code": "64787", "type": "CPT"}, {"code": "3480102195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "gross_charge": 5648.0, "discounted_cash": 8472.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5478.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4518.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEURO-GEN/RE", "code_information": [{"code": "64590", "type": "CPT"}, {"code": "3480102178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 57329.91, "gross_charge": 59103.0, "discounted_cash": 33484.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 50237.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23081.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 44327.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 41372.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 57329.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 41372.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22992.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 44327.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26563.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 50237.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 47282.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61864", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRDE ADDL", "code_information": [{"code": "61868", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRO", "code_information": [{"code": "64561", "type": "CPT"}, {"code": "3480103200", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 20089.67, "gross_charge": 20711.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17604.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14497.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20089.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14497.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17604.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16568.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRO", "code_information": [{"code": "64561", "type": "CPT"}, {"code": "3480103274", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 14027.17, "gross_charge": 14461.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12291.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10845.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10122.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14027.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10122.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10845.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12291.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11568.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRO", "code_information": [{"code": "64581", "type": "CPT"}, {"code": "3480103201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 20089.67, "gross_charge": 20711.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17604.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14497.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20089.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14497.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17604.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16568.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRO", "code_information": [{"code": "64581", "type": "CPT"}, {"code": "3480103275", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 14027.17, "gross_charge": 14461.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12291.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10845.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10122.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14027.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10122.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10845.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12291.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11568.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61863", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODE", "code_information": [{"code": "61867", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61850", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "61860", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROELECTRODES", "code_information": [{"code": "64553", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 30305.84, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT NEUROSTIM ARRAYS", "code_information": [{"code": "61886", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "discounted_cash": 47530.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT PROCEDURE", "code_information": [{"code": "D6199", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT PROPEL CONTO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SEMI-IMP HEAR", "code_information": [{"code": "S2230", "type": "HCPCS"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER", "code_information": [{"code": "3100103927", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 195CC*", "code_information": [{"code": "3100202397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 315CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 350CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 82.74, "maximum": 114.65, "gross_charge": 118.2, "discounted_cash": 177.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 375CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 395CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 400CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 501.9, "maximum": 695.49, "gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 440CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 490CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 525CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 535*R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 545CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 550CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 560CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 560CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 580CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 580CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 595*R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 595CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 595CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 615CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 615CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 615CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 620CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 640CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 655C*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 685CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 690C*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 700*R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 740C*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SIZER 790*R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 533.4, "maximum": 739.14, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 739.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 533.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 571.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 647.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SM JNT *AR89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPEED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1778.7, "maximum": 2464.77, "gross_charge": 2541.0, "discounted_cash": 3811.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2159.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1905.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1778.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2464.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1778.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1905.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2159.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2032.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPEEDBRIDGE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2411.5, "maximum": 3341.65, "gross_charge": 3445.0, "discounted_cash": 5167.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3341.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2411.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2583.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2928.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPEEDBRIDGE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5294.61, "maximum": 7336.82, "gross_charge": 7563.74, "discounted_cash": 11345.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6429.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5672.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5294.61, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7336.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5294.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5672.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6429.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6050.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINAL CANAL CATH", "code_information": [{"code": "62351", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7959.27, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SPINE INFUSION PUMP", "code_information": [{"code": "62361", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 19559.98, "discounted_cash": 27298.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19559.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SR MCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SR MCP SZ SM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT STABILIZER B", "code_information": [{"code": "3100202480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.8, "discounted_cash": 151.2, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED CROWN", "code_information": [{"code": "D6065", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED MTL CROWN", "code_information": [{"code": "D6066", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED MTL CROWN", "code_information": [{"code": "D6067", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6075", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6076", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SUPPORTED RETAINER", "code_information": [{"code": "D6077", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2471.7, "maximum": 3425.07, "gross_charge": 3531.0, "discounted_cash": 5296.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3001.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2648.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2471.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3425.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2471.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2648.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3001.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2824.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM BICEP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM MPFL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3070.2, "maximum": 4254.42, "gross_charge": 4386.0, "discounted_cash": 6579.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3728.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3289.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3070.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4254.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3070.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3289.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3728.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3508.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT SYSTEM MPFL*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3630.9, "maximum": 5031.39, "gross_charge": 5187.0, "discounted_cash": 7780.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4408.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3890.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3630.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5031.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3630.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3890.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4408.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT TCAT PULM VLV PERQ", "code_information": [{"code": "33477", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT TESTICULAR M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLANT URETER IN BOWEL", "code_information": [{"code": "50800", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33975", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT VENTRICULAR DEVICE", "code_information": [{"code": "33976", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANT/REPLACE HEAR", "code_information": [{"code": "69710", "type": "CPT"}, {"code": "3340102463", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 13981.9, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13981.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLANTATION OF MESH", "code_information": [{"code": "49568", "type": "CPT"}, {"code": "3480102003", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9895.94, "gross_charge": 10202.0, "discounted_cash": 15303.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9895.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8161.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLNT BIO IMPLNT FO", "code_information": [{"code": "15777", "type": "CPT"}, {"code": "3480101372", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2188.07, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 5836.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT FIXED DENT MAND", "code_information": [{"code": "D6115", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT FIXED DENT MAX", "code_information": [{"code": "D6114", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT REMOV DENT MAND", "code_information": [{"code": "D6111", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLNT/ABUT REMOV DENT MAX", "code_information": [{"code": "D6110", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT ANT SGM IO NBIO RX SYS", "code_information": [{"code": "660T", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 235CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1773.8, "maximum": 2457.98, "gross_charge": 2534.0, "discounted_cash": 3801.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2457.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2027.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 255CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1773.8, "maximum": 2457.98, "gross_charge": 2534.0, "discounted_cash": 3801.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2457.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2027.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 275CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1773.8, "maximum": 2457.98, "gross_charge": 2534.0, "discounted_cash": 3801.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2457.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1773.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1900.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2153.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2027.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 425CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 445CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 470CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 500CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 525CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT BRST GEL 550CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT CRAN BONE FLAP TO ABDO", "code_information": [{"code": "61316", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT SYSTEM TENODES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV GEN", "code_information": [{"code": "268T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "discounted_cash": 47530.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV LEAD", "code_information": [{"code": "267T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "discounted_cash": 5208.11, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS DEV TOTAL", "code_information": [{"code": "266T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "discounted_cash": 72293.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ NTRSTRML CRNL RNG SEG", "code_information": [{"code": "65785", "type": "CPT"}], "standard_charges": [{"minimum": 6993.18, "maximum": 6993.18, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ OSSEOINTEGRAT", "code_information": [{"code": "69714", "type": "CPT"}, {"code": "3480102235", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 13430.15, "maximum": 32598.79, "gross_charge": 33607.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28565.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25205.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23524.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32598.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23524.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25205.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28565.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26885.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13981.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPORTED LIPODOX INJ", "code_information": [{"code": "Q2049", "type": "HCPCS"}], "standard_charges": [{"minimum": 565.88, "maximum": 565.88, "discounted_cash": 628.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 565.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPRESSION AND CUSTO", "code_information": [{"code": "21085", "type": "CPT"}, {"code": "3480101458", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 157.53, "maximum": 1692.65, "gross_charge": 1745.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1692.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1396.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMPRESSION CASTING FT", "code_information": [{"code": "S0395", "type": "HCPCS"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMTERPRETE DIAGNOSTIC IMAGE", "code_information": [{"code": "D0391", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IMUGLUCERASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1786", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.94, "maximum": 43.94, "discounted_cash": 70.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 43.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN GEMCITABINE HCL NOS 200MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9201", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.65, "maximum": 3.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN GNOTYP CD44 EXONS 2 3 6", "code_information": [{"code": "191U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IN SITU HYBRIDIZTN E", "code_information": [{"code": "88365", "type": "CPT"}, {"code": "3440101247", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 109.0, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 109.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IN111 CAPROMAB", "code_information": [{"code": "A9507", "type": "HCPCS"}], "standard_charges": [{"minimum": 2586.47, "maximum": 2586.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2586.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 IBRITUMOMAB, DX", "code_information": [{"code": "A9542", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IN111 OXYQUINOLINE", "code_information": [{"code": "A9547", "type": "HCPCS"}], "standard_charges": [{"minimum": 1763.83, "maximum": 1763.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1763.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN111 PENTETATE", "code_information": [{"code": "A9548", "type": "HCPCS"}], "standard_charges": [{"minimum": 459.49, "maximum": 459.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 459.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INACTIVATED JE VACC IM", "code_information": [{"code": "90738", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB POLY INSERT*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5221.58, "maximum": 7235.61, "gross_charge": 7459.4, "discounted_cash": 11189.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7235.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5221.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5594.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6340.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5967.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIB TRAY*2002229", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL BASE STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL BASE STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL MID STEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL MID STEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TOP STEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TOP STEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TOP STEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TOP STEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INB TIBIAL TRAY*2202", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INBONE TIBIAL TRAY*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3354.26, "maximum": 4648.04, "gross_charge": 4791.8, "discounted_cash": 7187.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4648.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4073.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3833.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [{"code": "642", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5248.22, "maximum": 5248.22, "discounted_cash": 14550.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5248.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INC DEEP W/OPNG BONE", "code_information": [{"code": "23935", "type": "CPT"}, {"code": "3340102336", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "gross_charge": 5737.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC FLEXOR TENDON SH", "code_information": [{"code": "25001", "type": "CPT"}, {"code": "3480101580", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC IMPLTJ NEUROSTIM", "code_information": [{"code": "64581", "type": "CPT"}, {"code": "3480102174", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 23750.45, "gross_charge": 24485.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20812.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18363.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17139.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23750.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17139.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18363.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20812.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19588.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INC OF TENDON SHEATH", "code_information": [{"code": "25000", "type": "CPT"}, {"code": "3480101579", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6336.04, "gross_charge": 6532.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6336.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5225.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN EA SEP/ADDL", "code_information": [{"code": "11107", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCAL BX SKN SINGLE LES", "code_information": [{"code": "11106", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG CERV", "code_information": [{"code": "22210", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS DEEP HUM/ELBOW", "code_information": [{"code": "23935", "type": "CPT"}, {"code": "3340102306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "gross_charge": 5737.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCIS RMVL FB SUBQ C", "code_information": [{"code": "10121", "type": "CPT"}, {"code": "3340102350", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3891.64, "gross_charge": 4012.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3891.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3209.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & DRAIN BLADD", "code_information": [{"code": "51040", "type": "CPT"}, {"code": "3480103173", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & DRAIN BLADD", "code_information": [{"code": "51040", "type": "CPT"}, {"code": "3480103218", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51020", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE & TREAT BLADDER", "code_information": [{"code": "51030", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE BILE DUCT SPHINCTER", "code_information": [{"code": "47460", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": [{"code": "51045", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1767.1, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE DIAPHRAGM NERVE", "code_information": [{"code": "64746", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE EXTERNAL HEMORRHOID", "code_information": [{"code": "46083", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE FINGER TENDON", "code_information": [{"code": "26055", "type": "CPT"}, {"code": "3480101618", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HAND/FINGER TENDON", "code_information": [{"code": "26460", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64763", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE HIP/THIGH NERVE", "code_information": [{"code": "64766", "type": "CPT"}], "standard_charges": [{"minimum": 2242.36, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR", "code_information": [{"code": "69801", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69915", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EAR NERVE", "code_information": [{"code": "69950", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65860", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65865", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65870", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65875", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65880", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE STRANDS", "code_information": [{"code": "67030", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE NERVE BACK OF HEAD", "code_information": [{"code": "64744", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR TREATMENT", "code_information": [{"code": "61770", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL REPAIR", "code_information": [{"code": "62121", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN BIOPSY", "code_information": [{"code": "61750", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61720", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61556", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/SUTURES", "code_information": [{"code": "61557", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1927.74, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2109.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE TEAR DUCT OPENING", "code_information": [{"code": "68440", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE TENDON(S) & MUSCLE(S)", "code_information": [{"code": "23406", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE WRIST/FOREARM TENDON", "code_information": [{"code": "25290", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR SAC", "code_information": [{"code": "68420", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISE/GRAFT MIDFOOT BONES", "code_information": [{"code": "28305", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION & DRAINAGE", "code_information": [{"code": "10180", "type": "CPT"}, {"code": "3480101295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4478.49, "gross_charge": 4617.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3924.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3462.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3231.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4478.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3231.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3462.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3924.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3693.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAG", "code_information": [{"code": "27301", "type": "CPT"}, {"code": "3480101680", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5373.8, "gross_charge": 5540.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4709.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4155.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3878.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5373.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3878.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4155.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4709.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4432.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAG", "code_information": [{"code": "46060", "type": "CPT"}, {"code": "3480101971", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5209.87, "gross_charge": 5371.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4565.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4028.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3759.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5209.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3759.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4028.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4565.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4296.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION AND DRAINAG", "code_information": [{"code": "54700", "type": "CPT"}, {"code": "3480102068", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION EXTRADURAL", "code_information": [{"code": "64772", "type": "CPT"}, {"code": "3480102193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ACHILLES TENDON", "code_information": [{"code": "27605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL ABSCESS", "code_information": [{"code": "46050", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANAL SEPTUM", "code_information": [{"code": "46070", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ANKLE BONE", "code_information": [{"code": "28302", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47420", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BILE DUCT", "code_information": [{"code": "47425", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61541", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BRAIN TISSUE", "code_information": [{"code": "61567", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BROW NERVE", "code_information": [{"code": "64732", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHIN NERVE", "code_information": [{"code": "64736", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69420", "type": "CPT"}, {"code": "3480103154", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 886.58, "gross_charge": 914.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 776.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 639.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 886.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 639.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 776.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 731.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43020", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "65850", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYE", "code_information": [{"code": "66172", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID FOLD", "code_information": [{"code": "67715", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FACIAL NERVE", "code_information": [{"code": "64742", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FIBULA", "code_information": [{"code": "27707", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER T", "code_information": [{"code": "26455", "type": "CPT"}, {"code": "3340102374", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4245.69, "gross_charge": 4377.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4245.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3501.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FINGER TENDON", "code_information": [{"code": "26060", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF FOOT FASCIA", "code_information": [{"code": "28008", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLAD", "code_information": [{"code": "47490", "type": "CPT"}, {"code": "3480103140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2301.1, "maximum": 6071.23, "gross_charge": 6259.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5320.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4694.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4381.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6071.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4381.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4694.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5320.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5007.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEEL BONE", "code_information": [{"code": "28300", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8687.35, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27000", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4985.78, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27005", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDONS", "code_information": [{"code": "27006", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF IRIS", "code_information": [{"code": "66505", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW JOINT", "code_information": [{"code": "21010", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF KNEE JOINT", "code_information": [{"code": "27435", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LABIAL F", "code_information": [{"code": "40806", "type": "CPT"}, {"code": "3480101900", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "gross_charge": 804.0, "discounted_cash": 842.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 683.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 580.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 603.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 779.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 578.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 603.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 683.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 643.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LINGUAL", "code_information": [{"code": "41010", "type": "CPT"}, {"code": "3480101903", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "gross_charge": 1745.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1692.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1396.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LINGUAL", "code_information": [{"code": "41100", "type": "CPT"}, {"code": "3480101904", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 1692.65, "gross_charge": 1745.0, "discounted_cash": 842.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 580.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1692.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1221.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 578.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1483.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1396.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIVER DUCT", "code_information": [{"code": "47400", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28307", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSAL", "code_information": [{"code": "28308", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF METATARSALS", "code_information": [{"code": "28309", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF MIDFOOT BONES", "code_information": [{"code": "28304", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PALM TENDON", "code_information": [{"code": "26450", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}, {"code": "3480103188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}, {"code": "3480103250", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46040", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2670.89, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF RECTAL ABSCESS", "code_information": [{"code": "46045", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPERM DUCT", "code_information": [{"code": "55200", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1927.74, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF STOMACH NERVES", "code_information": [{"code": "64755", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TENDON & MUSCLE", "code_information": [{"code": "23405", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27450", "type": "CPT"}, {"code": "3340102412", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2398.2, "maximum": 4985.78, "gross_charge": 3426.0, "discounted_cash": 5139.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2912.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2569.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2398.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3323.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2398.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2569.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2912.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2740.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27306", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27307", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27392", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA", "code_information": [{"code": "27705", "type": "CPT"}, {"code": "3340102450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 12838.92, "gross_charge": 13236.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11250.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9927.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9265.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12838.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9265.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9927.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11250.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10588.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TIBIA & FIBULA", "code_information": [{"code": "27709", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDON", "code_information": [{"code": "28010", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TOE TENDONS", "code_information": [{"code": "28011", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF TONGUE NERVE", "code_information": [{"code": "64740", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53010", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53025", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF VAGUS NERVE", "code_information": [{"code": "64760", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3345.07, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31601", "type": "CPT"}], "standard_charges": [{"minimum": 3345.07, "maximum": 3345.07, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31603", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3345.07, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3345.07, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31610", "type": "CPT"}], "standard_charges": [{"minimum": 3345.07, "maximum": 3345.07, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION OF WRIST CAPSULE", "code_information": [{"code": "25085", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION/DRAIN ABSCESS EXTRA", "code_information": [{"code": "D7521", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION/DRAIN ABSCESS INTRA", "code_information": [{"code": "D7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCISION/FIXATION OF FEMUR", "code_information": [{"code": "27165", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCOBOTULINUMTOXIN A", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0588", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.2, "maximum": 5.2, "discounted_cash": 8.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCOMPL DONOR EGG CASE RATE", "code_information": [{"code": "S4023", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INCOMPLETE ENDODONTIC TX", "code_information": [{"code": "D3332", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDIRECT IMMUNOFLUORESCENCE", "code_information": [{"code": "D0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 AUTO PLATELET", "code_information": [{"code": "A9571", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 AUTO WBC", "code_information": [{"code": "A9570", "type": "HCPCS"}], "standard_charges": [{"minimum": 3527.66, "maximum": 3527.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3527.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INDIUM IN-111 PENTETREOTIDE", "code_information": [{"code": "A9572", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 17-24 WEEKS", "code_information": [{"code": "S2260", "type": "HCPCS"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 25-28 WKS", "code_information": [{"code": "S2265", "type": "HCPCS"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 29-31 WKS", "code_information": [{"code": "S2266", "type": "HCPCS"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INDUCED ABORTION 32 OR MORE", "code_information": [{"code": "S2267", "type": "HCPCS"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INF ADAPT TALAR DOME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9660.0, "maximum": 13386.0, "gross_charge": 13800.0, "discounted_cash": 20700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13386.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFANT SAFETY CLASS", "code_information": [{"code": "S9447", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFCTS AGNT DNA/RNA", "code_information": [{"code": "87500", "type": "CPT"}, {"code": "3440101200", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 367.63, "gross_charge": 379.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 284.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 367.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 284.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 303.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECT AGENT DET BY", "code_information": [{"code": "U0003", "type": "HCPCS"}, {"code": "3440103094", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 41.83, "maximum": 382.18, "gross_charge": 394.0, "discounted_cash": 591.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 334.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 275.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 382.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 275.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 334.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 315.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFECT DIS PATH SPEC", "code_information": [{"code": "3440103096", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 591.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "758", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4975.24, "maximum": 4975.24, "discounted_cash": 11081.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4975.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "757", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9360.85, "maximum": 9360.85, "discounted_cash": 16653.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9360.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "759", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3907.27, "maximum": 3907.27, "discounted_cash": 7214.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3907.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "854", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9820.13, "maximum": 9820.13, "discounted_cash": 22755.62, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9820.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "853", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22598.22, "maximum": 22598.22, "discounted_cash": 55815.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22598.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "855", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5823.09, "maximum": 5823.09, "discounted_cash": 18999.86, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5823.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFILTRATION THERA DRUG", "code_information": [{"code": "D9613", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "727", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5291.26, "maximum": 5291.26, "discounted_cash": 18097.76, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5291.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [{"code": "728", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4879.94, "maximum": 4879.94, "discounted_cash": 8932.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4879.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [{"code": "386", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6357.38, "maximum": 6357.38, "discounted_cash": 10847.49, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6357.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [{"code": "385", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7812.7, "maximum": 7812.7, "discounted_cash": 17493.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7812.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC", "code_information": [{"code": "387", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5266.05, "maximum": 5266.05, "discounted_cash": 7637.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5266.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLATION DEVI QL253", "code_information": [{"code": "3100204895", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.44, "discounted_cash": 236.16, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION DEVICE", "code_information": [{"code": "3100104583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION DEVICE 10C", "code_information": [{"code": "3100204539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.24, "discounted_cash": 262.86, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION DEVICE*AC3", "code_information": [{"code": "3100206601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION ENCORE", "code_information": [{"code": "3100102177", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLIXIMAB NOT BIOSIMIL 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1745", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.67, "maximum": 31.67, "discounted_cash": 51.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLOW/OUTFLOW TUBIN", "code_information": [{"code": "3100209631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLUENZA A AG IF", "code_information": [{"code": "87276", "type": "CPT"}], "standard_charges": [{"minimum": 16.07, "maximum": 24.03, "discounted_cash": 25.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA A/B AG EIA", "code_information": [{"code": "87400", "type": "CPT"}, {"code": "3440103026", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.13, "maximum": 102.82, "gross_charge": 106.0, "discounted_cash": 22.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 90.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 90.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA ASSAY W/OPTIC", "code_information": [{"code": "87804", "type": "CPT"}], "standard_charges": [{"minimum": 16.55, "maximum": 24.03, "discounted_cash": 26.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA B AG IF", "code_information": [{"code": "87275", "type": "CPT"}], "standard_charges": [{"minimum": 12.25, "maximum": 24.03, "discounted_cash": 19.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB 1+", "code_information": [{"code": "87501", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 51.31, "discounted_cash": 82.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB ADDL", "code_information": [{"code": "87503", "type": "CPT"}], "standard_charges": [{"minimum": 29.22, "maximum": 41.83, "discounted_cash": 46.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS ANTIBODY", "code_information": [{"code": "86710", "type": "CPT"}], "standard_charges": [{"minimum": 13.55, "maximum": 30.26, "discounted_cash": 21.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS VACC", "code_information": [{"code": "90656", "type": "CPT"}, {"code": "3480102241", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 18.92, "maximum": 55.18, "gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS VACC", "code_information": [{"code": "90658", "type": "CPT"}, {"code": "3400300324", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 16.09, "maximum": 55.18, "gross_charge": 50.0, "discounted_cash": 75.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 42.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 48.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 37.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 42.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFLUENZA VIRUS VACCINE, NOS", "code_information": [{"code": "Q2039", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X12*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X14*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X18*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X22*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X24*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X26*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X28*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206497", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X30*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X32*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X34*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X36*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X38*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X40*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X42*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X44*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X46*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMP 2.0X48*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME IMPLANT2.0*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFRAME INST KIT*EXI", "code_information": [{"code": "3100206329", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INFRARED THERAPY", "code_information": [{"code": "97026", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROA", "code_information": [{"code": "61590", "type": "CPT"}, {"code": "3340102484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6211.31, "maximum": 10087.03, "gross_charge": 10399.0, "discounted_cash": 15598.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8839.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7799.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7279.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10087.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7279.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7799.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8839.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8319.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFRATEMPORAL APPROACH/SKULL", "code_information": [{"code": "61591", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFUSE RADIOACTIVE MATERIALS", "code_information": [{"code": "77750", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP 20ML*8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16706.2, "maximum": 23150.02, "gross_charge": 23866.0, "discounted_cash": 35799.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20286.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17899.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16706.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23150.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16706.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17899.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20286.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19092.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP 40ML *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 21718.06, "maximum": 30095.02, "gross_charge": 31025.8, "discounted_cash": 46538.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 26371.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 23269.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21718.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 30095.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21718.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 23269.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 26371.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24820.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP*8637-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19171.6, "maximum": 26566.36, "gross_charge": 27388.0, "discounted_cash": 41082.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23279.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20541.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19171.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26566.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19171.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20541.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23279.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21910.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION PUMP*8637-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19171.6, "maximum": 26566.36, "gross_charge": 27388.0, "discounted_cash": 41082.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23279.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20541.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19171.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26566.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19171.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20541.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23279.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21910.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSION THER OTHER THAN CHE", "code_information": [{"code": "Q0081", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE ADDL 60 MIN", "code_information": [{"code": "95079", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGEST CHALLENGE INI 120 MIN", "code_information": [{"code": "95076", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [{"code": "351", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7212.62, "maximum": 7212.62, "discounted_cash": 16251.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7212.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [{"code": "350", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10843.83, "maximum": 10843.83, "discounted_cash": 26794.95, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10843.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "352", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4943.88, "maximum": 4943.88, "discounted_cash": 12381.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4943.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHALATION SOLUTION FOR DME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7699", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.66, "maximum": 8.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INHIBIN A", "code_information": [{"code": "86336", "type": "CPT"}], "standard_charges": [{"minimum": 15.59, "maximum": 30.26, "discounted_cash": 25.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INIT IP CON NEW/EST", "code_information": [{"code": "99251", "type": "CPT"}, {"code": "3500102292", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 91.7, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT IP CON NEW/EST", "code_information": [{"code": "99252", "type": "CPT"}, {"code": "3500102293", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 138.6, "maximum": 192.06, "gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 192.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 158.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT IP CON NEW/EST", "code_information": [{"code": "99253", "type": "CPT"}, {"code": "3500102294", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 184.1, "maximum": 255.11, "gross_charge": 263.0, "discounted_cash": 394.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 255.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT IP CON NEW/EST", "code_information": [{"code": "99254", "type": "CPT"}, {"code": "3500102295", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 231.0, "maximum": 320.1, "gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 320.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT IP CON NEW/EST", "code_information": [{"code": "99255", "type": "CPT"}, {"code": "3500102296", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 277.2, "maximum": 384.12, "gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 384.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 316.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INIT/SUB PSYCH CARE M 1ST 30", "code_information": [{"code": "G2214", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INITIAL TREATMENT OF BURN(S)", "code_information": [{"code": "16000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INITIAT MED ASSIST TX IN ER", "code_information": [{"code": "G2213", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INITL HOSP CARE/DAY", "code_information": [{"code": "99221", "type": "CPT"}, {"code": "3500102265", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 263.9, "maximum": 365.69, "gross_charge": 377.0, "discounted_cash": 565.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 320.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 365.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 320.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 301.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITL HOSP CARE/DAY", "code_information": [{"code": "99222", "type": "CPT"}, {"code": "3500102266", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITL HOSP CARE/DAY", "code_information": [{"code": "99223", "type": "CPT"}, {"code": "3500102267", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 532.7, "maximum": 738.17, "gross_charge": 761.0, "discounted_cash": 1141.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 646.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 570.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 532.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 738.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 532.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 570.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 646.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 608.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITL OBS CARE/DAY 3", "code_information": [{"code": "99218", "type": "CPT"}, {"code": "3500102262", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 261.1, "maximum": 361.81, "gross_charge": 373.0, "discounted_cash": 559.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 317.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 261.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 361.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 261.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 279.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 317.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 298.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITL OBS CARE/DAY 5", "code_information": [{"code": "99219", "type": "CPT"}, {"code": "3500102263", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITL OBS CARE/DAY 7", "code_information": [{"code": "99220", "type": "CPT"}, {"code": "3500102264", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 486.5, "maximum": 674.15, "gross_charge": 695.0, "discounted_cash": 1042.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 590.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 521.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 486.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 674.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 486.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 521.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 590.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 556.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ABDOMINAL SHUNT", "code_information": [{"code": "49427", "type": "CPT"}, {"code": "3430102311", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 668.39, "maximum": 1656.76, "gross_charge": 1708.0, "discounted_cash": 2562.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1451.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1281.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1195.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1656.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1195.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1281.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1451.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1366.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ACETAMINOPHEN -FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0134", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "discounted_cash": 0.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ALLOPURINOL SODIUM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0206", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.43, "maximum": 5.43, "discounted_cash": 8.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ALYMSYS 10 MG", "code_information": [{"code": "Q5126", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.81, "maximum": 58.81, "discounted_cash": 97.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANDEXXA, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7169", "type": "HCPCS"}], "standard_charges": [{"minimum": 229.01, "maximum": 229.01, "discounted_cash": 212.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 229.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANEST BRACHIAL P", "code_information": [{"code": "64415", "type": "CPT"}, {"code": "3300100257", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1565.58, "gross_charge": 1614.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1371.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1210.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1565.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1129.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1210.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1371.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1291.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ANEST FEMORAL NE", "code_information": [{"code": "64447", "type": "CPT"}, {"code": "3300100258", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1305.62, "gross_charge": 1346.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1144.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1009.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 942.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1305.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 942.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1009.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1144.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1076.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ANIFROLUMAB-FNIA 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.14, "maximum": 17.14, "discounted_cash": 27.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ANS&/STR W/IMG T", "code_information": [{"code": "64479", "type": "CPT"}, {"code": "3430100745", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ANS&/STR W/IMG T", "code_information": [{"code": "64480", "type": "CPT"}, {"code": "3430102295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 1960.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ANS&/STR W/IMG T", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "3430102294", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ANS&/STR W/IMG T", "code_information": [{"code": "64484", "type": "CPT"}, {"code": "3430102299", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 1960.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ APOTEX/BENDAMUSTINE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.13, "maximum": 24.13, "discounted_cash": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ARIPIPRAZOLE EXT REL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0401", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.81, "maximum": 6.81, "discounted_cash": 10.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ARTHRO INTERMEDI", "code_information": [{"code": "20605", "type": "CPT"}, {"code": "3480101435", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ARTHRO MAJOR JOI", "code_information": [{"code": "20610", "type": "CPT"}, {"code": "3480101436", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ AVAL ALFA-NQPT 4MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.0, "maximum": 76.0, "discounted_cash": 122.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 76.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BELANTAMAB MAFODOT BLMF", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9037", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.28, "maximum": 45.28, "discounted_cash": 75.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 45.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BENDAMUSTINE, BAXTER 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9059", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.13, "maximum": 24.13, "discounted_cash": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON IM 1 MCG", "code_information": [{"code": "Q3027", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.28, "maximum": 54.28, "discounted_cash": 86.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 54.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON SQ 1 MCG", "code_information": [{"code": "Q3028", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ BIMATOPROST ITC IMP1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7351", "type": "HCPCS"}], "standard_charges": [{"minimum": 206.19, "maximum": 206.19, "discounted_cash": 331.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 206.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIPERIDEN LACTATE/5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.07, "maximum": 2.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CALCITRIOL PER 0.1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0636", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.8, "maximum": 0.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, BAXTER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0689", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.24, "maximum": 1.24, "discounted_cash": 1.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, HIKMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0688", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.08, "maximum": 1.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFTOLOZANE TAZOBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0695", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.29, "maximum": 7.29, "discounted_cash": 11.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CELIAC PLEXUS", "code_information": [{"code": "64530", "type": "CPT"}, {"code": "3430100765", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2293.08, "gross_charge": 2364.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2009.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1773.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1654.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2293.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1654.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1773.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2009.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1891.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CLADRIBINE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9065", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.6, "maximum": 16.6, "discounted_cash": 25.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CODEINE PHOSPHATE /30 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0745", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"minimum": 127.35, "maximum": 127.35, "discounted_cash": 204.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 127.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CROTALIDAE IM F(AB')2 EQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0841", "type": "HCPCS"}], "standard_charges": [{"minimum": 1047.29, "maximum": 1047.29, "discounted_cash": 1465.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1047.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUTAQUIG 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1551", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.8, "maximum": 13.8, "discounted_cash": 22.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.83, "maximum": 15.83, "discounted_cash": 25.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOS DR.REDDY'S 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9072", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 6.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.76, "maximum": 1.76, "discounted_cash": 2.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 232.8, "maximum": 232.8, "discounted_cash": 372.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DELANDISTROGENE MOX ROKL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1413", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 5295024.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DESMOPRESSIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.27, "maximum": 6.27, "discounted_cash": 10.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DEXAMETHASONE ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1094", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.7, "maximum": 13.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DICLOFENAC SODIUM 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1130", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ DIHYDROERGOTAMINE MESYLT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1110", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.12, "maximum": 37.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DISCOGRAM CERVIC", "code_information": [{"code": "62291", "type": "CPT"}, {"code": "3430100734", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 668.39, "maximum": 1260.03, "gross_charge": 1299.0, "discounted_cash": 1948.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1104.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 909.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1260.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 909.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 974.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1104.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1039.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DISCOGRAM LUMBAR", "code_information": [{"code": "62290", "type": "CPT"}, {"code": "3430100733", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 668.39, "maximum": 1087.37, "gross_charge": 1121.0, "discounted_cash": 1681.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 952.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 840.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1087.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 784.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 840.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 952.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 896.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 456.57, "maximum": 456.57, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DX/TH AGT PVRT F", "code_information": [{"code": "64490", "type": "CPT"}, {"code": "3480102229", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DX/TH AGT PVRT F", "code_information": [{"code": "64491", "type": "CPT"}, {"code": "3430102298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DX/TH AGT PVRT F", "code_information": [{"code": "64493", "type": "CPT"}, {"code": "3430100756", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DX/TH AGT PVRT F", "code_information": [{"code": "64494", "type": "CPT"}, {"code": "3430100757", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFGART-ALFA 2MG HYA-QVFC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9334", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.17, "maximum": 33.17, "discounted_cash": 51.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.07, "maximum": 32.07, "discounted_cash": 51.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFLAPEGRASTIM-XNST 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1449", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.74, "maximum": 27.74, "discounted_cash": 47.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ENFORT VEDO-EJFV 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9177", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.2, "maximum": 36.2, "discounted_cash": 56.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EPCORITAMAB-BYSP 0.16 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9321", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.78, "maximum": 53.78, "discounted_cash": 86.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 53.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EPIDURAL BLOOD/C", "code_information": [{"code": "62273", "type": "CPT"}, {"code": "3300100256", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2373.59, "gross_charge": 2447.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2079.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1835.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1712.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2373.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1712.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1835.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2079.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1957.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EPIDURAL BLOOD/C", "code_information": [{"code": "62273", "type": "CPT"}, {"code": "3430100732", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2947.83, "gross_charge": 3039.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2947.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2431.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ESMOLOL HCL WG CRIT CARE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1806", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.42, "maximum": 0.42, "discounted_cash": 0.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FACET CERV/THORA", "code_information": [{"code": "64472", "type": "CPT"}, {"code": "3430100749", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1164.8, "maximum": 1614.08, "gross_charge": 1664.0, "discounted_cash": 2496.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1614.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1331.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FE-BASED MR CONTRAST,1ML", "code_information": [{"code": "Q9953", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.7, "maximum": 69.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FENSOLVI 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1951", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.71, "maximum": 131.71, "discounted_cash": 211.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 131.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.09, "maximum": 1.09, "discounted_cash": 1.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC PYROPHOSPHATE CIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1443", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FILGRASTIM EXCL BIOSIMIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "discounted_cash": 1.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FLUPHENAZINE HCL 1.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2679", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.89, "maximum": 7.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOR MYELOGRAPHY/", "code_information": [{"code": "62284", "type": "CPT"}, {"code": "3270100006", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 668.39, "gross_charge": 626.0, "discounted_cash": 939.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 532.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 469.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 438.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 607.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 438.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 469.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 532.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 500.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FOSNETUPITANT, PALONOSET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1454", "type": "HCPCS"}], "standard_charges": [{"minimum": 708.35, "maximum": 708.35, "discounted_cash": 1115.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 708.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GADOTERATE MEGLUMI 0.1ML", "code_information": [{"code": "A9575", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.13, "maximum": 0.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GANG SPHENOP", "code_information": [{"code": "64505", "type": "CPT"}, {"code": "3430100762", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 638.26, "gross_charge": 658.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 559.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 460.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 638.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 460.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 559.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 526.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GANGLION STELATE", "code_information": [{"code": "64510", "type": "CPT"}, {"code": "3430100763", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2947.83, "gross_charge": 3039.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2947.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2431.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GEMCITABINE HCL (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9196", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.24, "maximum": 4.24, "discounted_cash": 14.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GIVOSIRAN 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.02, "maximum": 112.02, "discounted_cash": 180.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 112.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLOFITAMAB GXBM, 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9286", "type": "HCPCS"}], "standard_charges": [{"minimum": 2707.25, "maximum": 2707.25, "discounted_cash": 4350.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.88, "maximum": 128.88, "discounted_cash": 198.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 128.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN SODIUM PER 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1642", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.34, "maximum": 4.34, "discounted_cash": 7.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.8, "maximum": 55.8, "discounted_cash": 64.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HUMAN FIBRINOGEN CON NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7178", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.45, "maximum": 1.45, "discounted_cash": 2.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.71, "maximum": 14.71, "discounted_cash": 29.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IMIP 4 CILAS 4 RELEB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0742", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.45, "maximum": 2.45, "discounted_cash": 3.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ INOTUZUMAB OZOGAM 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9229", "type": "HCPCS"}], "standard_charges": [{"minimum": 2580.15, "maximum": 2580.15, "discounted_cash": 4145.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2580.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IRINOTECAN LIPOSOME 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9205", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.44, "maximum": 63.44, "discounted_cash": 99.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 63.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IRON DEXTRAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.31, "maximum": 17.31, "discounted_cash": 27.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IVIG PRIVIGEN 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1459", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.86, "maximum": 47.86, "discounted_cash": 77.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LABETALOL HCL HIKMA, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1921", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.37, "maximum": 2.37, "discounted_cash": 4.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.72, "discounted_cash": 1.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEVOCARNITINE PER 1 GM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1955", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.14, "maximum": 35.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEVOLEUCOVORIN NOS 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0641", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "discounted_cash": 0.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LON TESIRIN-LPYL 0.075MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.49, "maximum": 200.49, "discounted_cash": 322.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 200.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LUSPATERCEPT-AAMT 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.98, "maximum": 39.98, "discounted_cash": 64.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LUXTURNA 1 BILLION VEC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3398", "type": "HCPCS"}], "standard_charges": [{"minimum": 2903.34, "maximum": 2903.34, "discounted_cash": 4614.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2903.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MAGNESIUM SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3475", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.64, "maximum": 0.64, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MELPHA HYDROCH NOS 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9245", "type": "HCPCS"}], "standard_charges": [{"minimum": 167.76, "maximum": 167.76, "discounted_cash": 237.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 167.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ METARAMINOL BITARTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0380", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM (WG CRIT CARE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.26, "discounted_cash": 0.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2250", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.14, "maximum": 0.14, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MILRINONE LACTATE / 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2260", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.55, "maximum": 1.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOGAMULIZUMAB-KPKC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9204", "type": "HCPCS"}], "standard_charges": [{"minimum": 234.17, "maximum": 234.17, "discounted_cash": 376.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 234.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOSUNETUZUMAB-AXGB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9350", "type": "HCPCS"}], "standard_charges": [{"minimum": 629.15, "maximum": 629.15, "discounted_cash": 1011.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 629.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.49, "maximum": 7.49, "discounted_cash": 9.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MULTIHANCE", "code_information": [{"code": "A9577", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.82, "maximum": 1.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MULTIHANCE MULTIPACK", "code_information": [{"code": "A9578", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.73, "maximum": 1.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MVASI 10 MG", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.75, "maximum": 26.75, "discounted_cash": 41.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ NIVOL RELATLIMAB 3MG/1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9298", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.0, "maximum": 187.0, "discounted_cash": 300.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OCTAFLUOROPROPANE MIC,ML", "code_information": [{"code": "Q9956", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.48, "maximum": 44.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.62, "maximum": 62.62, "discounted_cash": 71.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ OLIPUDASE ALFA-RPCP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0218", "type": "HCPCS"}], "standard_charges": [{"minimum": 376.58, "maximum": 376.58, "discounted_cash": 605.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 376.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ONASE ABEPAR-XIOI TREAT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3399", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 3699423.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.06, "maximum": 34.06, "discounted_cash": 62.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERT FACET C", "code_information": [{"code": "64470", "type": "CPT"}, {"code": "3430100748", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1164.8, "maximum": 1614.08, "gross_charge": 1664.0, "discounted_cash": 2496.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1614.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1414.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1331.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRAST EX BIO 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.75, "maximum": 109.75, "discounted_cash": 81.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 109.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.05, "maximum": 30.05, "discounted_cash": 557.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMBROLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.31, "maximum": 57.31, "discounted_cash": 89.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 57.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (ACCORD) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.74, "maximum": 9.74, "discounted_cash": 15.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (BLUEPOINT)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9322", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (SANDOZ) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.42, "maximum": 1.42, "discounted_cash": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.96, "maximum": 9.96, "discounted_cash": 32.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.34, "maximum": 10.34, "discounted_cash": 9.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.62, "maximum": 3.62, "discounted_cash": 16.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PERFLEXANE LIP MICROS,ML", "code_information": [{"code": "Q9955", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.88, "maximum": 14.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PERFLUTREN LIP MICROS,ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.48, "maximum": 44.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PHENYLEPHRINE HCL 20 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2371", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.1, "maximum": 30.1, "discounted_cash": 51.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROGESTERONE PER 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2675", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROHANCE MULTIPACK", "code_information": [{"code": "A9576", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.49, "maximum": 1.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROTIRELIN PER 250 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2725", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ PVRT F JNT C/T 3", "code_information": [{"code": "64492", "type": "CPT"}, {"code": "3430100755", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PVRT F JNT L/S 3", "code_information": [{"code": "64495", "type": "CPT"}, {"code": "3430100761", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RECOMBIN ESPEROCT PER IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7204", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.11, "maximum": 2.11, "discounted_cash": 3.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT ESRD ON DIALYSI", "code_information": [{"code": "Q5105", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.75, "maximum": 0.75, "discounted_cash": 1.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT NON-ESRD USE", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.51, "maximum": 7.51, "discounted_cash": 12.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RISANKIZUMAB-RZAA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2327", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.0, "maximum": 15.0, "discounted_cash": 24.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RISPERDAL CONSTA, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2794", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.18, "maximum": 12.18, "discounted_cash": 19.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.24, "maximum": 37.24, "discounted_cash": 60.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ROCTAVIAN ML 2X10^13VC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1412", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 19290.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN LYOPHIL 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9319", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.55, "maximum": 30.55, "discounted_cash": 51.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN NON-LYO 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9318", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.78, "maximum": 31.78, "discounted_cash": 54.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RONZANOLIXIZUM-NOLI 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9333", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.85, "maximum": 22.85, "discounted_cash": 35.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RUXIENCE, 10 MG", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.28, "maximum": 20.28, "discounted_cash": 32.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ S-PARS PLN/LIMBL", "code_information": [{"code": "67025", "type": "CPT"}, {"code": "3410100705", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SEBELIPASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2840", "type": "HCPCS"}], "standard_charges": [{"minimum": 520.08, "maximum": 520.08, "discounted_cash": 865.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 520.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.12, "maximum": 34.12, "discounted_cash": 67.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SINCALIDE, MAIA, 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2806", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ SINGLE-LUMB/SACR", "code_information": [{"code": "62322", "type": "CPT"}, {"code": "3430102310", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1572.37, "gross_charge": 1621.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1572.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SINUS TRACT FOR", "code_information": [{"code": "20501", "type": "CPT"}, {"code": "3480101426", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 215.6, "maximum": 668.39, "gross_charge": 308.0, "discounted_cash": 462.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 215.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 298.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 215.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 261.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SIROLIMUS PROT PART 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.29, "maximum": 109.29, "discounted_cash": 175.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 109.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 154.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ STREPTOKINASE /250000 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2995", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ SULF HEXA LIPID MICROSPH", "code_information": [{"code": "Q9950", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.94, "maximum": 18.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SYMPATH L/T", "code_information": [{"code": "64520", "type": "CPT"}, {"code": "3430100764", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2947.83, "gross_charge": 3039.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2947.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2127.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2279.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2583.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2431.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.8, "maximum": 66.8, "discounted_cash": 106.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TBO FILGRASTIM 1 MICROG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1447", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.41, "discounted_cash": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TECLISTAMAB CQYV 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9380", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.76, "maximum": 30.76, "discounted_cash": 49.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.82, "maximum": 1.82, "discounted_cash": 2.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TENDON SINGLE/IN", "code_information": [{"code": "20551", "type": "CPT"}, {"code": "3480101431", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TENDON/LIGAMENT/", "code_information": [{"code": "20550", "type": "CPT"}, {"code": "3480101430", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEPLIZUMAB MZWV 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9381", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.38, "maximum": 36.38, "discounted_cash": 58.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TESTOSTERO ENANTHATE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3121", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TESTOSTERONE CYPIONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1071", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.8, "maximum": 17.8, "discounted_cash": 29.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ THEOPHYLLINE PER 40 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2810", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.41, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ THERAPY- CARPAL", "code_information": [{"code": "20526", "type": "CPT"}, {"code": "3480101429", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TISOTU VEDOTIN-TFTV, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9273", "type": "HCPCS"}], "standard_charges": [{"minimum": 174.8, "maximum": 174.8, "discounted_cash": 270.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TOFERSEN INTRATHEC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1304", "type": "HCPCS"}], "standard_charges": [{"minimum": 150.84, "maximum": 150.84, "discounted_cash": 242.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.05, "maximum": 80.05, "discounted_cash": 129.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIAMCINOLONE ACE XR 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3304", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.49, "maximum": 17.49, "discounted_cash": 28.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIFERIC AVNU 0.1MG IRON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1445", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.13, "maximum": 0.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIG 2ND/3RD FOR", "code_information": [{"code": "64610", "type": "CPT"}, {"code": "3480102180", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4702.56, "gross_charge": 4848.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4120.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3636.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3393.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4702.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3393.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3636.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4120.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3878.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRIGGER POINT 3", "code_information": [{"code": "20553", "type": "CPT"}, {"code": "3480101433", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 926.35, "gross_charge": 955.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 811.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 716.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 668.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 926.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 668.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 716.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 811.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRIMETREXATE GLUCORONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3305", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ TRUXIMA 10 MG", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.98, "maximum": 30.98, "discounted_cash": 57.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ UBLITUXIMAB-XIIY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2329", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.23, "maximum": 67.23, "discounted_cash": 108.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VASOPRESSIN (AM REG) 1 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2599", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.28, "maximum": 0.28, "discounted_cash": 0.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VELMANASE ALFA-TYCV 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0217", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 681.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 668.39, "discounted_cash": 328.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ XIPERE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3299", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.58, "maximum": 48.58, "discounted_cash": 78.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ABILIFY ASIMTUFII, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.81, "maximum": 5.81, "discounted_cash": 9.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ABRILADA, 10 MG", "code_information": [{"code": "Q5132", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "discounted_cash": 0.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (HIKMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "discounted_cash": 0.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADO-TRASTUZUMAB EMT 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.44, "maximum": 38.44, "discounted_cash": 61.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADUCANUMAB-AVWA, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0172", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.98, "maximum": 5.98, "discounted_cash": 9.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AFSTYLA, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.46, "maximum": 1.46, "discounted_cash": 2.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ALFENTANIL HCL, 500MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0216", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, AMIODARONE (NEXTERONE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0283", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.55, "maximum": 2.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, AMISULPRIDE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 14.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.99, "maximum": 19.99, "discounted_cash": 32.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ARTESUNATE, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 76.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, ASPARA, RYLAZE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9021", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.2, "maximum": 51.2, "discounted_cash": 81.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ATEZOLIZUMAB,10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.94, "maximum": 83.94, "discounted_cash": 136.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 83.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BENDAMUSTINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.45, "maximum": 33.45, "discounted_cash": 53.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BEZLOTOXUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0565", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.87, "maximum": 39.87, "discounted_cash": 64.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BIORPHEN, 20 MICROGRAMS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2372", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.17, "maximum": 0.17, "discounted_cash": 0.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB (MAIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9051", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB FRESENIUSKAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.68, "maximum": 2.68, "discounted_cash": 77.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, DR. REDDY'S", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.55, "maximum": 48.55, "discounted_cash": 77.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, HOSPIRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9049", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.72, "maximum": 1.72, "discounted_cash": 2.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BROLUCIZUMAB-DBLL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 325.68, "maximum": 325.68, "discounted_cash": 522.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 325.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BUMETANIDE, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1939", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.63, "maximum": 0.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, BUPIVACAINE, NOS, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0665", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "discounted_cash": 0.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CABAZITAXEL (SANDOZ)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9064", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, CABOTE RILPIVIR 2MG 3MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0741", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.62, "maximum": 22.62, "discounted_cash": 36.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CARMUSTINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "discounted_cash": 29.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CEFEPIME HCL (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.95, "maximum": 4.95, "discounted_cash": 8.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CEFIDEROCOL, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0699", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.17, "maximum": 2.17, "discounted_cash": 3.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CIMERLI, 0.1 MG", "code_information": [{"code": "Q5128", "type": "HCPCS"}], "standard_charges": [{"minimum": 256.17, "maximum": 256.17, "discounted_cash": 421.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 256.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CLINDAMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0737", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.21, "maximum": 2.21, "discounted_cash": 2.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CLINDAMYCIN PHOSP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0736", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.27, "maximum": 2.27, "discounted_cash": 3.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0874", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0877", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 0.06, "discounted_cash": 0.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0873", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DECITABINE (SUN PHARMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0893", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.78, "maximum": 0.78, "discounted_cash": 1.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DOSTARLIMAB-GXLY, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9272", "type": "HCPCS"}], "standard_charges": [{"minimum": 232.55, "maximum": 232.55, "discounted_cash": 374.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 232.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DUROLANE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7318", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.55, "maximum": 6.55, "discounted_cash": 9.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ELAHERE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9063", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.68, "maximum": 65.68, "discounted_cash": 105.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EPINEPHRINE (BELCHER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.89, "maximum": 1.89, "discounted_cash": 2.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EPIRUBICIN HCL, 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9178", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.33, "maximum": 1.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ESMOLOL HCL, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1805", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.22, "maximum": 0.22, "discounted_cash": 0.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ETELCALCETIDE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0606", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.7, "maximum": 3.7, "discounted_cash": 4.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.14, "maximum": 179.14, "discounted_cash": 287.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 179.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FACTOR X, (HUMAN), 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7175", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.11, "maximum": 9.11, "discounted_cash": 14.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FARICIMAB-SVOA, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2777", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.44, "maximum": 35.44, "discounted_cash": 57.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FOSAPREPITANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1456", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.04, "maximum": 2.04, "discounted_cash": 0.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9394", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.29, "maximum": 5.29, "discounted_cash": 85.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FULVESTRANT (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9393", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.2, "maximum": 21.2, "discounted_cash": 34.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FYLNETRA, 0.5 MG", "code_information": [{"code": "Q5130", "type": "HCPCS"}], "standard_charges": [{"minimum": 201.32, "maximum": 201.32, "discounted_cash": 324.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 201.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, GADOPICLENOL, 1 ML", "code_information": [{"code": "A9573", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, GANCICLOVIR (EXELA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1574", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, GLYCOPYRROLATE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1596", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, GRANISETRON, XR, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1627", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.42, "maximum": 5.42, "discounted_cash": 9.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, HEMGENIX, PER TX DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1411", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 5960115.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, HYDROXOCOBALAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3425", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, IMM GLOB BIVIGAM, 500MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1556", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.97, "maximum": 72.97, "discounted_cash": 117.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 72.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, INVEGA HAFYERA/TRINZA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2427", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.19, "maximum": 12.19, "discounted_cash": 19.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, INVEGA SUSTENNA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2426", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.28, "maximum": 14.28, "discounted_cash": 23.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, IXINITY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7213", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.84, "maximum": 1.84, "discounted_cash": 2.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, KOVALTRY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7211", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.42, "maximum": 1.42, "discounted_cash": 2.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LABETALOL HCL, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1920", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.17, "maximum": 0.17, "discounted_cash": 0.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LANREOTIDE, (CIPLA) 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1932", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.02, "maximum": 44.02, "discounted_cash": 78.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LECANEMAB-IRMB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.34, "discounted_cash": 2.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LENACAPAVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1961", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.01, "maximum": 22.01, "discounted_cash": 35.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, LINEZOLID (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2021", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.43, "maximum": 16.43, "discounted_cash": 32.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MELPHALAN FLUFENAMI 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 503.5, "maximum": 503.5, "discounted_cash": 808.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 503.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MEROPENEM (B. BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2184", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.02, "maximum": 2.02, "discounted_cash": 3.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, METHOTREXATE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9255", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, METRONIDAZOLE, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1836", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "discounted_cash": 0.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MICAFUNGIN (PAR PHARM)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2247", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.27, "maximum": 0.27, "discounted_cash": 0.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MORPHINE (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2272", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.28, "maximum": 7.28, "discounted_cash": 11.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, MOXIFLOXACIN 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2280", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.77, "maximum": 8.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NALOXONE HCL (ZIMHI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2311", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.29, "maximum": 6.29, "discounted_cash": 9.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NITROGLYCERIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2305", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.44, "maximum": 1.44, "discounted_cash": 2.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NUSINERSEN, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2326", "type": "HCPCS"}], "standard_charges": [{"minimum": 1171.44, "maximum": 1171.44, "discounted_cash": 1882.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1171.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, NYVEPRIA", "code_information": [{"code": "Q5122", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.51, "maximum": 65.51, "discounted_cash": 100.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, OCRIPLASMIN, 0.125 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7316", "type": "HCPCS"}], "standard_charges": [{"minimum": 1222.53, "maximum": 1222.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1222.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, OLARATUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9285", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.32, "maximum": 50.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, OMACETAXINE MEP, 0.01MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9262", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.95, "maximum": 3.95, "discounted_cash": 6.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PANZYGA, 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1576", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.95, "maximum": 64.95, "discounted_cash": 106.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PASIREOTIDE LONG ACTING", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2502", "type": "HCPCS"}], "standard_charges": [{"minimum": 393.37, "maximum": 393.37, "discounted_cash": 722.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 393.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PEGCETACOPLAN, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 149.9, "maximum": 149.9, "discounted_cash": 243.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 149.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PEMRYDI RTU, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9324", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, POLATUZUMAB VEDOTIN 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9309", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.03, "maximum": 124.03, "discounted_cash": 199.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 124.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, PROPOFOL, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2704", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.12, "maximum": 0.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, RELEUKO 1 MCG", "code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.53, "maximum": 0.53, "discounted_cash": 0.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, REMDESIVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.06, "maximum": 6.06, "discounted_cash": 9.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, REMIMAZOLAM, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2249", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, RETIFANLIMAB-DLWR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.5, "maximum": 29.5, "discounted_cash": 47.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, REZAFUNGIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0349", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 16.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, RIMABOTULINUMTOXINB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.04, "maximum": 13.04, "discounted_cash": 20.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SCULPTRA, 0.5MG", "code_information": [{"code": "Q2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "discounted_cash": 2.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, SEZABY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2561", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ, SPESOLIMAB-SBZO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1747", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.15, "maximum": 60.15, "discounted_cash": 96.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 60.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, STIMUFEND, 0.5 MG", "code_information": [{"code": "Q5127", "type": "HCPCS"}], "standard_charges": [{"minimum": 344.1, "maximum": 344.1, "discounted_cash": 527.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 344.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SUSVIMO 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2779", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.37, "maximum": 80.37, "discounted_cash": 129.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, SUTIMLIMAB-JOME, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1302", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.77, "maximum": 17.77, "discounted_cash": 28.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TALIGLUCERASE ALFA 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3060", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.0, "maximum": 45.0, "discounted_cash": 72.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TEBENTAFUSP-TEBN, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9274", "type": "HCPCS"}], "standard_charges": [{"minimum": 208.93, "maximum": 208.93, "discounted_cash": 335.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 208.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TREMELIMUMAB-ACTL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 135.75, "maximum": 135.75, "discounted_cash": 218.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 135.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.42, "maximum": 7.42, "discounted_cash": 12.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.41, "maximum": 24.41, "discounted_cash": 39.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (MYLAN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3371", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.87, "maximum": 5.87, "discounted_cash": 9.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3372", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.4, "maximum": 6.4, "discounted_cash": 10.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VASOPRESSIN, 1 UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.88, "maximum": 1.88, "discounted_cash": 2.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.27, "maximum": 69.27, "discounted_cash": 116.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 69.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VINCRISTINE SUL LIP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9371", "type": "HCPCS"}], "standard_charges": [{"minimum": 3591.82, "maximum": 3591.82, "discounted_cash": 5495.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3591.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4935.21, "maximum": 4935.21, "discounted_cash": 7947.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4935.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.68, "maximum": 6.68, "discounted_cash": 11.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. (ANI), UP TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 3365.3, "maximum": 3365.3, "discounted_cash": 5380.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3365.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ACTHAR GEL TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 3370.39, "maximum": 3370.39, "discounted_cash": 6579.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3370.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"minimum": 491.41, "maximum": 491.41, "discounted_cash": 789.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 491.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.37, "maximum": 24.37, "discounted_cash": 41.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.88, "maximum": 8.88, "discounted_cash": 21.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 175.06, "maximum": 175.06, "discounted_cash": 301.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 175.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CALASPARGASE PEGOL-MKNL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9118", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.88, "maximum": 72.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 72.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.76, "maximum": 5.76, "discounted_cash": 9.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CETIRIZINE HCL 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1201", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.97, "maximum": 14.97, "discounted_cash": 24.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. EPTINEZUMAB-JJMR 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3032", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.05, "maximum": 18.05, "discounted_cash": 29.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. FE DERISOMALTOSE 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1437", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.94, "maximum": 19.94, "discounted_cash": 30.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.93, "maximum": 65.93, "discounted_cash": 106.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INEBILIZUMAB-CDON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1823", "type": "HCPCS"}], "standard_charges": [{"minimum": 473.51, "maximum": 473.51, "discounted_cash": 760.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 473.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.28, "maximum": 40.28, "discounted_cash": 64.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (FIASP)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1812", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (LYUMJEV)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1814", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ. ISATUXIMAB-IRFC 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9227", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.42, "maximum": 76.42, "discounted_cash": 122.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 76.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.34, "maximum": 2.34, "discounted_cash": 3.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. LUMASIRAN, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0224", "type": "HCPCS"}], "standard_charges": [{"minimum": 318.1, "maximum": 318.1, "discounted_cash": 513.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 318.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. LURBINECTEDIN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 199.52, "maximum": 199.52, "discounted_cash": 321.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 199.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MARGETUXIMAB-CMKB, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.04, "maximum": 47.04, "discounted_cash": 75.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MELOXICAM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1738", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.32, "maximum": 3.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MYCOPHENOLATE MOFETIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.71, "discounted_cash": 1.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. NAXITAMAB-GQGK, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 610.03, "maximum": 610.03, "discounted_cash": 979.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 610.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. OLANZAPINE, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2359", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.96, "maximum": 0.96, "discounted_cash": 1.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.97, "maximum": 3.97, "discounted_cash": 7.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.08, "maximum": 63.08, "discounted_cash": 100.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.42, "maximum": 41.42, "discounted_cash": 66.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ROMOSOZUMAB-AQQG 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3111", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.69, "maximum": 10.69, "discounted_cash": 17.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TAGRAXOFUSP-ERZS 10 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9269", "type": "HCPCS"}], "standard_charges": [{"minimum": 326.65, "maximum": 326.65, "discounted_cash": 523.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 326.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TEPROTUMUMAB-TRBW 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3241", "type": "HCPCS"}], "standard_charges": [{"minimum": 333.4, "maximum": 333.4, "discounted_cash": 526.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 333.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.6, "maximum": 0.6, "discounted_cash": 4.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. VILTOLARSEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1427", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.36, "maximum": 60.36, "discounted_cash": 94.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 60.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.13, "maximum": 14.13, "discounted_cash": 22.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.67, "maximum": 1.67, "discounted_cash": 2.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ARISTADA INITIO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1943", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.08, "maximum": 3.08, "discounted_cash": 4.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BENDEKA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.83, "maximum": 13.83, "discounted_cash": 23.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 165.25, "maximum": 165.25, "discounted_cash": 272.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 165.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BREXANOLONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1632", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.67, "maximum": 76.67, "discounted_cash": 115.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 76.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.58, "maximum": 27.58, "discounted_cash": 44.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CERLIPONASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0567", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.86, "maximum": 97.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 97.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.52, "maximum": 80.52, "discounted_cash": 140.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., COSYNTROPIN, 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0834", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.59, "maximum": 28.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.52, "maximum": 80.52, "discounted_cash": 129.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 80.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EMAPALUMAB-LZSG, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 364.87, "maximum": 364.87, "discounted_cash": 603.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 364.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EMICIZUMAB-KXWH 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7170", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.84, "maximum": 50.84, "discounted_cash": 81.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.11, "maximum": 1.11, "discounted_cash": 1.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.89, "maximum": 16.89, "discounted_cash": 26.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.42, "maximum": 1.42, "discounted_cash": 1.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., FREMANEZUMAB-VFRM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3031", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.93, "maximum": 2.93, "discounted_cash": 2.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.34, "maximum": 87.34, "discounted_cash": 116.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 87.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., HAEGARDA 10 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0599", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.14, "maximum": 10.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., IBALIZUMAB-UIYK, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1746", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.65, "maximum": 74.65, "discounted_cash": 119.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 74.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ILUVIEN, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7313", "type": "HCPCS"}], "standard_charges": [{"minimum": 487.54, "maximum": 487.54, "discounted_cash": 788.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 487.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.68, "maximum": 17.68, "discounted_cash": 21.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LANADELUMAB-FLYO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0593", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.09, "maximum": 79.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 79.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.39, "maximum": 23.39, "discounted_cash": 37.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.88, "maximum": 1.88, "discounted_cash": 3.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.75, "maximum": 3.75, "discounted_cash": 5.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PATISIRAN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 99.2, "maximum": 99.2, "discounted_cash": 160.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 99.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PERSERIS, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2798", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.63, "maximum": 11.63, "discounted_cash": 18.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.6, "maximum": 3.6, "discounted_cash": 5.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RAVULIZUMAB-CWVZ 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1303", "type": "HCPCS"}], "standard_charges": [{"minimum": 221.75, "maximum": 221.75, "discounted_cash": 356.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 221.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RETISERT, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 299.05, "maximum": 299.05, "discounted_cash": 480.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 299.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RITUXIMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9312", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.87, "maximum": 78.87, "discounted_cash": 127.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ROLAPITANT, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2797", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.58, "maximum": 13.58, "discounted_cash": 21.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"minimum": 140.23, "maximum": 140.23, "discounted_cash": 225.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 140.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRAZIMERA, 10 MG", "code_information": [{"code": "Q5116", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.77, "maximum": 12.77, "discounted_cash": 26.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TREANDA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.36, "maximum": 8.36, "discounted_cash": 14.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRIPTORELIN XR 3.75 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3316", "type": "HCPCS"}], "standard_charges": [{"minimum": 2966.94, "maximum": 2966.94, "discounted_cash": 5184.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2966.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., VESTRONIDASE ALFA-VJBK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3397", "type": "HCPCS"}], "standard_charges": [{"minimum": 234.86, "maximum": 234.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 234.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., YUTIQ, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7314", "type": "HCPCS"}], "standard_charges": [{"minimum": 527.08, "maximum": 527.08, "discounted_cash": 849.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 527.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ZIRABEV, 10 MG", "code_information": [{"code": "Q5118", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.76, "maximum": 20.76, "discounted_cash": 34.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT ANEST GREATER", "code_information": [{"code": "64405", "type": "CPT"}, {"code": "3480102168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT ANEST TRIGEMI", "code_information": [{"code": "64400", "type": "CPT"}, {"code": "3480102167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT CORPORA CAVER", "code_information": [{"code": "54235", "type": "CPT"}, {"code": "3480103330", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 987.46, "gross_charge": 1018.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 865.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 763.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 987.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 763.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 865.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 814.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT FOR SACROILIAC JOINT", "code_information": [{"code": "G0259", "type": "HCPCS"}], "standard_charges": [{"minimum": 720.01, "maximum": 720.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS </W 7", "code_information": [{"code": "11900", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT/ASPIRATE LIVER CYST", "code_information": [{"code": "47015", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67505", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT/TREAT EYE SOCKET", "code_information": [{"code": "67515", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION ANISTREPLASE 30 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0350", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION ESTRONE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1435", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR ANKLE X-RAY", "code_information": [{"code": "27648", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDE", "code_information": [{"code": "51600", "type": "CPT"}, {"code": "3480103174", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 108.5, "maximum": 668.39, "gross_charge": 155.0, "discounted_cash": 232.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDE", "code_information": [{"code": "51600", "type": "CPT"}, {"code": "3480103219", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 133.7, "maximum": 668.39, "gross_charge": 191.0, "discounted_cash": 286.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 162.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 143.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 185.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 143.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 162.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 152.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDE", "code_information": [{"code": "51610", "type": "CPT"}, {"code": "3480103175", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 158.2, "maximum": 668.39, "gross_charge": 226.0, "discounted_cash": 339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 169.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 219.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 169.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDE", "code_information": [{"code": "51610", "type": "CPT"}, {"code": "3480103220", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 194.6, "maximum": 668.39, "gross_charge": 278.0, "discounted_cash": 417.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 236.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 208.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 194.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 269.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 194.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 208.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 236.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 222.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47531", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SALIVARY X-RAY", "code_information": [{"code": "42550", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SHOULD", "code_information": [{"code": "23350", "type": "CPT"}, {"code": "3480103316", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 94.5, "maximum": 668.39, "gross_charge": 135.0, "discounted_cash": 202.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR SPLEEN X-RAY", "code_information": [{"code": "38200", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR TEAR SAC X-RAY", "code_information": [{"code": "68850", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER", "code_information": [{"code": "50690", "type": "CPT"}, {"code": "3480103171", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 173.6, "maximum": 668.39, "gross_charge": 248.0, "discounted_cash": 372.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 210.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 186.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 173.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 240.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 173.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 186.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 210.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 198.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER", "code_information": [{"code": "50690", "type": "CPT"}, {"code": "3480103216", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 213.5, "maximum": 668.39, "gross_charge": 305.0, "discounted_cash": 457.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 295.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR URETER X-RAY", "code_information": [{"code": "50684", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR WRIST X-RAY", "code_information": [{"code": "25246", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION GLATIRAMER ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1595", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.43, "maximum": 62.43, "discounted_cash": 250.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION INCLUDE CA", "code_information": [{"code": "62327", "type": "CPT"}, {"code": "3480103342", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "gross_charge": 935.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61026", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1385.29, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO BRAIN CANAL", "code_information": [{"code": "61055", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO HEMORRHOID(S)", "code_information": [{"code": "46500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTO SPINAL ARTERY", "code_information": [{"code": "62294", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION INTRAOP ADD-ON", "code_information": [{"code": "48400", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION JAW JOINT X-RAY", "code_information": [{"code": "21116", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION OF SINUS TRACT", "code_information": [{"code": "20500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCE FOR", "code_information": [{"code": "27093", "type": "CPT"}, {"code": "3480101665", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 422.1, "maximum": 668.39, "gross_charge": 603.0, "discounted_cash": 904.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 512.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 584.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 512.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 482.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCE FOR", "code_information": [{"code": "27095", "type": "CPT"}, {"code": "3480101666", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 449.4, "maximum": 668.39, "gross_charge": 642.0, "discounted_cash": 963.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 545.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 481.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 449.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 622.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 449.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 481.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 545.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 513.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCE FOR", "code_information": [{"code": "27096", "type": "CPT"}, {"code": "3480101667", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 720.01, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 3802.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PROCE FOR", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "3430102303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 705.68, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION PX FOR ELBOW ARTHG", "code_information": [{"code": "24220", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION SINGLE-CER", "code_information": [{"code": "62321", "type": "CPT"}, {"code": "3430100735", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION SINGLE-LUM", "code_information": [{"code": "62311", "type": "CPT"}, {"code": "3430102305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2119.45, "gross_charge": 2185.0, "discounted_cash": 3277.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1857.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1638.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1529.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2119.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1529.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1638.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1857.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1748.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION SINGLE-LUM", "code_information": [{"code": "62323", "type": "CPT"}, {"code": "3430100736", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.95, "gross_charge": 2535.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2458.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1774.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1901.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2154.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION SUBQ OR IM", "code_information": [{"code": "90772", "type": "CPT"}, {"code": "3430100789", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION SUPRASCAPU", "code_information": [{"code": "64418", "type": "CPT"}, {"code": "3340102351", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1434.63, "gross_charge": 1479.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1257.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1035.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1434.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1035.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1257.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1183.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION SYTEM*M005", "code_information": [{"code": "3100203687", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INJECTION TORSEMIDE 10 MG/ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3265", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION TRABECTEDIN 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9352", "type": "HCPCS"}], "standard_charges": [{"minimum": 338.39, "maximum": 338.39, "discounted_cash": 543.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 338.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66020", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF EYE", "code_information": [{"code": "66030", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1385.29, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64680", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NERVE", "code_information": [{"code": "64681", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION TREATMENT OF NOSE", "code_information": [{"code": "30200", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION, ALEMTUZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0202", "type": "HCPCS"}], "standard_charges": [{"minimum": 2347.58, "maximum": 2347.58, "discounted_cash": 3734.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2347.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, AMINOCAPROIC ACID", "code_information": [{"code": "S0017", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, AVELUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9023", "type": "HCPCS"}], "standard_charges": [{"minimum": 92.53, "maximum": 92.53, "discounted_cash": 148.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 92.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, AZTREONAM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0457", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.58, "maximum": 2.58, "discounted_cash": 4.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BELINOSTAT, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.84, "maximum": 48.84, "discounted_cash": 78.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BLINATUMOMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 145.36, "maximum": 145.36, "discounted_cash": 233.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 145.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BORTEZOMIB, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9041", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.07, "maximum": 2.07, "discounted_cash": 3.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, BUROSUMAB-TWZA 1M", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0584", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.86, "maximum": 447.86, "discounted_cash": 712.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 447.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CARFILZOMIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9047", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.18, "maximum": 47.18, "discounted_cash": 75.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CASIMERSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1426", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.31, "maximum": 164.31, "discounted_cash": 267.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 164.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOPERAZONE SOD", "code_information": [{"code": "S0021", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CEFOTETAN DISODIU", "code_information": [{"code": "S0074", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, CIMETIDINE HYDROC", "code_information": [{"code": "S0023", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.22, "maximum": 10.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DALBAVANCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0875", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.12, "maximum": 15.12, "discounted_cash": 24.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DARATUMUMAB 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.13, "maximum": 61.13, "discounted_cash": 99.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 61.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, DOXERCALCIFEROL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1270", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.84, "maximum": 0.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, EDARAVONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1301", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.83, "maximum": 21.83, "discounted_cash": 35.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ELOTUZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9176", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.4, "maximum": 7.4, "discounted_cash": 11.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FAMOTIDINE, 20 MG", "code_information": [{"code": "S0028", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.36, "maximum": 6.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FOSPHENYTOIN SODI", "code_information": [{"code": "S0078", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, FULPHILA", "code_information": [{"code": "Q5108", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.04, "maximum": 164.04, "discounted_cash": 196.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 164.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, FULVESTRANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9395", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.17, "maximum": 8.17, "discounted_cash": 13.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, INCLISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1306", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.12, "maximum": 12.12, "discounted_cash": 19.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, INFLECTRA", "code_information": [{"code": "Q5103", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.09, "maximum": 11.09, "discounted_cash": 22.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ISAVUCONAZONIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1833", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.86, "maximum": 0.86, "discounted_cash": 1.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, IXIFI, 10 MG", "code_information": [{"code": "Q5109", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, KHAPZORY, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0642", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.71, "maximum": 1.71, "discounted_cash": 2.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, MEPOLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2182", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.48, "maximum": 30.48, "discounted_cash": 49.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, NAFCILLIN SODIUM", "code_information": [{"code": "S0032", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, NECITUMUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9295", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.74, "maximum": 5.74, "discounted_cash": 9.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, NIVOLUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9299", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.09, "maximum": 31.09, "discounted_cash": 49.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, OCRELIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2350", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.76, "maximum": 58.76, "discounted_cash": 95.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 58.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, OFLOXACIN, 400 MG", "code_information": [{"code": "S0034", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2407", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.91, "maximum": 26.91, "discounted_cash": 44.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, ORITAVANCIN 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2406", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.9, "maximum": 40.9, "discounted_cash": 65.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PENTAMIDINE ISETH", "code_information": [{"code": "S0080", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERAMIVIR", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2547", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.09, "maximum": 1.09, "discounted_cash": 2.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PERTUZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9306", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.42, "maximum": 15.42, "discounted_cash": 24.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, PIPERACILLIN SODI", "code_information": [{"code": "S0081", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, RAMUCIRUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9308", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.65, "maximum": 69.65, "discounted_cash": 112.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 69.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RENFLEXIS", "code_information": [{"code": "Q5104", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.58, "maximum": 30.58, "discounted_cash": 50.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RESLIZUMAB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2786", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.23, "maximum": 10.23, "discounted_cash": 16.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, RUCONEST", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0596", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.4, "maximum": 33.4, "discounted_cash": 53.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, SILTUXIMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2860", "type": "HCPCS"}], "standard_charges": [{"minimum": 151.31, "maximum": 151.31, "discounted_cash": 239.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 151.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, SULFAMETHOXAZOLE", "code_information": [{"code": "S0039", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, TICARCILLIN DISOD", "code_information": [{"code": "S0040", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INJECTION, TRILACICLIB, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1448", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.29, "maximum": 5.29, "discounted_cash": 8.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, UDENYCA 0.5 MG", "code_information": [{"code": "Q5111", "type": "HCPCS"}], "standard_charges": [{"minimum": 135.49, "maximum": 135.49, "discounted_cash": 196.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, VEDOLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3380", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.85, "maximum": 21.85, "discounted_cash": 35.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION, VORICONAZOLE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3465", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.1, "maximum": 1.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION,NEURO SUBS", "code_information": [{"code": "62282", "type": "CPT"}, {"code": "3430102306", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2666.53, "gross_charge": 2749.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2336.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2061.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1924.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2666.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1924.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2061.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2336.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2199.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECTION,ONABOTULINUMTOXINA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0585", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.32, "maximum": 6.32, "discounted_cash": 10.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY 10MM*PDL-M-PT1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INLAY COMPOSITE/RESIN ONE SU", "code_information": [{"code": "D2650", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INLAY COMPOSITE/RESIN TWO SU", "code_information": [{"code": "D2651", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INLAY PORCELAIN/CERAMIC 1 SU", "code_information": [{"code": "D2610", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INLAY PORCELAIN/CERAMIC 2 SU", "code_information": [{"code": "D2620", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INLAY REPAIR", "code_information": [{"code": "D2981", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INLAY TITANIUM", "code_information": [{"code": "D6624", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 3.6 X35*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3194.1, "maximum": 4426.11, "gross_charge": 4563.0, "discounted_cash": 6844.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3878.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3422.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3194.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4426.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3194.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3422.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3878.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3650.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 3.6 X40*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3194.1, "maximum": 4426.11, "gross_charge": 4563.0, "discounted_cash": 6844.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3878.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3422.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3194.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4426.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3194.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3422.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3878.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3650.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 3.6 X45*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 3.6 X50*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 3.6 X55*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5 X 35*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5 X40*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2520.7, "maximum": 3492.97, "gross_charge": 3601.0, "discounted_cash": 5401.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3492.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2520.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2700.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3060.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5 X45*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5 X50*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5 X55*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5 X65*E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE IMP 4.5X75*EX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INNATE INST KIT*EXIN", "code_information": [{"code": "3100205460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INNATE INST KIT*EXIN", "code_information": [{"code": "3100205605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INNATE INST KIT*EXIN", "code_information": [{"code": "3100205686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INNATE INST KIT*EXIN", "code_information": [{"code": "3100206677", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INNER SKULL VESSEL SURGERY", "code_information": [{"code": "61702", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INNOVABRN/INNOVAMATX XL SQCM", "code_information": [{"code": "A2022", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INNOVAMATRIX PD, 1 MG", "code_information": [{"code": "A2023", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INS BONE DEVICE FOR RSA", "code_information": [{"code": "347T", "type": "CPT"}], "standard_charges": [{"minimum": 453.46, "maximum": 453.46, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 453.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [{"code": "36245", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART ADDL", "code_information": [{"code": "36248", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST BILAT", "code_information": [{"code": "36252", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ BILAT", "code_information": [{"code": "36254", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 2ND+ UNILAT", "code_information": [{"code": "36253", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS ENDOVAS VENA CAV", "code_information": [{"code": "37191", "type": "CPT"}, {"code": "3480103319", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 5001.8, "maximum": 12640.07, "gross_charge": 13031.0, "discounted_cash": 8411.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11076.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5798.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9773.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9121.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12640.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5719.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9121.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5775.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9773.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6673.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11076.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10424.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5719.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS MARK ABD/PEL FOR RT PERQ", "code_information": [{"code": "49411", "type": "CPT"}], "standard_charges": [{"minimum": 2192.96, "maximum": 2192.96, "discounted_cash": 2120.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS MARK THOR FOR RT PERQ", "code_information": [{"code": "32553", "type": "CPT"}], "standard_charges": [{"minimum": 2192.96, "maximum": 2192.96, "discounted_cash": 2120.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS PERPHRL VASCLR D", "code_information": [{"code": "36000", "type": "CPT"}, {"code": "3480101878", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 11.2, "maximum": 300.38, "gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS TUN IP CATH FOR DIAL OPN", "code_information": [{"code": "49421", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4404.17, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS VAG BRACHYTX DEVICE", "code_information": [{"code": "57156", "type": "CPT"}], "standard_charges": [{"minimum": 551.8, "maximum": 551.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS/REP SUBQ DEFIBRILLATOR", "code_information": [{"code": "33270", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 50357.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSEMINATION OF OOCYTES", "code_information": [{"code": "89268", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSER POSTR SPNE FIX", "code_information": [{"code": "22844", "type": "CPT"}, {"code": "3480101519", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2020.9, "maximum": 7959.27, "gross_charge": 2887.0, "discounted_cash": 4330.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2453.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2165.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2020.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2800.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2020.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2165.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2453.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2309.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT", "code_information": [{"code": "3100103808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5060.0, "discounted_cash": 7590.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT", "code_information": [{"code": "3100104756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5415.0, "discounted_cash": 8122.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2700.6, "maximum": 3742.26, "gross_charge": 3858.0, "discounted_cash": 5787.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3279.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2893.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2700.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3742.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2700.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2893.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3279.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3086.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3294.2, "maximum": 4564.82, "gross_charge": 4706.0, "discounted_cash": 7059.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4564.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 1 ELECTRODE PM-DEFIB", "code_information": [{"code": "33216", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT 11MM SZ3-4*71", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4284.28, "maximum": 5936.78, "gross_charge": 6120.4, "discounted_cash": 9180.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5202.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4590.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4284.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5936.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4284.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4590.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5202.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4896.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 2 ELECTRODE PM-DEFIB", "code_information": [{"code": "33217", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT 9MM SZ3-4*714", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4284.28, "maximum": 5936.78, "gross_charge": 6120.4, "discounted_cash": 9180.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5202.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4590.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4284.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5936.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4284.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4590.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5202.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4896.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ACETABULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5101.82, "maximum": 7069.67, "gross_charge": 7288.32, "discounted_cash": 10932.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6195.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5466.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5101.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7069.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5101.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5466.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6195.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5830.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ACETABULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5557.3, "maximum": 7700.83, "gross_charge": 7939.0, "discounted_cash": 11908.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6748.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5954.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5557.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7700.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5557.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5954.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6748.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6351.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ACETABULAR 36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ACETABULAR*69", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5101.82, "maximum": 7069.67, "gross_charge": 7288.32, "discounted_cash": 10932.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6195.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5466.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5101.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7069.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5101.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5466.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6195.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5830.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ADM 28*7236-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AND REMOVE BO", "code_information": [{"code": "20650", "type": "CPT"}, {"code": "3480103075", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ANTER SPINE F", "code_information": [{"code": "22845", "type": "CPT"}, {"code": "3480101520", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1236.9, "maximum": 7959.27, "gross_charge": 1767.0, "discounted_cash": 2650.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1501.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1325.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1236.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1713.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1236.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1325.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1501.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1413.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ANTER SPINE F", "code_information": [{"code": "22846", "type": "CPT"}, {"code": "3480101521", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1284.5, "maximum": 14462.5, "gross_charge": 1835.0, "discounted_cash": 2752.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1559.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1376.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1284.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1779.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1284.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1376.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1559.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1468.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT AOX 12MM*1517", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6603.87, "maximum": 9151.07, "gross_charge": 9434.1, "discounted_cash": 14151.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7547.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AOX 14MM*1517", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6603.87, "maximum": 9151.07, "gross_charge": 9434.1, "discounted_cash": 14151.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7547.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AOX 18MM*1517", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6603.87, "maximum": 9151.07, "gross_charge": 9434.1, "discounted_cash": 14151.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7547.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AOX 18MM*1517", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6603.87, "maximum": 9151.07, "gross_charge": 9434.1, "discounted_cash": 14151.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6603.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7075.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8018.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7547.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATH", "code_information": [{"code": "51703", "type": "CPT"}, {"code": "3340102433", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 159.4, "maximum": 944.78, "gross_charge": 974.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 827.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 730.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 681.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 944.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 681.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 730.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 827.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 779.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BLADDER CATHE", "code_information": [{"code": "51701", "type": "CPT"}, {"code": "3340102431", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BRAIN-FLUID DEVICE", "code_information": [{"code": "61215", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5178.02, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CARD ELECTRODES DUAL", "code_information": [{"code": "33211", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W", "code_information": [{"code": "32557", "type": "CPT"}, {"code": "3480103318", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1282.05, "maximum": 3725.77, "gross_charge": 3841.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3264.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2880.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2688.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3725.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2688.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2880.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3264.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CERVICAL DILATOR", "code_information": [{"code": "59200", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2169.82, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CROSSFIRE 32M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2087.08, "maximum": 2892.1, "gross_charge": 2981.55, "discounted_cash": 4472.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2534.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2236.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2087.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2892.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2087.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2236.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2534.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2385.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CRS SZ 4*1517", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3902.08, "maximum": 5407.16, "gross_charge": 5574.4, "discounted_cash": 8361.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5407.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 2910.3, "maximum": 2910.3, "discounted_cash": 13254.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CVA DEVICE W/", "code_information": [{"code": "36571", "type": "CPT"}, {"code": "3480101882", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5954.83, "gross_charge": 6139.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5218.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4604.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4297.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5954.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4297.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4604.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5218.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4911.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT DEPUY FIXED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3061.1, "maximum": 4241.81, "gross_charge": 4373.0, "discounted_cash": 6559.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3717.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3279.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3061.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4241.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3061.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3279.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3717.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3498.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT DEPUY STABALI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1955.1, "maximum": 2709.21, "gross_charge": 2793.0, "discounted_cash": 4189.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2374.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2374.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ECCENTRIC 36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ECCENTRIC 36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EYE SOCKET IMPLANT", "code_information": [{"code": "67550", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT FLOW DIR CATH", "code_information": [{"code": "93503", "type": "CPT"}, {"code": "3300100260", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1634.27, "maximum": 3926.56, "gross_charge": 4048.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3440.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3036.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2833.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3926.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2833.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3036.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3440.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3238.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM ATRIAL", "code_information": [{"code": "33206", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEART PM VENTRICULAR", "code_information": [{"code": "33207", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HOODE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUM LAT 42X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3831.1, "maximum": 5308.81, "gross_charge": 5473.0, "discounted_cash": 8209.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4652.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4104.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3831.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5308.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3831.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4104.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4652.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4378.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 33*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 33*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 33*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 33*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 33*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 36*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1551.73, "maximum": 2150.25, "gross_charge": 2216.76, "discounted_cash": 3325.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1662.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1551.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2150.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1551.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1662.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1773.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL 36*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1551.73, "maximum": 2150.25, "gross_charge": 2216.76, "discounted_cash": 3325.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1662.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1551.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2150.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1551.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1662.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1773.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL L/42*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1332.89, "maximum": 1847.01, "gross_charge": 1904.14, "discounted_cash": 2856.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1618.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1332.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1847.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1332.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1618.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1523.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL L/42*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL M/39*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL S/36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1591.52, "maximum": 2205.39, "gross_charge": 2273.6, "discounted_cash": 3410.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1932.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1591.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2205.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1591.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1932.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1818.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL S/36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1428.1, "maximum": 1978.94, "gross_charge": 2040.15, "discounted_cash": 3060.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1978.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1428.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1530.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1734.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1632.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL36+3*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERAL36+6*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT HUMERALM/39*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1591.52, "maximum": 2205.39, "gross_charge": 2273.6, "discounted_cash": 3410.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1932.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1591.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2205.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1591.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1932.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1818.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INDWEL CATH E", "code_information": [{"code": "62319", "type": "CPT"}, {"code": "3430100737", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2995.36, "gross_charge": 3088.0, "discounted_cash": 4632.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2624.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2316.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2161.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2995.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2161.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2316.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2624.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2470.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT IOL WO CONC C", "code_information": [{"code": "66985", "type": "CPT"}, {"code": "3410100701", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5875.29, "gross_charge": 6057.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5875.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4239.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4542.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5148.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4845.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT LEVONORGESTREL IUS", "code_information": [{"code": "S4981", "type": "HCPCS"}], "standard_charges": [{"minimum": 167.32, "maximum": 167.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MESH/PELVIC FLR ADDON", "code_information": [{"code": "57267", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6427.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NASAL SEPTAL BUTTON", "code_information": [{"code": "30220", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 456.57, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TNLD CVC", "code_information": [{"code": "36556", "type": "CPT"}, {"code": "3340100565", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3870.64, "gross_charge": 3626.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3082.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2719.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2538.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3517.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2538.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2719.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3082.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2900.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1735.06, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65130", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION", "code_information": [{"code": "22848", "type": "CPT"}, {"code": "3480101522", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 614.6, "maximum": 5178.02, "gross_charge": 878.0, "discounted_cash": 1317.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 746.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 658.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 614.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 851.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 614.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 658.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 746.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 702.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 167.32, "maximum": 277.43, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PICC LINE AGE", "code_information": [{"code": "36569", "type": "CPT"}, {"code": "3340100566", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3517.22, "gross_charge": 3626.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3082.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2719.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2538.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3517.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2538.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2719.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3082.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2900.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36570", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1735.06, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT POLY SZ 4*336", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4366.18, "maximum": 6050.27, "gross_charge": 6237.4, "discounted_cash": 9356.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5301.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4678.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4366.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6050.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4366.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4678.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5301.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4989.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT POSTR SPINE F", "code_information": [{"code": "22842", "type": "CPT"}, {"code": "3480101517", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1295.0, "maximum": 7959.27, "gross_charge": 1850.0, "discounted_cash": 2775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1572.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1295.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1794.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1295.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1572.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1480.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT POSTR SPNE FI", "code_information": [{"code": "22843", "type": "CPT"}, {"code": "3480101518", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1383.2, "maximum": 7959.27, "gross_charge": 1976.0, "discounted_cash": 2964.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1679.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1482.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1383.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1383.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1482.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1679.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1580.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 29825.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN SNGL LEAD", "code_information": [{"code": "33212", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT RADIAL*8WRP-M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4226.04, "maximum": 5856.08, "gross_charge": 6037.2, "discounted_cash": 9055.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5131.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4527.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4226.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5856.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4226.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4527.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5131.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4829.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT RADIAL*8WRP-M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208466", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4226.04, "maximum": 5856.08, "gross_charge": 6037.2, "discounted_cash": 9055.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5131.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4527.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4226.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5856.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4226.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4527.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5131.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4829.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT RADIAL*8WRP-S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7585.2, "maximum": 10510.92, "gross_charge": 10836.0, "discounted_cash": 16254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9210.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8127.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7585.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10510.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7585.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8127.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9210.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8668.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED*DWF-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2182.18, "maximum": 3023.87, "gross_charge": 3117.4, "discounted_cash": 4676.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2649.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2338.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2182.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3023.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2182.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2338.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2649.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2493.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED*DWF-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2573.48, "maximum": 3566.1, "gross_charge": 3676.4, "discounted_cash": 5514.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3124.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2757.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2573.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3566.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2573.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2757.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3124.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2941.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED*DWF-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED*DWF-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED*DWF3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3294.2, "maximum": 4564.82, "gross_charge": 4706.0, "discounted_cash": 7059.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4564.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVERSED*DWF4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3294.2, "maximum": 4564.82, "gross_charge": 4706.0, "discounted_cash": 7059.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4564.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVISION*5612", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7840.0, "maximum": 10864.0, "gross_charge": 11200.0, "discounted_cash": 16800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9520.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10864.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9520.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVISION*5612", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6115.2, "maximum": 8473.92, "gross_charge": 8736.0, "discounted_cash": 13104.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7425.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6115.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8473.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6115.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7425.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6988.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT REVISION*5612", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 4*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3902.08, "maximum": 5407.16, "gross_charge": 5574.4, "discounted_cash": 8361.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5407.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 5*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3902.08, "maximum": 5407.16, "gross_charge": 5574.4, "discounted_cash": 8361.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5407.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 6*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3902.08, "maximum": 5407.16, "gross_charge": 5574.4, "discounted_cash": 8361.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5407.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 6*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3902.08, "maximum": 5407.16, "gross_charge": 5574.4, "discounted_cash": 8361.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5407.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 6*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3902.08, "maximum": 5407.16, "gross_charge": 5574.4, "discounted_cash": 8361.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5407.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3902.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4180.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4738.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 7*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4877.6, "maximum": 6758.96, "gross_charge": 6968.0, "discounted_cash": 10452.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5922.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5226.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4877.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6758.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4877.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5226.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5922.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5574.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 8*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4877.6, "maximum": 6758.96, "gross_charge": 6968.0, "discounted_cash": 10452.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5922.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5226.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4877.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6758.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4877.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5226.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5922.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5574.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ROTAT SZ 9*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SEMI-RIGID PROSTHESIS", "code_information": [{"code": "54400", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 21321.73, "discounted_cash": 19648.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SHOULDER *004", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIX DEV", "code_information": [{"code": "22841", "type": "CPT"}, {"code": "3480101516", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7959.27, "maximum": 15067.01, "gross_charge": 15533.0, "discounted_cash": 23299.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13203.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11649.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10873.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15067.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10873.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11649.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13203.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12426.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATIO", "code_information": [{"code": "22840", "type": "CPT"}, {"code": "3480101515", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1292.2, "maximum": 14462.5, "gross_charge": 1846.0, "discounted_cash": 2769.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1569.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1384.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1292.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1790.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1292.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1384.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1569.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1476.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22847", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE INFUSION DEVICE", "code_information": [{"code": "62360", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 19559.98, "discounted_cash": 27298.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19559.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT STABILIZ 2.5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3101.09, "maximum": 4297.23, "gross_charge": 4430.14, "discounted_cash": 6645.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3765.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3322.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3101.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4297.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3101.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3322.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3765.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3544.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT STABILIZ 2.5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT STABILIZED 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.66, "maximum": 2535.38, "gross_charge": 2613.8, "discounted_cash": 3920.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1960.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2535.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1960.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2091.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"minimum": 1083.58, "maximum": 1083.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2212.7, "maximum": 3066.17, "gross_charge": 3161.0, "discounted_cash": 4741.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2686.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2370.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2212.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3066.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2212.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2370.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2686.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2528.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 3*KIMP312R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5665.66, "maximum": 7850.98, "gross_charge": 8093.8, "discounted_cash": 12140.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6879.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6070.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5665.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7850.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5665.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6070.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6879.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6475.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 3/4 42MM*D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TANDEM CUFF", "code_information": [{"code": "53444", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 30876.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TEMP BLADDER", "code_information": [{"code": "51702", "type": "CPT"}, {"code": "3340102432", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2142.0, "maximum": 2968.2, "gross_charge": 3060.0, "discounted_cash": 4590.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2601.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2295.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2968.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2295.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2601.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1580.6, "maximum": 2190.26, "gross_charge": 2258.0, "discounted_cash": 3387.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1919.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1693.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1580.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2190.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1580.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1693.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1919.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 3 12.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2831.82, "maximum": 3924.1, "gross_charge": 4045.47, "discounted_cash": 6068.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3924.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3236.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 3 15MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2831.82, "maximum": 3924.1, "gross_charge": 4045.47, "discounted_cash": 6068.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3924.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3236.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 3 17.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2831.82, "maximum": 3924.1, "gross_charge": 4045.47, "discounted_cash": 6068.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3924.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3236.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 3 20.0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2831.82, "maximum": 3924.1, "gross_charge": 4045.47, "discounted_cash": 6068.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3924.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2831.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3034.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3438.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3236.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 4 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2970.24, "maximum": 4115.9, "gross_charge": 4243.2, "discounted_cash": 6364.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3606.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4115.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3606.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3394.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 4 15MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 4 17.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 4 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 5 12.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2970.24, "maximum": 4115.9, "gross_charge": 4243.2, "discounted_cash": 6364.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3606.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4115.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2970.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3606.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3394.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 5 15MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2831.28, "maximum": 3923.34, "gross_charge": 4044.69, "discounted_cash": 6067.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3437.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3033.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2831.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3923.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2831.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3033.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3437.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3235.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 5 17.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL 5 20MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL DEBAKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 486.5, "maximum": 674.15, "gross_charge": 695.0, "discounted_cash": 1042.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 590.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 521.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 486.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 674.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 486.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 521.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 590.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 556.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "3100104484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5274.0, "discounted_cash": 7911.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2970.1, "maximum": 4115.71, "gross_charge": 4243.0, "discounted_cash": 6364.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3606.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3182.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2970.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4115.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2970.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3182.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3606.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3394.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1382.5, "maximum": 1915.75, "gross_charge": 1975.0, "discounted_cash": 2962.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1678.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1481.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1382.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1915.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1382.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1481.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1678.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1580.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1674.4, "maximum": 2320.24, "gross_charge": 2392.0, "discounted_cash": 3588.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2033.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1674.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2320.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1674.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2033.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1913.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1688.4, "maximum": 2339.64, "gross_charge": 2412.0, "discounted_cash": 3618.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2050.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1809.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1688.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2339.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1688.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1809.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2050.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1929.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1810.2, "maximum": 2508.42, "gross_charge": 2586.0, "discounted_cash": 3879.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2198.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1939.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1810.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2508.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1810.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1939.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2198.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2068.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1856.9, "maximum": 2573.13, "gross_charge": 2652.72, "discounted_cash": 3979.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2254.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1989.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1856.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2573.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1856.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1989.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2254.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2122.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1895.6, "maximum": 2626.76, "gross_charge": 2708.0, "discounted_cash": 4062.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2301.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2031.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1895.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2626.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1895.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2031.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2301.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1946.0, "maximum": 2696.6, "gross_charge": 2780.0, "discounted_cash": 4170.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2085.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1946.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2696.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1946.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2085.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1981.0, "maximum": 2745.1, "gross_charge": 2830.0, "discounted_cash": 4245.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2405.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2122.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1981.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2745.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1981.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2122.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2405.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.4, "maximum": 3164.14, "gross_charge": 3262.0, "discounted_cash": 4893.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2293.2, "maximum": 3177.72, "gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2293.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3177.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2293.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2475.9, "maximum": 3430.89, "gross_charge": 3537.0, "discounted_cash": 5305.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3006.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2652.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2475.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3430.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2475.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2652.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3006.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2829.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2644.6, "maximum": 3664.66, "gross_charge": 3778.0, "discounted_cash": 5667.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3211.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2833.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2644.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3664.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2644.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2833.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3211.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3022.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2753.1, "maximum": 3815.01, "gross_charge": 3933.0, "discounted_cash": 5899.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3343.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2949.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2753.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3815.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2753.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2949.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3343.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3146.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2757.3, "maximum": 3820.83, "gross_charge": 3939.0, "discounted_cash": 5908.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3348.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2954.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2757.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3820.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2757.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2954.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3348.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2825.2, "maximum": 3914.92, "gross_charge": 4036.0, "discounted_cash": 6054.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3430.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3027.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2825.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3914.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2825.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3027.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3430.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL LG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "3100104299", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2757.3, "maximum": 3820.83, "gross_charge": 3939.0, "discounted_cash": 5908.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3348.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2954.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2757.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3820.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2757.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2954.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3348.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2954.0, "maximum": 4093.4, "gross_charge": 4220.0, "discounted_cash": 6330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3587.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2954.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4093.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2954.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3587.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3376.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3500.0, "maximum": 4850.0, "gross_charge": 5000.0, "discounted_cash": 7500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4250.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4850.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3500.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4250.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4633.3, "maximum": 6420.43, "gross_charge": 6619.0, "discounted_cash": 9928.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5626.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4964.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4633.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6420.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4633.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4964.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5626.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5295.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5019.7, "maximum": 6955.87, "gross_charge": 7171.0, "discounted_cash": 10756.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6095.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5378.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5019.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6955.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5019.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5378.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6095.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5736.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4957.4, "maximum": 6869.54, "gross_charge": 7082.0, "discounted_cash": 10623.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6019.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5311.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4957.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6869.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4957.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5311.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6019.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5665.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3019.1, "maximum": 4183.61, "gross_charge": 4313.0, "discounted_cash": 6469.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3666.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3234.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3019.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4183.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3019.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3234.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3666.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3450.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ5 17", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ5 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2644.6, "maximum": 3664.66, "gross_charge": 3778.0, "discounted_cash": 5667.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3211.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2833.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2644.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3664.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2644.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2833.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3211.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3022.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2704.8, "maximum": 3748.08, "gross_charge": 3864.0, "discounted_cash": 5796.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3284.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2898.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2704.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3748.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2704.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2898.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3284.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3091.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2954.0, "maximum": 4093.4, "gross_charge": 4220.0, "discounted_cash": 6330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3587.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2954.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4093.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2954.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3587.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3376.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3168.2, "maximum": 4390.22, "gross_charge": 4526.0, "discounted_cash": 6789.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3847.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3394.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3168.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4390.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3168.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3394.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3847.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3620.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3303.3, "maximum": 4577.43, "gross_charge": 4719.0, "discounted_cash": 7078.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4011.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3539.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3303.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4577.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3303.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3539.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4011.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3775.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4260.2, "maximum": 5903.42, "gross_charge": 6086.0, "discounted_cash": 9129.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5173.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4564.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4260.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5903.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4260.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4564.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5173.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL TPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL2.5 15M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TORNIER COMPA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8630.3, "maximum": 11959.13, "gross_charge": 12329.0, "discounted_cash": 18493.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10479.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9246.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8630.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11959.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8630.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9246.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10479.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9863.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TORNIER HUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TORNIER HUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4686.5, "maximum": 6494.15, "gross_charge": 6695.0, "discounted_cash": 10042.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5690.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5021.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4686.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6494.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4686.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5021.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5690.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5356.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TORNIER POLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1895.6, "maximum": 2626.76, "gross_charge": 2708.0, "discounted_cash": 4062.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2301.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2031.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1895.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2626.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1895.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2031.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2301.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH W/PORT", "code_information": [{"code": "49419", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4404.17, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNEL CV CAT", "code_information": [{"code": "36558", "type": "CPT"}, {"code": "3480101880", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7145.99, "gross_charge": 7367.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6261.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5156.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7145.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5156.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5525.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6261.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5893.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV A", "code_information": [{"code": "36561", "type": "CPT"}, {"code": "3480101881", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4862.61, "gross_charge": 5013.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4261.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3759.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3509.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4862.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3509.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3759.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4261.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4010.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36560", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36563", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36565", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CV CATH", "code_information": [{"code": "36566", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT URO/VES NCK S", "code_information": [{"code": "53445", "type": "CPT"}, {"code": "3340102443", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 45909.13, "gross_charge": 47329.0, "discounted_cash": 30876.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 40229.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21283.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 35496.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33130.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 45909.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33130.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 35496.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24495.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40229.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 37863.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT UTERI TANDEM/OVOIDS", "code_information": [{"code": "57155", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36625", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36640", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION CATHETER ARTERY", "code_information": [{"code": "36660", "type": "CPT"}], "standard_charges": [{"minimum": 300.38, "maximum": 300.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36810", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA(S)", "code_information": [{"code": "36823", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36481", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36510", "type": "CPT"}], "standard_charges": [{"minimum": 300.38, "maximum": 300.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST T", "code_information": [{"code": "32551", "type": "CPT"}, {"code": "3340102377", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1188.6, "maximum": 1944.78, "gross_charge": 1698.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1443.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1273.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1188.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1647.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1188.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1273.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1443.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1358.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 11831.66, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INTRAUT", "code_information": [{"code": "58300", "type": "CPT"}, {"code": "3480102102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 167.32, "maximum": 549.99, "gross_charge": 567.0, "discounted_cash": 850.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 481.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 425.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 549.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 425.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 481.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF IRIS PROSTHESIS", "code_information": [{"code": "616T", "type": "CPT"}], "standard_charges": [{"minimum": 1367.49, "maximum": 1367.49, "discounted_cash": 26556.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF LEFT HEART VENT", "code_information": [{"code": "33988", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF MULTI-C", "code_information": [{"code": "54405", "type": "CPT"}, {"code": "3480102057", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 42487.94, "gross_charge": 43802.0, "discounted_cash": 30876.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37231.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21283.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32851.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30661.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42487.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30661.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32851.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24495.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37231.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35041.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF PENILE", "code_information": [{"code": "54401", "type": "CPT"}, {"code": "3480102056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 50986.11, "gross_charge": 52563.0, "discounted_cash": 30876.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44678.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21283.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39422.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36794.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50986.11, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36794.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39422.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24495.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44678.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 42050.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF PIN-RET", "code_information": [{"code": "42281", "type": "CPT"}, {"code": "3480101920", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7111.29, "gross_charge": 4016.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION OF TUNNELE", "code_information": [{"code": "36557", "type": "CPT"}, {"code": "3480101879", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7145.99, "gross_charge": 7367.0, "discounted_cash": 8411.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6261.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5798.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5156.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7145.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5719.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5156.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5775.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5525.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6673.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6261.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5893.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5719.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION SS DFB ELECTRODE", "code_information": [{"code": "572T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERTION TOOL*M0063", "code_information": [{"code": "3100209279", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSIT HYBRID MAN ADD", "code_information": [{"code": "88369", "type": "CPT"}, {"code": "3440103035", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 110.63, "maximum": 182.01, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 110.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSIT HYBRIDIZATION", "code_information": [{"code": "88368", "type": "CPT"}, {"code": "3440103016", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 128.74, "maximum": 436.49, "gross_charge": 234.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 226.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 187.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 128.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRID PER SP", "code_information": [{"code": "88364", "type": "CPT"}, {"code": "3440103038", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 108.01, "maximum": 182.01, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 108.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSITU HYBRIDIZATION (FISH)", "code_information": [{"code": "88366", "type": "CPT"}], "standard_charges": [{"minimum": 182.01, "maximum": 252.67, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 252.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ ANT SGM AQ DRG DEV 1+", "code_information": [{"code": "671T", "type": "CPT"}], "standard_charges": [{"minimum": 1367.49, "maximum": 1367.49, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV 1ST", "code_information": [{"code": "449T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRAIN DEV EACH", "code_information": [{"code": "450T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ AQUEOUS DRG DEV IO RSVR", "code_information": [{"code": "474T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22853", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22854", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ BIOMECHANICAL DEVICE", "code_information": [{"code": "22859", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ GTUBE PERQ MAG GASTRPXY", "code_information": [{"code": "647T", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IMPLTBL GLUCOSE SENSOR", "code_information": [{"code": "446T", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 26556.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH W/RMVL&INSJ", "code_information": [{"code": "617T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 26556.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ NON-BIODEGRADAB", "code_information": [{"code": "11981", "type": "CPT"}, {"code": "3480101337", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 121.8, "maximum": 277.43, "gross_charge": 174.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 26556.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTERIAL", "code_information": [{"code": "33990", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1735.06, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I 5 YR+", "code_information": [{"code": "36573", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1735.06, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1735.06, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SINUS TARSI IMPLANT", "code_information": [{"code": "335T", "type": "CPT"}], "standard_charges": [{"minimum": 3498.15, "maximum": 3498.15, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22867", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/DCMPRN", "code_information": [{"code": "22868", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22869", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ STABLJ DEV W/O DCMPRN", "code_information": [{"code": "22870", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ VNT ELT", "code_information": [{"code": "411T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CARDIAC MODULJ SYS", "code_information": [{"code": "408T", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 50357.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT DEFIB W/LEAD(S)", "code_information": [{"code": "33249", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 50357.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 50357.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], "standard_charges": [{"minimum": 8198.68, "maximum": 8198.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSPACE MEDIUM*0131", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSPACE SMALL*0130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT HEART PM ATRIAL & VENT", "code_information": [{"code": "33208", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 50357.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/REDO NEUROSTIM 1 ARRAY", "code_information": [{"code": "61885", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 30305.84, "discounted_cash": 33484.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/REDO PN/GASTR", "code_information": [{"code": "64590", "type": "CPT"}, {"code": "3480103203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 62255.57, "gross_charge": 64181.0, "discounted_cash": 33484.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 54553.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23081.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48135.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 44926.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 62255.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 44926.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22992.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48135.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26563.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 54553.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 51344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSRT/REDO PN/GASTR", "code_information": [{"code": "64590", "type": "CPT"}, {"code": "3480103277", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 42550.02, "gross_charge": 43866.0, "discounted_cash": 33484.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37286.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23081.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32899.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30706.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42550.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30706.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22992.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32899.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26563.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37286.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35092.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTACLEAR 0*LCS1500", "code_information": [{"code": "3100207069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 190.12, "discounted_cash": 285.18, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTACLEAR 0*LCS4K00", "code_information": [{"code": "3100208403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.8, "discounted_cash": 436.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTACLEAR 30*LCS4K3", "code_information": [{"code": "3100208404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.8, "discounted_cash": 436.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63740", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTALL SPINAL SHUNT", "code_information": [{"code": "63741", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTI HEXAMINOLEVULINATE HCL", "code_information": [{"code": "A9589", "type": "HCPCS"}], "standard_charges": [{"minimum": 1321.84, "maximum": 1321.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1321.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSTRACLEAR 30*LCS15", "code_information": [{"code": "3100207070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 190.12, "discounted_cash": 285.18, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRACLEAR TUBING*L", "code_information": [{"code": "3100207071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.56, "discounted_cash": 66.84, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BATTERY", "code_information": [{"code": "3100102270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN ANTIBODIES", "code_information": [{"code": "86337", "type": "CPT"}, {"code": "3440101080", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 21.41, "maximum": 187.21, "gross_charge": 193.0, "discounted_cash": 34.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN ASPART", "code_information": [{"code": "3400300063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 181.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1817", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.56, "maximum": 7.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN FREE", "code_information": [{"code": "83527", "type": "CPT"}, {"code": "3440100939", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.95, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1815", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.02, "maximum": 3.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSULIN LISPRO", "code_information": [{"code": "3400300004", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 51.9, "discounted_cash": 77.85, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN NPH HUMAN/RE", "code_information": [{"code": "3400300003", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.9, "discounted_cash": 55.35, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN NPH HUMAN/RE", "code_information": [{"code": "3400300062", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 241.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN PUMP INITIATION", "code_information": [{"code": "S9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN REG HUMAN RE", "code_information": [{"code": "3400300002", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.1, "discounted_cash": 16.65, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN REG HUMAN RE", "code_information": [{"code": "3400300061", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 88.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSULIN SUPPRESSION PANEL", "code_information": [{"code": "80432", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 165.61, "discounted_cash": 266.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 165.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80434", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 285.03, "discounted_cash": 457.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 285.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN TOLERANCE PANEL", "code_information": [{"code": "80435", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 103.0, "discounted_cash": 165.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 103.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULIN TOTAL", "code_information": [{"code": "83525", "type": "CPT"}, {"code": "3440100938", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.43, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 18.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSULSCAN WANDS", "code_information": [{"code": "3100100881", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 144.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INT CARIES MED APP PER TOOTH", "code_information": [{"code": "D1354", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 1 HROID W/O IMG", "code_information": [{"code": "46945", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC LIG 2+HROID W/O IMG", "code_information": [{"code": "46946", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT HRHC TRANAL DARTLZJ 2+", "code_information": [{"code": "46948", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT THERAPEUTIC RESTORATION", "code_information": [{"code": "D2941", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INT/ABUT INT FIXED DENT MAX", "code_information": [{"code": "D6119", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTAKE ACT W/MED EXAM", "code_information": [{"code": "G2076", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTEGRA BMWD", "code_information": [{"code": "Q4104", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.88, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTEGRA DRT OR OMNIGRAFT", "code_information": [{"code": "Q4105", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.6, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTEGRA FLOWABLE WOUND MATRI", "code_information": [{"code": "Q4114", "type": "HCPCS"}], "standard_charges": [{"minimum": 1497.92, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1497.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTEGRA MATRIX", "code_information": [{"code": "Q4108", "type": "HCPCS"}], "standard_charges": [{"minimum": 49.68, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTEGRA MESHED BIL WOUND MAT", "code_information": [{"code": "C9363", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTENS BEHAVE THER CARDIO DX", "code_information": [{"code": "G0446", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB NO EXER", "code_information": [{"code": "G0423", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.9, "maximum": 186.9, "discounted_cash": 202.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTENS CARDIAC REHAB W/EXERC", "code_information": [{"code": "G0422", "type": "HCPCS"}], "standard_charges": [{"minimum": 186.9, "maximum": 186.9, "discounted_cash": 202.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTENSIVE OUTPATIENT PSYCHIA", "code_information": [{"code": "S9480", "type": "HCPCS"}], "standard_charges": [{"minimum": 524.66, "maximum": 524.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 524.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTENTIONAL REPLANTATION", "code_information": [{"code": "D3470", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERACTIVE GRP PSYC PHP/IOP", "code_information": [{"code": "G0411", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.55, "maximum": 84.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X10*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X11*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X11*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X12*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X12*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X13*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X132*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X14*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X14*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X15*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X15*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X16*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5369.0, "maximum": 7439.9, "gross_charge": 7670.0, "discounted_cash": 11505.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7439.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X16*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X8*WO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X28X9*WO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X12*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X13*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X13*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X14*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X14*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X15*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X15*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 11X32X16*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 12X17X6*36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 14X27X12*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 9X24X13*WO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8217.3, "maximum": 11386.83, "gross_charge": 11739.0, "discounted_cash": 17608.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11386.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8804.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9978.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY 9X24X141*W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY CAGE MED 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6190.73, "maximum": 8578.58, "gross_charge": 8843.9, "discounted_cash": 13265.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7517.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6632.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6190.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8578.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6190.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6632.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7517.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7075.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY DEV", "code_information": [{"code": "3100104611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERBODY FUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4678.1, "maximum": 6482.51, "gross_charge": 6683.0, "discounted_cash": 10024.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5680.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5012.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4678.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6482.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4678.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5012.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5680.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5346.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2140.6, "maximum": 2966.26, "gross_charge": 3058.0, "discounted_cash": 4587.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2599.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2293.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2140.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2966.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2140.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2293.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2599.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2446.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS 11X22X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS 13X22X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS 13X27X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS 14X22X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS 15X22X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUS 15X27X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUSI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4823.0, "maximum": 6683.3, "gross_charge": 6890.0, "discounted_cash": 10335.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5856.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5167.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4823.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6683.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4823.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5167.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5856.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5512.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUSION*939", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUSION*939", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY FUSION*939", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY SPACER 32X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY SPACER 37X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY SPACER 37X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY SPACER 37X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY SPACER 37X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY SUS-O", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5329.1, "maximum": 7384.61, "gross_charge": 7613.0, "discounted_cash": 11419.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6471.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5709.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5329.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7384.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5329.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5709.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6471.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY*6101210281", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY*6101212321", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY*6101212321", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY*6101222451", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7735.0, "maximum": 10718.5, "gross_charge": 11050.0, "discounted_cash": 16575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9392.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10718.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9392.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY*6101222501", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7735.0, "maximum": 10718.5, "gross_charge": 11050.0, "discounted_cash": 16575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9392.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10718.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8287.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9392.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY*6101285221", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERBODY30X11X12*10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5369.0, "maximum": 7439.9, "gross_charge": 7670.0, "discounted_cash": 11505.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7439.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERCALARY ALGRFT COMPL", "code_information": [{"code": "20934", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL FIXATION", "code_information": [{"code": "21110", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDENTAL WIRING", "code_information": [{"code": "21497", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERDISCAL PERQ ASPIR DX", "code_information": [{"code": "62267", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERFACE SOFT AK SE", "code_information": [{"code": "3100104128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9213", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-2B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9214", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.57, "maximum": 32.57, "discounted_cash": 52.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFA-N3 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9215", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.29, "maximum": 25.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON ALFACON-1 INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9212", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1A INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1826", "type": "HCPCS"}], "standard_charges": [{"minimum": 1631.96, "maximum": 1631.96, "discounted_cash": 3069.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1631.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON BETA-1B / .25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1830", "type": "HCPCS"}], "standard_charges": [{"minimum": 307.32, "maximum": 307.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 307.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFERON GAMMA 1-B INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9216", "type": "HCPCS"}], "standard_charges": [{"minimum": 4208.89, "maximum": 4208.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4208.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERFYL, 1 MG", "code_information": [{"code": "Q4171", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.53, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERIM CROWN", "code_information": [{"code": "D2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERIM IMPLANT ABUTMENT", "code_information": [{"code": "D6051", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERIM IMPLANT CROWN", "code_information": [{"code": "D6085", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERIM PONTIC", "code_information": [{"code": "D6253", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERIM RETAINER CROWN", "code_information": [{"code": "D6793", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERMEDIATE VISUAL FIELD XM", "code_information": [{"code": "92082", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERNAL ROOT REPAIR", "code_information": [{"code": "D3333", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERNALBRACE LIGAME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERRO EVAL CARDIAC MODULJ", "code_information": [{"code": "418T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICDS SS IP", "code_information": [{"code": "576T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ICPMS IP", "code_information": [{"code": "93290", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL IIMS IP", "code_information": [{"code": "529T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL ISDSS IP", "code_information": [{"code": "685T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL SCRMS IP", "code_information": [{"code": "93291", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEV EVAL WCS IP", "code_information": [{"code": "521T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG DEVICE EVAL HEART", "code_information": [{"code": "93289", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROG EVL PM/LDLS PM IP", "code_information": [{"code": "93288", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS DEV", "code_information": [{"code": "272T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROGATE CRTD SNS W/PGRMG", "code_information": [{"code": "273T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROGATE SUBQ DEFIB", "code_information": [{"code": "93261", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERROGATION VAD IN PERSON", "code_information": [{"code": "93750", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTERSTIM CABLE PT*0", "code_information": [{"code": "3100203117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 130.0, "discounted_cash": 195.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM EXTENSION", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3100100883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM FORAMEN ND", "code_information": [{"code": "3100208437", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM FORAMEN ND", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM LEAD*30590", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM LEAD*30910", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM MEDTRONIC", "code_information": [{"code": "3100103865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM PATIENT PR", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "3100100884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2165.8, "maximum": 3001.18, "gross_charge": 3094.0, "discounted_cash": 4641.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2629.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3001.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2629.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM PNE LEAD*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTIM SMART PROG", "code_information": [{"code": "3100204589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM TEST KIT*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [{"code": "197", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5427.75, "maximum": 5427.75, "discounted_cash": 11136.66, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5427.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [{"code": "196", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8575.7, "maximum": 8575.7, "discounted_cash": 21161.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8575.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC", "code_information": [{"code": "198", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4565.14, "maximum": 4565.14, "discounted_cash": 8688.27, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4565.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTESTINAL STRICTUROPLASTY", "code_information": [{"code": "44615", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLANT LIVE", "code_information": [{"code": "44136", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTESTINE TRANSPLNT CADAVER", "code_information": [{"code": "44135", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 12.6-20 CM", "code_information": [{"code": "12055", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 20.1-30.0", "code_information": [{"code": "12056", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 5.1-7.5 CM", "code_information": [{"code": "12053", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM >30.0 CM", "code_information": [{"code": "12057", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT >30.0CM", "code_information": [{"code": "12047", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 736.48, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT12.6-20", "code_information": [{"code": "12045", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT20.1-30", "code_information": [{"code": "12046", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTMD RPR S/A/T/EXT 20.1-30", "code_information": [{"code": "12036", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL PACING", "code_information": [{"code": "93610", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRA-ATRIAL RECORDING", "code_information": [{"code": "93602", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAABDOMINAL PRESSURE TEST", "code_information": [{"code": "51797", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACARDIAC ECG (ICE)", "code_information": [{"code": "93662", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACATH", "code_information": [{"code": "3100100885", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRACEPT ADD LEVEL*", "code_information": [{"code": "3100208339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRACEPT INST.*FG00", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3100207602", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 3967.6, "maximum": 5497.96, "gross_charge": 5668.0, "discounted_cash": 8502.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4817.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4251.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3967.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5497.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3967.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4251.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4817.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4534.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACEPT INST.*RLV0", "code_information": [{"code": "3100209018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6708.0, "discounted_cash": 10062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRACRAN ANGIOPLSTY W/STENT", "code_information": [{"code": "61635", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL ANGIOPLASTY", "code_information": [{"code": "61630", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL COMPLETE STUDY", "code_information": [{"code": "93886", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [{"code": "65", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6281.76, "maximum": 6281.76, "discounted_cash": 11347.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6281.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [{"code": "64", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10597.28, "maximum": 10597.28, "discounted_cash": 22362.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10597.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC", "code_information": [{"code": "66", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4042.53, "maximum": 4042.53, "discounted_cash": 7675.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4042.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL LIMITED STUDY", "code_information": [{"code": "93888", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [{"code": "21", "type": "MS-DRG"}], "standard_charges": [{"minimum": 41303.93, "maximum": 41303.93, "discounted_cash": 68566.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41303.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [{"code": "20", "type": "MS-DRG"}], "standard_charges": [{"minimum": 52448.41, "maximum": 52448.41, "discounted_cash": 94367.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 52448.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC", "code_information": [{"code": "22", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29886.47, "maximum": 29886.47, "discounted_cash": 38815.85, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29886.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61680", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61684", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61690", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61692", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRADISCAL SHIM*274", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAGASTRIC HYPOTHERMIA", "code_information": [{"code": "M0100", "type": "HCPCS"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAMED ROD 3.0*RR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3648.4, "maximum": 5055.64, "gross_charge": 5212.01, "discounted_cash": 7818.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4430.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3909.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3648.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5055.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3648.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3909.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4430.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAMUSC AUTO BONEM", "code_information": [{"code": "263T", "type": "CPT"}, {"code": "3340102489", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 890.4, "maximum": 5619.66, "gross_charge": 1272.0, "discounted_cash": 7083.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1081.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4882.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 954.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 890.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1233.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4816.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 890.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4864.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 954.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4722.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5619.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1081.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4722.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1017.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4722.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4816.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRANASAL BIOPSY", "code_information": [{"code": "30100", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR FOMIVIRSEN NA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1452", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITH CC/MCC", "code_information": [{"code": "116", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7917.22, "maximum": 7917.22, "discounted_cash": 20440.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7917.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "117", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7917.22, "maximum": 7917.22, "discounted_cash": 13379.61, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7917.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOP SENTINEL LYM", "code_information": [{"code": "38900", "type": "CPT"}, {"code": "3480101898", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 233.8, "maximum": 668.39, "gross_charge": 334.0, "discounted_cash": 501.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 283.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 250.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 233.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 323.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 233.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 250.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 283.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 267.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAOR COMPREHENSIVE SERIES", "code_information": [{"code": "D0210", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.78, "maximum": 179.78, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL BITE RADIO IMAGE", "code_information": [{"code": "D0708", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL COMP IMAGE CAPTURE", "code_information": [{"code": "D0709", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL CON DEF INTER PLT", "code_information": [{"code": "D5958", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL CON DEF MOD PALAT", "code_information": [{"code": "D5959", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL OCCLUS RADIO IMAGE", "code_information": [{"code": "D0706", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL OCCLUSAL FILM", "code_information": [{"code": "D0240", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAP RADIO IMAGE", "code_information": [{"code": "D0707", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAPICAL EA ADD", "code_information": [{"code": "D0230", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PERIAPICAL FIRST", "code_information": [{"code": "D0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORAL PLACE OF FIX DEV", "code_information": [{"code": "D7998", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAORIFICE BARRIER", "code_information": [{"code": "D3911", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAUT COPPER CONTRACEPTIVE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 988.59, "maximum": 988.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 988.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAUTERINE TRANSFUSION FTL", "code_information": [{"code": "36460", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 11431.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRAVIT INJ PHARM A", "code_information": [{"code": "67028", "type": "CPT"}, {"code": "3410100706", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 786.67, "gross_charge": 811.0, "discounted_cash": 518.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 357.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 786.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 352.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 355.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 352.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR ANT", "code_information": [{"code": "86340", "type": "CPT"}, {"code": "3440101081", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.08, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 24.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRNL BLEACHING PER TOOTH", "code_information": [{"code": "D9974", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS", "code_information": [{"code": "36901", "type": "CPT"}, {"code": "3480103155", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1634.27, "maximum": 2113.75, "gross_charge": 0.01, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS", "code_information": [{"code": "36902", "type": "CPT"}, {"code": "3480103156", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 5001.8, "maximum": 13135.74, "gross_charge": 13542.0, "discounted_cash": 8748.74, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11510.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6030.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10156.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9479.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13135.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9479.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6007.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10156.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6940.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11510.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10833.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS", "code_information": [{"code": "36903", "type": "CPT"}, {"code": "3480103157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8133.27, "maximum": 13358.96, "gross_charge": 0.01, "discounted_cash": 16839.03, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11607.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11562.8, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13358.96, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO DELIVERY", "code_information": [{"code": "3100100886", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO DELIVERY", "code_information": [{"code": "3100102859", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 1053.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO ET BOUGI", "code_information": [{"code": "3100100887", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO ET BOUGI", "code_information": [{"code": "3100102860", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 769.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO ET BOUGI", "code_information": [{"code": "3100104478", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.6, "discounted_cash": 30.9, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRO GASTROINTESTINAL TUBE", "code_information": [{"code": "44500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO MIX SALINE&AIR F/SSG", "code_information": [{"code": "568T", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO NDL ICATH UPR/LXTR ART", "code_information": [{"code": "36140", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO WINDPIPE WIRE/TUBE", "code_information": [{"code": "31730", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3345.07, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INTRO/SHEATH, NON-LASER", "code_information": [{"code": "C1894", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTROD SHEATH 10X8*R", "code_information": [{"code": "3100205171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.8, "discounted_cash": 58.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER FROVIA", "code_information": [{"code": "3100100888", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER FROVIA", "code_information": [{"code": "3100102861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER GRAFT HDL", "code_information": [{"code": "3100100889", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2753.0, "discounted_cash": 4129.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER SET SP*G1", "code_information": [{"code": "3100205025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 332.64, "discounted_cash": 498.96, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCR SYS PTFE 8", "code_information": [{"code": "3100104063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INTUBATION SET LACRI", "code_information": [{"code": "3100100890", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM INIT", "code_information": [{"code": "95980", "type": "CPT"}], "standard_charges": [{"minimum": 303.49, "maximum": 303.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO ANAL GAST N-STIM SUBSQ", "code_information": [{"code": "95981", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO GA N-STIM SUBSQ W/REPROG", "code_information": [{"code": "95982", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO LENS", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100102117", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVER BY ELCTRNS", "code_information": [{"code": "77425", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 11919.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO RAD TX DELIVERY BY X-RAY", "code_information": [{"code": "77424", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 11919.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IO RADIATION TX MANAGEMENT", "code_information": [{"code": "77469", "type": "CPT"}], "standard_charges": [{"minimum": 586.07, "maximum": 586.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 586.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IOBP PROCEDURE KIT*A", "code_information": [{"code": "3100206790", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IODINE I-123 IOFLUPANE", "code_information": [{"code": "A9584", "type": "HCPCS"}], "standard_charges": [{"minimum": 2756.29, "maximum": 2756.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2756.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 SOD IODIDE MIC", "code_information": [{"code": "A9516", "type": "HCPCS"}], "standard_charges": [{"minimum": 216.76, "maximum": 216.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 216.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IODINE I-123 SOD IODIDE MIL", "code_information": [{"code": "A9509", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-125 SODIUM IODIDE", "code_information": [{"code": "A9527", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 96.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-131 IOBENGUANE 1MCI", "code_information": [{"code": "A9590", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 545.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODINE I-131 IODIDE CAP, DX", "code_information": [{"code": "A9528", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IODOFORM POWDER 500G", "code_information": [{"code": "3100100891", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IONM 1-1 IN OR W/ATT", "code_information": [{"code": "95940", "type": "CPT"}, {"code": "3480103011", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 76.3, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 163.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IONM REMO/NEAR/>1 PA", "code_information": [{"code": "95941", "type": "CPT"}, {"code": "3480101387", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 91.7, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IOVERA CARTRIDGE*CRX", "code_information": [{"code": "3100204203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IOVERA LONG NEEDLE*S", "code_information": [{"code": "3100204313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IOVERA SMART TIP*STT", "code_information": [{"code": "3100204202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1000.0, "discounted_cash": 1500.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IPG BATTERY*977006", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 20776.0, "maximum": 28789.6, "gross_charge": 29680.0, "discounted_cash": 44520.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25228.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22260.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20776.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28789.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20776.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22260.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG CHARGING/PROGRAM", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100102273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG CHARGING/PROGRAM", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100103729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2538.9, "maximum": 3518.19, "gross_charge": 3627.0, "discounted_cash": 5440.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3082.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2720.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2538.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3518.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2538.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2720.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3082.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2901.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG PAIN THERAPY", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100102272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 26453.0, "maximum": 36656.3, "gross_charge": 37790.0, "discounted_cash": 56685.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 32121.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28342.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26453.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36656.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26453.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28342.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 32121.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG PAIN THERAPY", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100103726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 20713.0, "maximum": 28702.3, "gross_charge": 29590.0, "discounted_cash": 44385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25151.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20713.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28702.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20713.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25151.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23672.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG PAIN THERAPY", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100103727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 22386.0, "maximum": 31020.6, "gross_charge": 31980.0, "discounted_cash": 47970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 27183.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 23985.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 22386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 31020.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 22386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 23985.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 27183.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 25584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPG PAIN THERAPY", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100103728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25193.0, "maximum": 34910.3, "gross_charge": 35990.0, "discounted_cash": 53985.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30591.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26992.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25193.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34910.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25193.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26992.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30591.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPILIMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9228", "type": "HCPCS"}], "standard_charges": [{"minimum": 172.71, "maximum": 172.71, "discounted_cash": 276.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 172.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7645", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IPRATROPIUM BROMIDE NON-COMP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7644", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.33, "maximum": 0.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IPRISM*SX1", "code_information": [{"code": "3100207587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IR OR PROC 1ST 30 MI", "code_information": [{"code": "3480103328", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3006.0, "discounted_cash": 4509.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IR OR PROC EA ADD 15", "code_information": [{"code": "3480103329", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5191.0, "discounted_cash": 7786.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUM ORGAN PERQ", "code_information": [{"code": "600T", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRE ABLTJ 1+TUMORS OPEN", "code_information": [{"code": "601T", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRINOTECAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9206", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.51, "maximum": 3.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRON", "code_information": [{"code": "83540", "type": "CPT"}, {"code": "3440100940", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.47, "maximum": 52.38, "gross_charge": 54.0, "discounted_cash": 10.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRON BINDING CAPACIT", "code_information": [{"code": "83550", "type": "CPT"}, {"code": "3440100941", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.74, "maximum": 74.69, "gross_charge": 77.0, "discounted_cash": 14.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRON STAIN PERIPHERAL BLOOD", "code_information": [{"code": "85536", "type": "CPT"}], "standard_charges": [{"minimum": 6.88, "maximum": 20.92, "discounted_cash": 11.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRON SUCROSE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1756", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IRRIG TUBING SET*OEM", "code_information": [{"code": "3100208120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.52, "discounted_cash": 204.78, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIGATION NEEDLE", "code_information": [{"code": "3100102182", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IRRIGATION OF BLADDE", "code_information": [{"code": "51700", "type": "CPT"}, {"code": "3480103176", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 733.32, "gross_charge": 756.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 733.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRRIGATION OF BLADDE", "code_information": [{"code": "51700", "type": "CPT"}, {"code": "3480103221", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 189.13, "maximum": 902.1, "gross_charge": 930.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 902.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 651.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 697.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 790.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 744.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IRRISEPT*ISEPT-450-U", "code_information": [{"code": "3100209112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.6, "discounted_cash": 413.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [{"code": "62", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12447.31, "maximum": 12447.31, "discounted_cash": 20896.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12447.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [{"code": "61", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14984.73, "maximum": 14984.73, "discounted_cash": 31292.04, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14984.73, "methodology": "fee schedule"}], "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": 11053.49, "maximum": 11053.49, "discounted_cash": 16599.48, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11053.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISH P/SPEC MAN EA AD", "code_information": [{"code": "88377", "type": "CPT"}, {"code": "3440103120", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 174.29, "maximum": 404.49, "gross_charge": 417.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 354.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 312.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 291.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 404.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 291.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 312.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 354.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 333.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 238.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLAND PEDICLE FLAP GRAFT", "code_information": [{"code": "15740", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLET CELL ANTIBODY", "code_information": [{"code": "86341", "type": "CPT"}, {"code": "3440101082", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 23.57, "maximum": 171.69, "gross_charge": 177.0, "discounted_cash": 37.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 150.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 171.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 30.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 150.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 141.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 25.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISLET CELL TISSUE TRANSPLANT", "code_information": [{"code": "S2102", "type": "HCPCS"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7647", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7650", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7648", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOETHARINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7649", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOFLURANE", "code_information": [{"code": "3400300307", "type": "CDM"}, {"code": "999", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOLATION- TOOTH W RUBB DAM", "code_information": [{"code": "D3910", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7657", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7660", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7658", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOPROTERENOL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7659", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ISOVUE", "code_information": [{"code": "3100102183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 151.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOVUE", "code_information": [{"code": "3100103706", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOVUE", "code_information": [{"code": "3100103707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOVUE", "code_information": [{"code": "3100103708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOVUE", "code_information": [{"code": "3100103709", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ISOVUE-M 200 10ML", "code_information": [{"code": "Q9966", "type": "HCPCS"}, {"code": "3400300488", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.39, "maximum": 150.43, "gross_charge": 155.09, "discounted_cash": 232.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ISTENT INJECT W*G2-W", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2995.08, "maximum": 4150.32, "gross_charge": 4278.69, "discounted_cash": 6418.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3636.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3209.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2995.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4150.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2995.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3209.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3636.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3422.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ITIND SYSTEM*WA2ITA0", "code_information": [{"code": "3100210210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ITRACONAZOLE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1835", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "IUD COPPER*59365-512", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV CATH ANGIOCATH", "code_information": [{"code": "3100100892", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IV INFUSION HYDRATIO", "code_information": [{"code": "90760", "type": "CPT"}, {"code": "3430100787", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 147.7, "maximum": 204.67, "gross_charge": 211.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 179.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 158.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 147.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 204.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 147.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 158.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 179.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 168.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INFUSION UP TO 1", "code_information": [{"code": "90765", "type": "CPT"}, {"code": "3430100788", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IV INJ RA DRUG DX STUDY", "code_information": [{"code": "78808", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IV MOD SEDATION, 1ST 15 MIN", "code_information": [{"code": "D9239", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IV MONITORING KIT", "code_information": [{"code": "3100104472", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IV SEDATION EA ADDL 15M", "code_information": [{"code": "D9243", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IVF CANC A ASPIR CASE RATE", "code_information": [{"code": "S4020", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IVF CANC A STIM CASE RATE", "code_information": [{"code": "S4017", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IVF CANC P ASPIR CASE RATE", "code_information": [{"code": "S4021", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IVF PACKAGE", "code_information": [{"code": "S4011", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "IVIG NON-LYOPHILIZED, NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1599", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.95, "maximum": 62.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IXABEPILONE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9207", "type": "HCPCS"}], "standard_charges": [{"minimum": 127.5, "maximum": 127.5, "discounted_cash": 205.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Immunization Administration By Intramuscular Injection Of Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]) Vaccine, 30 Mcg/0.3 Ml Dosage, Diluent Reconstituted; Booster Dose", "code_information": [{"code": "4A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Immunologic Analysis For Detection Of Organism By Immunoassay Technique, Single Step Method", "code_information": [{"code": "87450", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Impl pressure sensor w/angio", "code_information": [{"code": "C9741", "type": "HCPCS"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Implantable Heart Assist Systems, Major", "code_information": [{"code": "161.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 299259.72, "maximum": 299259.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299259.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Implantable Heart Assist Systems, Minor", "code_information": [{"code": "161.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 211525.67, "maximum": 211525.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 211525.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Implantable Heart Assist Systems, Moderate", "code_information": [{"code": "161.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 225104.45, "maximum": 225104.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 225104.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Implantable Heart Assist Systems, Severe", "code_information": [{"code": "161.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 374931.02, "maximum": 374931.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 374931.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Implantation Of Brain Neurostimulator Electrodes", "code_information": [{"code": "61870", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Implantation Of Neurostimulator Electrodes And Pulse Generator For Vagus Nerve Blocking Therapy For Obesity Using An Endoscope", "code_information": [{"code": "312T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inborn Errors Of Metabolism, Major", "code_information": [{"code": "423.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13430.12, "maximum": 13430.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13430.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inborn Errors Of Metabolism, Minor", "code_information": [{"code": "423.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4776.15, "maximum": 4776.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4776.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inborn Errors Of Metabolism, Moderate", "code_information": [{"code": "423.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10272.5, "maximum": 10272.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10272.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inborn Errors Of Metabolism, Severe", "code_information": [{"code": "423.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31012.3, "maximum": 31012.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31012.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Incision Of Valve Between Lower Right Heart Chamber And Main Lung Artery, Closed Heart Procedure, Approached Through Heart", "code_information": [{"code": "33470", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infections Of Upper Respiratory Tract, Major", "code_information": [{"code": "113.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8017.06, "maximum": 8017.06, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8017.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infections Of Upper Respiratory Tract, Minor", "code_information": [{"code": "113.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4621.09, "maximum": 4621.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4621.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infections Of Upper Respiratory Tract, Moderate", "code_information": [{"code": "113.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6560.0, "maximum": 6560.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6560.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infections Of Upper Respiratory Tract, Severe", "code_information": [{"code": "113.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19804.3, "maximum": 19804.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19804.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infectious And Parasitic Diseases Including Hiv With O.R. Procedure, Major", "code_information": [{"code": "710.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33520.2, "maximum": 33520.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33520.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infectious And Parasitic Diseases Including Hiv With O.R. Procedure, Minor", "code_information": [{"code": "710.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16845.32, "maximum": 16845.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16845.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infectious And Parasitic Diseases Including Hiv With O.R. Procedure, Moderate", "code_information": [{"code": "710.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21598.4, "maximum": 21598.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21598.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Infectious And Parasitic Diseases Including Hiv With O.R. Procedure, Severe", "code_information": [{"code": "710.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 69057.47, "maximum": 69057.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69057.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inflammatory Bowel Disease, Major", "code_information": [{"code": "245.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14643.7, "maximum": 14643.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14643.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inflammatory Bowel Disease, Minor", "code_information": [{"code": "245.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8201.6, "maximum": 8201.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8201.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inflammatory Bowel Disease, Moderate", "code_information": [{"code": "245.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10046.96, "maximum": 10046.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10046.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inflammatory Bowel Disease, Severe", "code_information": [{"code": "245.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22008.48, "maximum": 22008.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22008.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inguinal, Femoral And Umbilical Hernia Procedures, Major", "code_information": [{"code": "228.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18868.81, "maximum": 18868.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18868.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inguinal, Femoral And Umbilical Hernia Procedures, Minor", "code_information": [{"code": "228.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11314.36, "maximum": 11314.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11314.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inguinal, Femoral And Umbilical Hernia Procedures, Moderate", "code_information": [{"code": "228.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12303.68, "maximum": 12303.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12303.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inguinal, Femoral And Umbilical Hernia Procedures, Severe", "code_information": [{"code": "228.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38439.87, "maximum": 38439.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38439.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inhalation Of Allergic Substances With Reaction Analysis", "code_information": [{"code": "95071", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Init psych care manag, 70min", "code_information": [{"code": "G0502", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Init/sub psych care add 30 m", "code_information": [{"code": "G0504", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inj avacincaptad pegol 0.1mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2782", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.07, "maximum": 109.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 109.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj brixadi, more than 7 day", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0578", "type": "HCPCS"}], "standard_charges": [{"minimum": 1616.35, "maximum": 1616.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1616.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj cyclophosphamd (ingenus)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9073", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.98, "maximum": 0.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj daxibotulinumtoxina-lanm", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0589", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj hydroxocobalamin iv 25mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3424", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj melphalan (hepzato) 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9248", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj pozelimab-bbfg, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9376", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj talquetamab-tgvs 0.25 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3055", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.72, "maximum": 67.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj, aflibercept hd, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 341.75, "maximum": 341.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 341.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj, brixadi, 7 days or less", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0577", "type": "HCPCS"}], "standard_charges": [{"minimum": 404.09, "maximum": 404.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 404.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj, cipaglucosidase, 5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1203", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, cyclophosphamd, sandoz", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9074", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, cyclophosphamide, nos", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9075", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.92, "maximum": 0.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj, elranatamab-bcmm, 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1323", "type": "HCPCS"}], "standard_charges": [{"minimum": 181.67, "maximum": 181.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 181.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj, focinvez, 1mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1434", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, human-lans, per i.u", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7165", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, levothyroxine nos 10mcg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0650", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, levothyroxine, freskabi", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0651", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, levothyroxine, hikma", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0652", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, melphalan (apotex) 1 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9249", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, methylpred sod succ 5mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2919", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.27, "maximum": 0.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inj, motixafortide, 0.25 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2277", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, rykindo, 0.5 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2801", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, sod thiosulfate (hope)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0209", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, tofidence, 1 mg", "code_information": [{"code": "Q5133", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Inj, tyruko, 1 mg", "code_information": [{"code": "Q5134", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Injection Of Medication Into Space Above Choroid Membrane Of Eye", "code_information": [{"code": "465T", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Injection adenosine 6 mg", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0150", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Ins/rem-replace compl iims", "code_information": [{"code": "C9750", "type": "HCPCS"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93531", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers Through Existing Septal Opening For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93533", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right And Left Heart Chambers Through Intact Septum For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93532", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Of Catheter Into Right Upper Heart Chamber For Evaluation Of Congenital Abnormalities", "code_information": [{"code": "93530", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Of Lower Spine Artificial Disc, Anterior Approach", "code_information": [{"code": "163T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Complete Neurostimulator System For Treatment Of Central Sleep Apnea, Complete System", "code_information": [{"code": "424T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Complete Neurostimulator System For Treatment Of Central Sleep Apnea, Sensing Leads Only", "code_information": [{"code": "425T", "type": "CPT"}], "standard_charges": [{"minimum": 8198.68, "maximum": 8198.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Pulse Generator Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "427T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion Or Replacement Of Stimulation Lead Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "426T", "type": "CPT"}], "standard_charges": [{"minimum": 8198.68, "maximum": 8198.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices, Major", "code_information": [{"code": "176.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51666.24, "maximum": 51666.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51666.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices, Minor", "code_information": [{"code": "176.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25290.4, "maximum": 25290.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25290.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices, Moderate", "code_information": [{"code": "176.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40146.83, "maximum": 40146.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40146.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices, Severe", "code_information": [{"code": "176.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 76983.55, "maximum": 76983.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76983.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intentional Self-Harm And Attempted Suicide, Major", "code_information": [{"code": "817.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13545.46, "maximum": 13545.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13545.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intentional Self-Harm And Attempted Suicide, Minor", "code_information": [{"code": "817.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5574.53, "maximum": 5574.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5574.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intentional Self-Harm And Attempted Suicide, Moderate", "code_information": [{"code": "817.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7742.82, "maximum": 7742.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7742.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intentional Self-Harm And Attempted Suicide, Severe", "code_information": [{"code": "817.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31940.11, "maximum": 31940.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31940.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Inter devc remote 30d", "code_information": [{"code": "G2066", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Interrogation Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea", "code_information": [{"code": "434T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Interstitial And Alveolar Lung Diseases, Major", "code_information": [{"code": "142.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15864.97, "maximum": 15864.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15864.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Interstitial And Alveolar Lung Diseases, Minor", "code_information": [{"code": "142.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8257.99, "maximum": 8257.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8257.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Interstitial And Alveolar Lung Diseases, Moderate", "code_information": [{"code": "142.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13064.89, "maximum": 13064.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13064.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Interstitial And Alveolar Lung Diseases, Severe", "code_information": [{"code": "142.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23146.45, "maximum": 23146.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23146.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intestinal Obstruction, Major", "code_information": [{"code": "247.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15238.32, "maximum": 15238.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15238.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intestinal Obstruction, Minor", "code_information": [{"code": "247.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6429.29, "maximum": 6429.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6429.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intestinal Obstruction, Moderate", "code_information": [{"code": "247.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8142.65, "maximum": 8142.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8142.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intestinal Obstruction, Severe", "code_information": [{"code": "247.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20788.49, "maximum": 20788.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20788.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intracranial Hemorrhage, Major", "code_information": [{"code": "44.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19651.8, "maximum": 19651.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19651.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intracranial Hemorrhage, Minor", "code_information": [{"code": "44.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9684.3, "maximum": 9684.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9684.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intracranial Hemorrhage, Moderate", "code_information": [{"code": "44.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13308.38, "maximum": 13308.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13308.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intracranial Hemorrhage, Severe", "code_information": [{"code": "44.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62849.89, "maximum": 62849.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62849.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage, Single Dose", "code_information": [{"code": "31A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Chimpanzee Adenovirus Oxford 1 (Chadox1) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage; First Dose", "code_information": [{"code": "21A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Chimpanzee Adenovirus Oxford 1 (Chadox1) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage; Second Dose", "code_information": [{"code": "22A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 100 Mcg/0.5ml Dosage; First Dose", "code_information": [{"code": "11A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 100 Mcg/0.5ml Dosage; Second Dose", "code_information": [{"code": "12A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted; First Dose", "code_information": [{"code": "1A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted; Second Dose", "code_information": [{"code": "2A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Recombinant Spike Protein Nanoparticle, Saponin-Based Adjuvant, Preservative Free, 5 Mcg/0.5ml Dosage; First Dose", "code_information": [{"code": "41A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Recombinant Spike Protein Nanoparticle, Saponin-Based Adjuvant, Preservative Free, 5 Mcg/0.5ml Dosage; Second Dose", "code_information": [{"code": "42A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intraosseous des lumb/sacrum", "code_information": [{"code": "C9752", "type": "HCPCS"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intraosseous destruct add'l", "code_information": [{"code": "C9753", "type": "HCPCS"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Intravenous (Iv) Therapy", "code_information": [{"code": "260", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "JAGWIRE .025 260*M00", "code_information": [{"code": "3100203691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 561.0, "setting": "both", "billing_class": "facility"}]}, {"description": "JAGWIRE STRAIGHT", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100100893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 291.2, "maximum": 403.52, "gross_charge": 416.0, "discounted_cash": 624.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 403.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE", "code_information": [{"code": "81270", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 91.66, "discounted_cash": 147.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 91.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQ ALYS", "code_information": [{"code": "27U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 195.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81279", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JANSSEN VACCINE ADMIN", "code_information": [{"code": "D1707", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JATOME 39*M00573080", "code_information": [{"code": "3100203681", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 897.0, "discounted_cash": 1345.5, "setting": "both", "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29800", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29804", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JEJUNAL FEEDING TUBE", "code_information": [{"code": "3100205534", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 439.2, "discounted_cash": 658.8, "setting": "both", "billing_class": "facility"}]}, {"description": "JK GNOTYP SLC14A1 EXON 9", "code_information": [{"code": "192U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JOHN CUNNINGHAM ANTIBODY", "code_information": [{"code": "86711", "type": "CPT"}], "standard_charges": [{"minimum": 16.89, "maximum": 30.26, "discounted_cash": 27.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JOINT COMP GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2620.8, "maximum": 3631.68, "gross_charge": 3744.0, "discounted_cash": 5616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3631.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2620.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3182.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2995.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT COMP GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1509.2, "maximum": 2091.32, "gross_charge": 2156.0, "discounted_cash": 3234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2091.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1509.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT COMP GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT PLATE ASSEMBLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7327.6, "maximum": 10153.96, "gross_charge": 10468.0, "discounted_cash": 15702.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8897.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7851.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10153.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7327.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7851.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8897.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8374.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT REAMING KIT*70", "code_information": [{"code": "3100210250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1224.99, "discounted_cash": 1837.49, "setting": "both", "billing_class": "facility"}]}, {"description": "JOINT STEM DISTAL*DR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4868.5, "maximum": 6746.35, "gross_charge": 6955.0, "discounted_cash": 10432.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5911.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5216.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4868.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6746.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4868.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5216.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5911.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT STEM DISTAL*DR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4868.5, "maximum": 6746.35, "gross_charge": 6955.0, "discounted_cash": 10432.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5911.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5216.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4868.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6746.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4868.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5216.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5911.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT SURVEY SINGLE VIEW", "code_information": [{"code": "77077", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JP BULB*K08-01907", "code_information": [{"code": "3100206644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "JR GNOTYP ABCG2 EXONS 2-26", "code_information": [{"code": "193U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "JURGAN PIN BALL", "code_information": [{"code": "3100100896", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.64, "discounted_cash": 45.96, "setting": "both", "billing_class": "facility"}]}, {"description": "K -WIRE 1.6 X 100*54", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209952", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 468.3, "maximum": 648.93, "gross_charge": 669.0, "discounted_cash": 1003.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 501.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 648.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 501.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 535.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE MULTIPLE", "code_information": [{"code": "78709", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/DRUG", "code_information": [{"code": "78708", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/O DRUG", "code_information": [{"code": "78707", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "K WIRE .28 X 6*16420", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 235.2, "maximum": 325.92, "gross_charge": 336.0, "discounted_cash": 504.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 325.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE .35 X 6*16420", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE .45 X 6*16420", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE .62 X 6*16420", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 235.2, "maximum": 325.92, "gross_charge": 336.0, "discounted_cash": 504.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 325.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE 9\" 2.4 THREAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 69.88, "maximum": 96.84, "gross_charge": 99.84, "discounted_cash": 149.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 84.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 74.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 69.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 96.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 69.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 74.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 84.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 79.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-FILE SS 15-40 21MM", "code_information": [{"code": "3100204236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-FILE SS 45-80 21MM", "code_information": [{"code": "3100204237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-PAD HEAT", "code_information": [{"code": "3100100991", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-PAD HEAT", "code_information": [{"code": "3100104466", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "3100104021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.0, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 81.2, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 84.0, "maximum": 116.4, "gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30.8, "maximum": 42.68, "gross_charge": 44.0, "discounted_cash": 66.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE .028 6\"*KM710", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7.14, "maximum": 9.89, "gross_charge": 10.2, "discounted_cash": 15.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE .054 1.4MM*34", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.8, "maximum": 100.88, "gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE .062*AR-2663", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE .8X100MM*45-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 482.32, "maximum": 668.36, "gross_charge": 689.04, "discounted_cash": 1033.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 585.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 516.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 482.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 668.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 482.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 516.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 585.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 551.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 0.8X100MM*45-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 86.8, "maximum": 120.28, "gross_charge": 124.0, "discounted_cash": 186.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 105.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 93.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 86.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 120.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 86.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 93.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 105.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 99.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 0.9X100*3715-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 54.88, "maximum": 76.04, "gross_charge": 78.4, "discounted_cash": 117.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 66.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 54.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 76.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 54.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 66.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 62.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 0.9X127*KWIR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 75.6, "maximum": 104.76, "gross_charge": 108.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 104.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.1X127*KWIR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 75.6, "maximum": 104.76, "gross_charge": 108.0, "discounted_cash": 162.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 104.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.25MM 6\"*CS6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.35X170*AR86", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.4*500036", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.6 W BALL*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.6 X 200MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.6 X150*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 36.4, "maximum": 50.44, "gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 1.6*2N1IA0000", "code_information": [{"code": "3100209458", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6*44112008", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.8, "maximum": 100.88, "gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2 X 200*70535", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 231.89, "maximum": 321.34, "gross_charge": 331.28, "discounted_cash": 496.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 281.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 248.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 231.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 321.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 231.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 248.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 281.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.0MM*705234", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.47, "maximum": 344.31, "gross_charge": 354.96, "discounted_cash": 532.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 301.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 248.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 344.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 248.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 301.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 283.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.0X4IN*7000-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.0X6IN*7000-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.3*P99-192-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.8, "maximum": 100.88, "gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.4*0S1GK0000", "code_information": [{"code": "3100209457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 196.0, "discounted_cash": 294.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 2.4*200072", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 89.6, "maximum": 124.16, "gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 108.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 124.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 108.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 102.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.4X170*AR861", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 42.0, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.5MM*KN1115", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.7, "maximum": 136.77, "gross_charge": 141.0, "discounted_cash": 211.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 136.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.5X100MM*45-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 97.38, "maximum": 134.94, "gross_charge": 139.12, "discounted_cash": 208.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2.8 X 200*03.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 101.3, "maximum": 140.37, "gross_charge": 144.72, "discounted_cash": 217.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 123.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 101.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 140.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 101.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 123.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 2MM W STOP*70", "code_information": [{"code": "3100209732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 3 X 285*1806-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.89, "maximum": 461.29, "gross_charge": 475.56, "discounted_cash": 713.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 404.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 356.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 461.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 356.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 404.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 380.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE 500MM*T076-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE BEVELED TIP N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE BEVELED TIP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 287.0, "maximum": 397.7, "gross_charge": 410.0, "discounted_cash": 615.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 348.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 307.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 287.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 397.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 287.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 307.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 348.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE BLUNT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE BLUNT TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE NITINOL LOOP*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 10MM*03", "code_information": [{"code": "3100202797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 15MM*0", "code_information": [{"code": "3100202798", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.76, "discounted_cash": 250.14, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 20MM*03", "code_information": [{"code": "3100202892", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE OLIVE 25MM*03", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 156.43, "maximum": 216.77, "gross_charge": 223.48, "discounted_cash": 335.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 189.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 167.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 156.43, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 216.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 156.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 167.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 189.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 178.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE SMOOTH 1.8*03", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.22, "maximum": 427.11, "gross_charge": 440.32, "discounted_cash": 660.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 427.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER", "code_information": [{"code": "3100102877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER", "code_information": [{"code": "3100104459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 29.4, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 32.9, "maximum": 45.59, "gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 35.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 35.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12.6, "maximum": 17.46, "gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.8, "maximum": 159.08, "gross_charge": 164.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 159.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 131.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 163.8, "maximum": 226.98, "gross_charge": 234.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 226.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 187.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 84.0, "maximum": 116.4, "gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE STRYKER LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 265.3, "maximum": 367.63, "gross_charge": 379.0, "discounted_cash": 568.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 284.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 367.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 265.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 284.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 322.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 303.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE SYNTHES", "code_information": [{"code": "3100104421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 39.8, "discounted_cash": 59.7, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 27.86, "maximum": 38.6, "gross_charge": 39.8, "discounted_cash": 59.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 27.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 33.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 31.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 41.97, "maximum": 58.16, "gross_charge": 59.96, "discounted_cash": 89.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 50.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 44.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 41.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 41.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 44.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 50.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 47.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE TEDAN*1100-00", "code_information": [{"code": "3100207835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 452.0, "discounted_cash": 678.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE TROCAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7.98, "maximum": 11.05, "gross_charge": 11.4, "discounted_cash": 17.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE WRIGHT MEDICA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE*WIRE-0.8/120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K-WIRE*WIRE-1.1/120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KARMA FIX IMPLANT*75", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KEL GNOTYP KEL EXON 8", "code_information": [{"code": "194U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KENALOG-40 1ML", "code_information": [{"code": "3400300514", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.09, "discounted_cash": 34.64, "setting": "both", "billing_class": "facility"}]}, {"description": "KERAMATRIX, KERASORB SQ CM", "code_information": [{"code": "Q4165", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KERECIS OMEGA3, PER SQ CM", "code_information": [{"code": "Q4158", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KEROXX (2.5G/CC), 1CC", "code_information": [{"code": "Q4202", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KETAMINE AND NORKETAMINE", "code_information": [{"code": "80357", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KETAMINE HCL", "code_information": [{"code": "3400300308", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.6, "discounted_cash": 12.9, "setting": "both", "billing_class": "facility"}]}, {"description": "KETONE ACETONE QUALI", "code_information": [{"code": "82009", "type": "CPT"}, {"code": "3440100841", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.52, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 7.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KETONE ACETONE QUANT", "code_information": [{"code": "82010", "type": "CPT"}, {"code": "3440100842", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.17, "maximum": 71.78, "gross_charge": 74.0, "discounted_cash": 13.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.75, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KETOROLAC TROMETHAMI", "code_information": [{"code": "3400300236", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KETOROLAC TROMETHAMINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1885", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.7, "maximum": 0.7, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KETOSTEROIDS 17 TOTA", "code_information": [{"code": "83586", "type": "CPT"}, {"code": "3440100942", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.8, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [{"code": "657", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9336.25, "maximum": 9336.25, "discounted_cash": 20589.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9336.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [{"code": "656", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15096.02, "maximum": 15096.02, "discounted_cash": 35029.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15096.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "658", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7932.59, "maximum": 7932.59, "discounted_cash": 16528.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7932.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [{"code": "660", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6356.15, "maximum": 6356.15, "discounted_cash": 15026.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6356.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [{"code": "659", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10693.81, "maximum": 10693.81, "discounted_cash": 28903.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10693.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC", "code_information": [{"code": "661", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5349.06, "maximum": 5349.06, "discounted_cash": 11704.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5349.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [{"code": "689", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5566.71, "maximum": 5566.71, "discounted_cash": 13111.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5566.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [{"code": "690", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3877.14, "maximum": 3877.14, "discounted_cash": 9008.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3877.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [{"code": "687", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5030.57, "maximum": 5030.57, "discounted_cash": 11670.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5030.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [{"code": "686", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7542.78, "maximum": 7542.78, "discounted_cash": 20536.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7542.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "688", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4214.69, "maximum": 4214.69, "discounted_cash": 8718.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4214.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "695", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6988.2, "maximum": 6988.2, "discounted_cash": 13352.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6988.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "696", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2675.14, "maximum": 2675.14, "discounted_cash": 7727.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2675.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50551", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50553", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50570", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY", "code_information": [{"code": "50572", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50555", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & BIOPSY", "code_information": [{"code": "50574", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50557", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50576", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4163.42, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50580", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY FUNCTION STUDY", "code_information": [{"code": "78725", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING MORPHOL", "code_information": [{"code": "78700", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY IMAGING WITH FLOW", "code_information": [{"code": "78701", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT", "code_information": [{"code": "652", "type": "MS-DRG"}], "standard_charges": [{"minimum": 83758.84, "maximum": 83758.84, "discounted_cash": 33542.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 83758.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [{"code": "650", "type": "MS-DRG"}], "standard_charges": [{"minimum": 59648.74, "maximum": 59648.74, "discounted_cash": 50212.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 59648.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [{"code": "651", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22709.51, "maximum": 22709.51, "discounted_cash": 38611.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22709.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KING LTSD SZ5*477-KL", "code_information": [{"code": "3100204519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.12, "discounted_cash": 160.68, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT 1.8M PERC INSERT", "code_information": [{"code": "3100207528", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY", "code_information": [{"code": "3100100897", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACCESSORY", "code_information": [{"code": "3100102862", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3491.41, "discounted_cash": 5237.12, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACDF*104.NPS-SUK", "code_information": [{"code": "3100207219", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACP SERIES", "code_information": [{"code": "3100100898", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACP SERIES II", "code_information": [{"code": "3100100899", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ACUCISE DEVICE", "code_information": [{"code": "3100102184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4017.0, "discounted_cash": 6025.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ANKLE BUTRESS RE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT ANKLE DISTRACTOR", "code_information": [{"code": "3100100901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 133.0, "discounted_cash": 199.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ANKLE DISTRACTOR", "code_information": [{"code": "3100102863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT APPLICATOR SPRAY", "code_information": [{"code": "3100100902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT APPLICTOR", "code_information": [{"code": "3100100903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTERIAL LINE", "code_information": [{"code": "3100100904", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.0, "discounted_cash": 129.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTH BIO-TENODES", "code_information": [{"code": "3100100905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTH DISTAL BICE", "code_information": [{"code": "3100100906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTH DISTAL BICE", "code_information": [{"code": "3100102864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTH HEAD RESECT", "code_information": [{"code": "3100100907", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTH HIP W/BLADE", "code_information": [{"code": "3100100908", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1417.5, "discounted_cash": 2126.25, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ARTH SUTURETAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT ARTHREX AC REPAI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1956.5, "maximum": 2711.15, "gross_charge": 2795.0, "discounted_cash": 4192.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2375.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2096.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1956.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2711.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1956.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2096.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2375.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2236.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT ARTHREX AC REPAI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2047.5, "maximum": 2837.25, "gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2837.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT ASPIREX PLUS", "code_information": [{"code": "3100100911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.32, "discounted_cash": 489.48, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT AUG LIG REPAIR*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.94, "maximum": 3958.9, "gross_charge": 4081.35, "discounted_cash": 6122.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT BEACH ARTH", "code_information": [{"code": "3100100912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BIO-TENODESIS DI", "code_information": [{"code": "3100100913", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE BIOPSY", "code_information": [{"code": "3100100914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 358.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE BIOPSY", "code_information": [{"code": "3100102866", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 379.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE BIOPSY", "code_information": [{"code": "3100102867", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 466.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BONE CEMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT CARTICEL CARTILA", "code_information": [{"code": "3100100916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CARTICEL CARTILA", "code_information": [{"code": "3100102868", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CATH LUMBAR DRAI", "code_information": [{"code": "3100100917", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT CENTRAL VENOUS", "code_information": [{"code": "C1751", "type": "HCPCS"}, {"code": "3100100919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 68.6, "maximum": 95.06, "gross_charge": 98.0, "discounted_cash": 147.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 95.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT CHEST DRAINAGE S", "code_information": [{"code": "3100100920", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT COLLECTION UTERI", "code_information": [{"code": "3100100921", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT COLOSTOMY NATURA", "code_information": [{"code": "3100100922", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.2, "discounted_cash": 97.8, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DESCICCANT", "code_information": [{"code": "3100100923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DIS CRVD KNOTLE*", "code_information": [{"code": "3100206022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DIS CRVD KNOTLE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8772.4, "maximum": 12156.04, "gross_charge": 12532.0, "discounted_cash": 18798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12156.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8772.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10652.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10025.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT DIS STR KNOTLES*", "code_information": [{"code": "3100205899", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISP MAS TLIF", "code_information": [{"code": "3100100924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4974.0, "discounted_cash": 7461.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISP MAXCESS", "code_information": [{"code": "3100100925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5194.0, "discounted_cash": 7791.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DISPOSABLE", "code_information": [{"code": "3100104510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1571.85, "discounted_cash": 2357.78, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRAIN HEMOVAC", "code_information": [{"code": "3100100926", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRAIN HEMOVAC", "code_information": [{"code": "3100102869", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT DRESSING EAR GLA", "code_information": [{"code": "3100100927", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ELITE FX*0808-01", "code_information": [{"code": "3100205194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6181.19, "discounted_cash": 9271.79, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ELITE SYSTEM*080", "code_information": [{"code": "3100207325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5044.0, "discounted_cash": 7566.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENDOSCOPIC CARPA", "code_information": [{"code": "3100100928", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 558.0, "discounted_cash": 837.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ENT APPLICATOR", "code_information": [{"code": "3100100929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 409.0, "discounted_cash": 613.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT EPI DISC EAR PAT", "code_information": [{"code": "3100100930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 663.0, "discounted_cash": 994.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT ESOPHAGEAL", "code_information": [{"code": "3100102185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 1126.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FIBERTAK DISP *A", "code_information": [{"code": "3100204620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FIBERTAK DISP *A", "code_information": [{"code": "3100205448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FLOWONIX", "code_information": [{"code": "3100102386", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FLOWONIX", "code_information": [{"code": "3100103801", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FLOWONIX", "code_information": [{"code": "3100103802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT FOR BIOUNI*ABS-4", "code_information": [{"code": "3100204673", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GASTRIC BAND POR", "code_information": [{"code": "3100100931", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT GENE ANALYS D816 VARIANT", "code_information": [{"code": "81273", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 124.87, "discounted_cash": 200.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 124.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIT GENE TARGETED SEQ ANALYS", "code_information": [{"code": "81272", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 329.51, "discounted_cash": 529.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KIT GPS III DISPOSAB", "code_information": [{"code": "3100100932", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 2272.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT HIP ACCESS*AR-65", "code_information": [{"code": "3100209767", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INTRO", "code_information": [{"code": "3100102314", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT INTRO LEAD INTER", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100100933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3915.1, "maximum": 5425.21, "gross_charge": 5593.0, "discounted_cash": 8389.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4754.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4194.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3915.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5425.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3915.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4194.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4754.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4474.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT INTRODUCER 11G*V", "code_information": [{"code": "3100209761", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2195.56, "discounted_cash": 3293.34, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IR ACCESS 9FR*G0", "code_information": [{"code": "3100206841", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1684.8, "discounted_cash": 2527.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT IV TRANSER", "code_information": [{"code": "3100102186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT JACKSON OSI", "code_information": [{"code": "3100102281", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 187.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT JACKSON OSI", "code_information": [{"code": "3100103734", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.16, "discounted_cash": 217.74, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LAG SCREW*EXINN9", "code_information": [{"code": "3100208331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LEAD INTERSTIM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100100934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6433.7, "maximum": 8915.27, "gross_charge": 9191.0, "discounted_cash": 13786.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7812.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6893.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6433.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8915.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6433.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6893.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7812.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7352.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT LEAD MEDTRONIC 3", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100100935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7812.0, "maximum": 10825.2, "gross_charge": 11160.0, "discounted_cash": 16740.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9486.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8370.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7812.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7812.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8370.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9486.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT LEAD SURGICAL BO", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100100936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10115.0, "maximum": 14016.5, "gross_charge": 14450.0, "discounted_cash": 21675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12282.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10115.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14016.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10115.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12282.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT LOOP&TAK TENO*AR", "code_information": [{"code": "3100206770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT LUR COMBO", "code_information": [{"code": "3100100937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MANUAL BLOOD PRE", "code_information": [{"code": "3100100938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MAR 3K", "code_information": [{"code": "3100100939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12896.0, "discounted_cash": 19344.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MEDTRONIC ACCESS", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3100100940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT MEDTRONIC ACCESS", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3100100941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT MICROPUNCTURE", "code_information": [{"code": "3100102187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT MICROPUNCTURE", "code_information": [{"code": "3100104407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2973.6, "maximum": 4120.56, "gross_charge": 4248.0, "discounted_cash": 6372.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3610.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3186.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2973.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4120.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2973.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3186.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3610.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3398.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT NEBULIZER PREFIL", "code_information": [{"code": "3100100942", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEEDLE NVM5 EMG", "code_information": [{"code": "3100100943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4511.0, "discounted_cash": 6766.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NERVE BLOCK CONT", "code_information": [{"code": "3100100944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 358.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT NEUROSTIM EXTENS", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3100100945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1314.6, "maximum": 1821.66, "gross_charge": 1878.0, "discounted_cash": 2817.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1596.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1408.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1314.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1821.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1314.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1408.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1596.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1502.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT NEUROSTIM LEAD O", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100100946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT NVMS OR", "code_information": [{"code": "3100104095", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT OSTEOSET RESORB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3490", "type": "HCPCS"}, {"code": "3100100947", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 746.4, "maximum": 746.4, "gross_charge": 1866.0, "discounted_cash": 2799.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 746.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT PENILE PROSTH AS", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100100948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT PERICENTESIS*TAP", "code_information": [{"code": "3100206674", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.92, "discounted_cash": 217.38, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PLSVC FAN", "code_information": [{"code": "3100100949", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.8, "discounted_cash": 158.7, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PNEUMOTHORAX*AK-", "code_information": [{"code": "3100205934", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.8, "discounted_cash": 790.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PROBE ORAL SURET", "code_information": [{"code": "3100100951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.0, "discounted_cash": 328.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PUSHLOCK", "code_information": [{"code": "3100102404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT PUSHLOCK DISP", "code_information": [{"code": "3100100952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SALIVARY DILATOR", "code_information": [{"code": "3100204260", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SHOULDER", "code_information": [{"code": "3100102188", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SINUS INFLATION", "code_information": [{"code": "3100100953", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 298.2, "discounted_cash": 447.3, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SMALL JOINT INST", "code_information": [{"code": "3100100954", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.75, "discounted_cash": 685.13, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SNARE EV3 6FR*ON", "code_information": [{"code": "3100206646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 697.41, "discounted_cash": 1046.12, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPEEDBRIDGE*AR-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3650.01, "maximum": 5057.87, "gross_charge": 5214.3, "discounted_cash": 7821.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4432.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3910.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3650.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5057.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3650.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3910.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4432.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4171.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT SPINE RETRACTOR", "code_information": [{"code": "3100100955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4754.0, "discounted_cash": 7131.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SPINE RETRACTOR", "code_information": [{"code": "3100100956", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1339.0, "discounted_cash": 2008.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT STRYKER VERTBRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT SUTURETAK", "code_information": [{"code": "3100100958", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SUTURETAK", "code_information": [{"code": "3100102870", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT SUTURETAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT SUTURETAK MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT TITAN PATIENT", "code_information": [{"code": "3100100959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1419.0, "discounted_cash": 2128.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TLC PROSTH ASSEM", "code_information": [{"code": "3100100960", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRAP WATSON", "code_information": [{"code": "3100100961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.0, "discounted_cash": 253.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT TRAP WATSON", "code_information": [{"code": "3100102871", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT URO LEG BAG", "code_information": [{"code": "3100100962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VALVE MAIN", "code_information": [{"code": "3100100963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 700.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VERSCUT TISSUE*A", "code_information": [{"code": "3100204557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2352.0, "discounted_cash": 3528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT VERT BONE EXPAND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100100964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIT VERTEBROPLASTY*V", "code_information": [{"code": "3100208180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2195.56, "discounted_cash": 3293.34, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT WATER INLET", "code_information": [{"code": "3100100965", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT XLIF", "code_information": [{"code": "3100100966", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2487.0, "discounted_cash": 3730.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT2.9 HIP PUSHLOCK*", "code_information": [{"code": "3100206940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KLF1 TARGETED SEQUENCING", "code_information": [{"code": "195U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 602.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHREX POST TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/DRA", "code_information": [{"code": "29871", "type": "CPT"}, {"code": "3340102427", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7318.65, "gross_charge": 7545.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6413.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5658.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5281.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7318.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5281.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5658.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6413.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6036.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29851", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3461.21, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29885", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCOPY/SURGERY", "code_information": [{"code": "29887", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE ARTHROSCP HARV", "code_information": [{"code": "S2112", "type": "HCPCS"}], "standard_charges": [{"minimum": 3461.21, "maximum": 3461.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KNEE COMP HIGHFLEX A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100968", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE COMPONENT ZIMME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE COMPONENT ZIMME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE COMPONENT ZIMME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE DJO INSERT 3D T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE DJO INSERT 3D T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2802.8, "maximum": 3883.88, "gross_charge": 4004.0, "discounted_cash": 6006.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3883.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE FLEX SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE GUIDE BIOMET", "code_information": [{"code": "3100100974", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5584.3, "maximum": 7738.25, "gross_charge": 7977.58, "discounted_cash": 11966.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6780.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5983.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5584.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7738.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5584.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5983.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6780.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6382.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7502.04, "maximum": 10395.68, "gross_charge": 10717.2, "discounted_cash": 16075.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9109.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8037.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7502.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10395.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7502.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8037.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9109.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8573.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB39", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5278.0, "maximum": 7313.8, "gross_charge": 7540.0, "discounted_cash": 11310.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7313.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5278.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5655.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6409.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6032.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB4*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6706.7, "maximum": 9293.57, "gross_charge": 9581.0, "discounted_cash": 14371.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8143.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6706.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9293.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6706.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7185.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8143.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7664.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB4*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2802.8, "maximum": 3883.88, "gross_charge": 4004.0, "discounted_cash": 6006.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3883.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB5/", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7502.04, "maximum": 10395.68, "gross_charge": 10717.2, "discounted_cash": 16075.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9109.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8037.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7502.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10395.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7502.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8037.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9109.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8573.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB6*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4699.24, "maximum": 6511.8, "gross_charge": 6713.2, "discounted_cash": 10069.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5706.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5034.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4699.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6511.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4699.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5034.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5706.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5370.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8348.34, "maximum": 11568.41, "gross_charge": 11926.2, "discounted_cash": 17889.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10137.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8944.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8348.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11568.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8348.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8944.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10137.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9540.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT 3D TIB8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7347.2, "maximum": 10181.12, "gross_charge": 10496.0, "discounted_cash": 15744.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8921.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7872.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7347.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10181.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7347.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7872.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8921.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8396.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT TIB 12/1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7802.34, "maximum": 10811.81, "gross_charge": 11146.2, "discounted_cash": 16719.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9474.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8359.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7802.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10811.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7802.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8359.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9474.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8916.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT TIB 6*39", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6706.7, "maximum": 9293.57, "gross_charge": 9581.0, "discounted_cash": 14371.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8143.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6706.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9293.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6706.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7185.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8143.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7664.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE INSERT TIB4/11*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7802.34, "maximum": 10811.81, "gross_charge": 11146.2, "discounted_cash": 16719.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9474.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8359.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7802.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10811.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7802.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8359.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9474.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8916.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE KIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2174.9, "maximum": 3013.79, "gross_charge": 3107.0, "discounted_cash": 4660.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2640.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2330.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2174.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3013.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2174.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2330.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2640.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2485.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXEGEN OFFSET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2879.1, "maximum": 3989.61, "gross_charge": 4113.0, "discounted_cash": 6169.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3496.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3084.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2879.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3989.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2879.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3084.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3496.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3290.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN ART SURF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN ART SURF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3794.7, "maximum": 5258.37, "gross_charge": 5421.0, "discounted_cash": 8131.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4607.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4065.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3794.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5258.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3794.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4065.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4607.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4336.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN CRSLNK P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN DISTAL A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1883.7, "maximum": 2610.27, "gross_charge": 2691.0, "discounted_cash": 4036.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2610.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2152.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN LCCK FEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 18811.52, "maximum": 26067.39, "gross_charge": 26873.6, "discounted_cash": 40310.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22842.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20155.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18811.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26067.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18811.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20155.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22842.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21498.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN LCK ART", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3794.7, "maximum": 5258.37, "gross_charge": 5421.0, "discounted_cash": 8131.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4607.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4065.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3794.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5258.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3794.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4065.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4607.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4336.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN OFFSET S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2853.2, "maximum": 3953.72, "gross_charge": 4076.0, "discounted_cash": 6114.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3464.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3057.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2853.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3953.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2853.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3057.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3464.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3260.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN PATELLA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN STEM EXT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3421.6, "maximum": 4741.36, "gross_charge": 4888.0, "discounted_cash": 7332.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4154.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3666.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3421.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4741.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3421.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3666.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4154.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3910.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN STEM EXT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2545.9, "maximum": 3527.89, "gross_charge": 3637.0, "discounted_cash": 5455.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3527.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2909.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN STEM TIB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN STEMMED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1883.7, "maximum": 2610.27, "gross_charge": 2691.0, "discounted_cash": 4036.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2610.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2152.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN TIBIAL B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1938.3, "maximum": 2685.93, "gross_charge": 2769.0, "discounted_cash": 4153.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2353.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2076.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1938.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2685.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1938.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2076.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2353.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2215.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN TIBIAL B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2305.1, "maximum": 3194.21, "gross_charge": 3293.0, "discounted_cash": 4939.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2799.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2469.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2305.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3194.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2305.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2469.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2799.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2634.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN TIBIAL B", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1967.0, "maximum": 2725.7, "gross_charge": 2810.0, "discounted_cash": 4215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2388.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2107.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1967.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2725.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1967.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2107.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2388.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXGEN WEDGE TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4504.5, "maximum": 6241.95, "gross_charge": 6435.0, "discounted_cash": 9652.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5469.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4826.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4504.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6241.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4504.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4826.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5469.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5148.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE NEXOGEN STEM EX", "code_information": [{"code": "3100104491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4888.0, "discounted_cash": 7332.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE NEXOGEN STEM EX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3789.1, "maximum": 5250.61, "gross_charge": 5413.0, "discounted_cash": 8119.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4601.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4059.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3789.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5250.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3789.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4059.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4601.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4330.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE OXFORD PARTIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1505.0, "maximum": 2085.5, "gross_charge": 2150.0, "discounted_cash": 3225.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1827.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1612.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1505.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2085.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1505.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1612.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1827.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [{"code": "486", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12213.68, "maximum": 12213.68, "discounted_cash": 22421.79, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12213.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [{"code": "485", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14862.38, "maximum": 14862.38, "discounted_cash": 36776.07, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14862.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "487", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8710.97, "maximum": 8710.97, "discounted_cash": 17248.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8710.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC", "code_information": [{"code": "488", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11833.1, "maximum": 11833.1, "discounted_cash": 23519.27, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11833.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC", "code_information": [{"code": "489", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6187.07, "maximum": 6187.07, "discounted_cash": 13818.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6187.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE SUBCHONDROPLA K", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5996.9, "maximum": 8309.99, "gross_charge": 8567.0, "discounted_cash": 12850.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7281.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6425.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5996.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8309.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5996.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6425.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7281.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6853.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE SYSTEM LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10530.8, "maximum": 14592.68, "gross_charge": 15044.0, "discounted_cash": 22566.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12787.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11283.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10530.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14592.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10530.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11283.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12787.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12035.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE TIBAL BASEPLATE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100100988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEE TRACKING KIT*10", "code_information": [{"code": "3100205159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.35, "discounted_cash": 1068.53, "setting": "both", "billing_class": "facility"}]}, {"description": "KNEE UCG 1-2 L 13M*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.64, "maximum": 2129.34, "gross_charge": 2195.2, "discounted_cash": 3292.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KNEEALIGN 2*133631", "code_information": [{"code": "3100202377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE COLLINGS*CK-24", "code_information": [{"code": "3100203039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 252.28, "discounted_cash": 378.42, "setting": "both", "billing_class": "facility"}]}, {"description": "KNIFE STAB", "code_information": [{"code": "3100102189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOT PUSHER", "code_information": [{"code": "3100100989", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOT PUSHER", "code_information": [{"code": "3100104618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 733.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOT PUSHER ARTHREX", "code_information": [{"code": "3100102287", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.0, "discounted_cash": 1093.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOT PUSHER SUT/CUTT", "code_information": [{"code": "3100204614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "KNOT PUSHER/SUTURE C", "code_information": [{"code": "3100100990", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "KRAS GENE ADDL VARIANTS", "code_information": [{"code": "81276", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 193.25, "discounted_cash": 310.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KRAS GENE VARIANTS EXON 2", "code_information": [{"code": "81275", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 193.25, "discounted_cash": 310.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 510.3, "maximum": 707.13, "gross_charge": 729.0, "discounted_cash": 1093.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 707.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 583.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.0, "maximum": 87.3, "gross_charge": 90.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 120.4, "maximum": 166.84, "gross_charge": 172.0, "discounted_cash": 258.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 166.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 137.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KWIRE .09X100*3715-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 64.59, "maximum": 89.51, "gross_charge": 92.28, "discounted_cash": 138.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 78.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 69.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 64.59, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 89.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 64.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 69.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 78.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 73.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYLEENA IUD*50419-42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1692.5, "maximum": 2345.32, "gross_charge": 2417.86, "discounted_cash": 3626.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2055.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1813.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1692.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2345.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1692.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1813.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2055.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1934.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYLEENA, 19.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7296", "type": "HCPCS"}], "standard_charges": [{"minimum": 1098.38, "maximum": 1098.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1098.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 1-2 SEGMENTS", "code_information": [{"code": "22818", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KYPHECTOMY 3 OR MORE", "code_information": [{"code": "22819", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "KYPHON CEMENT*CO1A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHON CEMENT/MIX PA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KYPHON MIXER KIT*C01", "code_information": [{"code": "3100207518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.8, "discounted_cash": 778.2, "setting": "both", "billing_class": "facility"}]}, {"description": "KYPHON MIXER*A07A", "code_information": [{"code": "3100207864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Infections, Major", "code_information": [{"code": "463.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12088.39, "maximum": 12088.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12088.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Infections, Minor", "code_information": [{"code": "463.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6691.99, "maximum": 6691.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6691.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Infections, Moderate", "code_information": [{"code": "463.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8051.66, "maximum": 8051.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8051.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Infections, Severe", "code_information": [{"code": "463.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20792.34, "maximum": 20792.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20792.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Malignancy, Major", "code_information": [{"code": "461.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15015.34, "maximum": 15015.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15015.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Malignancy, Minor", "code_information": [{"code": "461.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8147.78, "maximum": 8147.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8147.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Malignancy, Moderate", "code_information": [{"code": "461.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9827.82, "maximum": 9827.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9827.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Malignancy, Severe", "code_information": [{"code": "461.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31373.68, "maximum": 31373.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31373.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Malignancy, Major", "code_information": [{"code": "442.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33561.2, "maximum": 33561.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33561.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Malignancy, Minor", "code_information": [{"code": "442.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15439.51, "maximum": 15439.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15439.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Malignancy, Moderate", "code_information": [{"code": "442.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17124.68, "maximum": 17124.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17124.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Malignancy, Severe", "code_information": [{"code": "442.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46773.47, "maximum": 46773.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46773.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Non-Malignancy, Major", "code_information": [{"code": "443.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28196.84, "maximum": 28196.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28196.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Non-Malignancy, Minor", "code_information": [{"code": "443.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13536.48, "maximum": 13536.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13536.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Non-Malignancy, Moderate", "code_information": [{"code": "443.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14761.6, "maximum": 14761.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14761.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney And Urinary Tract Procedures For Non-Malignancy, Severe", "code_information": [{"code": "443.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48855.91, "maximum": 48855.91, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48855.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney Transplant, Major", "code_information": [{"code": "440.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 148529.69, "maximum": 148529.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 148529.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney Transplant, Minor", "code_information": [{"code": "440.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 104382.02, "maximum": 104382.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 104382.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney Transplant, Moderate", "code_information": [{"code": "440.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 145117.06, "maximum": 145117.06, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145117.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Kidney Transplant, Severe", "code_information": [{"code": "440.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 225328.71, "maximum": 225328.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 225328.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Knee And Lower Leg Procedures Except Foot, Major", "code_information": [{"code": "313.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33780.34, "maximum": 33780.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33780.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Knee And Lower Leg Procedures Except Foot, Minor", "code_information": [{"code": "313.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19331.43, "maximum": 19331.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19331.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Knee And Lower Leg Procedures Except Foot, Moderate", "code_information": [{"code": "313.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27231.88, "maximum": 27231.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27231.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Knee And Lower Leg Procedures Except Foot, Severe", "code_information": [{"code": "313.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51206.18, "maximum": 51206.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51206.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L COLECTOMY/COLOPROCTOSTOMY", "code_information": [{"code": "44208", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT ART/GRFT ANGIO", "code_information": [{"code": "93459", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT ARTERY/VENTRICLE ANGIO", "code_information": [{"code": "93458", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT CATH CHD NM/ABN NT CNJ", "code_information": [{"code": "93595", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L HRT CATH TRNSPTL PUNCTURE", "code_information": [{"code": "93462", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L VENTRIC PACING LEAD ADD-ON", "code_information": [{"code": "33225", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L&D OF VULVA/PERINEU", "code_information": [{"code": "56405", "type": "CPT"}, {"code": "3480103063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 167.32, "maximum": 643.11, "gross_charge": 663.0, "discounted_cash": 491.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 338.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 643.11, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 333.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 337.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 327.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 389.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 327.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 327.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 333.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "L/S RATIO FETAL LUNG", "code_information": [{"code": "83661", "type": "CPT"}], "standard_charges": [{"minimum": 21.99, "maximum": 40.05, "discounted_cash": 35.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAB PROCESS MICROBIAL SPEC", "code_information": [{"code": "D0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER PORC INDIRECT", "code_information": [{"code": "D2962", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER RESIN DIRECT", "code_information": [{"code": "D2960", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LABIAL VENEER RESIN INDIRECT", "code_information": [{"code": "D2961", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LABRALTAPE", "code_information": [{"code": "3100101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LACTATE DEHYDROGENAS", "code_information": [{"code": "83615", "type": "CPT"}, {"code": "3440100944", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.04, "maximum": 50.44, "gross_charge": 52.0, "discounted_cash": 9.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LACTATION CLASS", "code_information": [{"code": "S9443", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LACTIC ACID", "code_information": [{"code": "83605", "type": "CPT"}, {"code": "3440100943", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.57, "maximum": 93.12, "gross_charge": 96.0, "discounted_cash": 18.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL (QUANT)", "code_information": [{"code": "83631", "type": "CPT"}], "standard_charges": [{"minimum": 19.63, "maximum": 40.05, "discounted_cash": 31.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LACTOFERRIN FECAL QU", "code_information": [{"code": "83630", "type": "CPT"}, {"code": "3440103014", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 19.7, "maximum": 166.84, "gross_charge": 172.0, "discounted_cash": 31.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 166.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 25.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 137.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 21.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAETRILE AMYGDALIN VIT B17", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3570", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAG SCREW 4.0/36MM*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAG SCREW RASP 12MM*", "code_information": [{"code": "3100209363", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 891.0, "discounted_cash": 1336.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAG SCREW RASP 16MM*", "code_information": [{"code": "3100209211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 891.0, "discounted_cash": 1336.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAIV VACC PANDEMIC INTRANASL", "code_information": [{"code": "90664", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAIV4 VACCINE INTRANASAL", "code_information": [{"code": "90672", "type": "CPT"}], "standard_charges": [{"minimum": 27.79, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACETC/FRMT ARTHRD LUM 1", "code_information": [{"code": "63052", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM FACTC/FRMT ARTHRD LUM EA", "code_information": [{"code": "63053", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM W/ RHIZOTOMY ONE", "code_information": [{"code": "63185", "type": "CPT"}, {"code": "3480102158", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2413.6, "maximum": 5178.02, "gross_charge": 3448.0, "discounted_cash": 5172.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2930.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2586.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2413.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3344.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2413.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2586.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2930.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2758.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAM W/CORDOTOMY 1STG THRC", "code_information": [{"code": "63197", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMAZE CLASS", "code_information": [{"code": "S9436", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMELLAR BDY FETAL LUNG", "code_information": [{"code": "83664", "type": "CPT"}], "standard_charges": [{"minimum": 19.32, "maximum": 40.05, "discounted_cash": 31.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMELLAS XT, PER SQ CM", "code_information": [{"code": "Q4291", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMELLAS, PER SQ CM", "code_information": [{"code": "Q4292", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAMINA HOOK*5541143", "code_information": [{"code": "3100203399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1902.0, "discounted_cash": 2853.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAMINECT BX/EX THORA", "code_information": [{"code": "63276", "type": "CPT"}, {"code": "3340102325", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4058.6, "maximum": 14462.5, "gross_charge": 5798.0, "discounted_cash": 8697.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4928.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4348.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4058.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5624.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4058.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4348.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4928.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4638.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY DECMP-CE", "code_information": [{"code": "63048", "type": "CPT"}, {"code": "3480102151", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 19732.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY DECOMPRE", "code_information": [{"code": "63045", "type": "CPT"}, {"code": "3480102148", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 15312.42, "gross_charge": 15786.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15312.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12628.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY DECOMPRE", "code_information": [{"code": "63046", "type": "CPT"}, {"code": "3480102149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY DECOMPRE", "code_information": [{"code": "63047", "type": "CPT"}, {"code": "3480102150", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 8687.35, "gross_charge": 8457.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7188.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6342.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5919.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8203.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5919.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6342.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7188.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXPL/DEC", "code_information": [{"code": "63001", "type": "CPT"}, {"code": "3480102136", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 15312.42, "gross_charge": 15786.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15312.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12628.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXPL/DEC", "code_information": [{"code": "63003", "type": "CPT"}, {"code": "3480102137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXPL/DEC", "code_information": [{"code": "63005", "type": "CPT"}, {"code": "3480102138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXPL/DEC", "code_information": [{"code": "63015", "type": "CPT"}, {"code": "3480102140", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXPL/DEC", "code_information": [{"code": "63016", "type": "CPT"}, {"code": "3480102141", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 14934.12, "gross_charge": 15396.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13086.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11547.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10777.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14934.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10777.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11547.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13086.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12316.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY EXPL/DEC", "code_information": [{"code": "63017", "type": "CPT"}, {"code": "3480102142", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY FOR BIOP", "code_information": [{"code": "63282", "type": "CPT"}, {"code": "3480103099", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4473.7, "maximum": 7959.27, "gross_charge": 6391.0, "discounted_cash": 9586.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5432.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4793.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4473.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6199.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4473.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4793.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5432.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5112.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINECTOMY W/ REMOV", "code_information": [{"code": "63012", "type": "CPT"}, {"code": "3480102139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY ADDL CERVICAL", "code_information": [{"code": "63043", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY DECOMP-CE", "code_information": [{"code": "63020", "type": "CPT"}, {"code": "3480102143", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY DECOMP-LU", "code_information": [{"code": "63030", "type": "CPT"}, {"code": "3480102144", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY DECOMP-LU", "code_information": [{"code": "63035", "type": "CPT"}, {"code": "3480102145", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 19732.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY DECOMP-LU", "code_information": [{"code": "63042", "type": "CPT"}, {"code": "3480102146", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 15312.42, "gross_charge": 15786.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15312.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12628.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY DECOMP-LU", "code_information": [{"code": "63044", "type": "CPT"}, {"code": "3480102147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7959.27, "maximum": 12445.1, "gross_charge": 12830.0, "discounted_cash": 19245.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10905.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9622.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8981.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12445.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8981.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9622.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10905.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10264.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMINOTOMY SINGLE CERVICAL", "code_information": [{"code": "63040", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMOTRIGINE", "code_information": [{"code": "80175", "type": "CPT"}, {"code": "3440100817", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAMP XENON", "code_information": [{"code": "3100104732", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LANGUAGE SCREENING", "code_information": [{"code": "V5363", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LANREOTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1930", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.3, "maximum": 56.3, "discounted_cash": 77.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 56.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP APPENDECTOMY", "code_information": [{"code": "44970", "type": "CPT"}, {"code": "3480101967", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP CHOLE", "code_information": [{"code": "47562", "type": "CPT"}, {"code": "3480101991", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY PART W/ILEUM", "code_information": [{"code": "44205", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP COLECTOMY, PARTI", "code_information": [{"code": "44204", "type": "CPT"}, {"code": "3480101956", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2659.3, "maximum": 5608.78, "gross_charge": 3799.0, "discounted_cash": 5698.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3229.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2849.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2659.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3685.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2659.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2849.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3229.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3039.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP COLOSTOMY", "code_information": [{"code": "44188", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ENDOCATCH", "code_information": [{"code": "3100102190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP ENTEROLYSIS INTE", "code_information": [{"code": "44180", "type": "CPT"}, {"code": "3480101953", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5608.78, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP FUNDOPLASTY", "code_information": [{"code": "43280", "type": "CPT"}, {"code": "3480101943", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8334.85, "maximum": 20864.7, "gross_charge": 21510.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20864.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17208.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP GASTRIC BYPASS/ROUX-EN-Y", "code_information": [{"code": "43644", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP HERNIA", "code_information": [{"code": "49659", "type": "CPT"}, {"code": "3480102014", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 11122.02, "gross_charge": 11466.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9746.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8599.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8026.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11122.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8026.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8599.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9746.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9172.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INC HERN REPAIR", "code_information": [{"code": "49655", "type": "CPT"}, {"code": "3480102012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 17387.25, "gross_charge": 17925.0, "discounted_cash": 26887.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17387.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14340.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INC HERNIA REPAI", "code_information": [{"code": "49654", "type": "CPT"}, {"code": "3480102011", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 17387.25, "gross_charge": 17925.0, "discounted_cash": 26887.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17387.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14340.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INC HERNIA REPAI", "code_information": [{"code": "49656", "type": "CPT"}, {"code": "3480103086", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 18215.63, "gross_charge": 18779.0, "discounted_cash": 28168.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15962.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14084.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13145.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18215.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13145.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14084.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15962.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15023.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INSERT TUNNEL IP CATH", "code_information": [{"code": "49324", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP INSUFFLA TUBING*", "code_information": [{"code": "3100205362", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.4, "discounted_cash": 33.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP JEJUNOSTOMY", "code_information": [{"code": "44186", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP MOBIL SPLENIC FL", "code_information": [{"code": "44213", "type": "CPT"}, {"code": "3480101959", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5608.78, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 14332.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP MONO HANDLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1071.0, "maximum": 1484.1, "gross_charge": 1530.0, "discounted_cash": 2295.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1300.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1484.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1300.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP MYOTOMY HELLER", "code_information": [{"code": "43279", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP NEEDLE 14G SHORT", "code_information": [{"code": "3100209055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.72, "discounted_cash": 313.08, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP PARAESOPHAG HERN", "code_information": [{"code": "43281", "type": "CPT"}, {"code": "3480101944", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 10504.11, "maximum": 20864.7, "gross_charge": 21510.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20864.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17208.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PART COLECTOMY W/STOMA", "code_information": [{"code": "44206", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP PROCTOPEXY W/SIG RESECT", "code_information": [{"code": "45402", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RADICAL HYST", "code_information": [{"code": "58548", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REMOVAL OF RECTUM", "code_information": [{"code": "45395", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REPAIR PARAESOPH", "code_information": [{"code": "43282", "type": "CPT"}, {"code": "3480101945", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3558.8, "maximum": 12499.89, "gross_charge": 5084.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4321.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3813.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3558.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4931.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3558.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3813.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4321.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4067.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", "code_information": [{"code": "43648", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP REVISION PERM IP CATH", "code_information": [{"code": "49325", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAP SPONGE 18x18*S24", "code_information": [{"code": "3100205068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.36, "discounted_cash": 6.54, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP SUTURE DEVICE", "code_information": [{"code": "3100102191", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAP W/OMENTOPEXY ADD-ON", "code_information": [{"code": "49326", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER CRYOSURG", "code_information": [{"code": "47371", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE LIVER TUMOR RF", "code_information": [{"code": "47370", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL CYST", "code_information": [{"code": "50541", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO ABLATE RENAL MASS", "code_information": [{"code": "50542", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTECTOMY/EXPLR", "code_information": [{"code": "47564", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO CHOLECYSTOENTEROSTOMY", "code_information": [{"code": "47570", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO DRAIN LYMPHOCELE", "code_information": [{"code": "49323", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50947", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO NEW URETER/BLADDER", "code_information": [{"code": "50948", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO SLING OPERATION", "code_information": [{"code": "51992", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4354.77, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44210", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO TOTAL PROCTOCOLECTOMY", "code_information": [{"code": "44212", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO URETHRAL SUSPENSION", "code_information": [{"code": "51990", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-MYOMECTOMY COMPLEX", "code_information": [{"code": "58546", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST COMPLEX", "code_information": [{"code": "58553", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST INCL T/O", "code_information": [{"code": "58552", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARO-VAG HYST W/T/O COMPL", "code_information": [{"code": "58554", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC ESO", "code_information": [{"code": "43289", "type": "CPT"}, {"code": "3340102464", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4624.44, "maximum": 9950.26, "gross_charge": 10258.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9950.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8206.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC INT", "code_information": [{"code": "44238", "type": "CPT"}, {"code": "3340102442", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2458.18, "maximum": 9950.26, "gross_charge": 10258.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9950.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8206.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPE PROC RECTUM", "code_information": [{"code": "45499", "type": "CPT"}], "standard_charges": [{"minimum": 2670.89, "maximum": 2670.89, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CAPSURE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 588.0, "maximum": 814.8, "gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 814.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "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": 8706.05, "maximum": 8706.05, "discounted_cash": 18250.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8706.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [{"code": "417", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10183.5, "maximum": 10183.5, "discounted_cash": 25877.24, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10183.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC", "code_information": [{"code": "419", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6920.57, "maximum": 6920.57, "discounted_cash": 14661.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6920.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC CORSON", "code_information": [{"code": "3100101003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 207.68, "discounted_cash": 311.52, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC DISSECT", "code_information": [{"code": "3100209016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.24, "discounted_cash": 93.36, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC ENDOCLO", "code_information": [{"code": "3100101004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.0, "discounted_cash": 153.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC ENDOLOO", "code_information": [{"code": "3100101005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 211.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC FALLOPI", "code_information": [{"code": "3100101006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC HOOK", "code_information": [{"code": "3100101007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 255.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC HOOK BL", "code_information": [{"code": "3100207041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.52, "discounted_cash": 98.28, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC HOOK*E3", "code_information": [{"code": "3100208720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.92, "discounted_cash": 167.88, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC INSERTS", "code_information": [{"code": "3100101008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC INST 37", "code_information": [{"code": "3100206459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC LDS", "code_information": [{"code": "3100101009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.0, "discounted_cash": 841.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC LIN CUT", "code_information": [{"code": "3100101010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC LIN CUT", "code_information": [{"code": "3100101011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 991.0, "discounted_cash": 1486.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC MYOMECTOMY", "code_information": [{"code": "58545", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC NEPHRECTOMY", "code_information": [{"code": "50546", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROC", "code_information": [{"code": "45400", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PROTACK", "code_information": [{"code": "3100101012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1573.0, "discounted_cash": 2359.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC PURSEST", "code_information": [{"code": "3100101013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 599.0, "discounted_cash": 898.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC QUICKLD", "code_information": [{"code": "3100101014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC SEALER", "code_information": [{"code": "3100206382", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1713.42, "discounted_cash": 2570.13, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC SUTURE", "code_information": [{"code": "3100101015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.0, "discounted_cash": 138.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC SUTURE", "code_information": [{"code": "3100205817", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.6, "discounted_cash": 396.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC TK5 SUT", "code_information": [{"code": "3100101016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC VARIES", "code_information": [{"code": "3100101017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 88.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC VARIES", "code_information": [{"code": "3100202675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.32, "discounted_cash": 82.98, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ADRENALECTOMY", "code_information": [{"code": "60650", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ASPIRATI", "code_information": [{"code": "49322", "type": "CPT"}, {"code": "3340102359", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9950.26, "gross_charge": 10258.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9950.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8206.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY BIOPSY", "code_information": [{"code": "49321", "type": "CPT"}, {"code": "3340102410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9950.26, "gross_charge": 10258.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9950.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7180.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7693.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8719.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8206.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY FIMBRIOPLASTY", "code_information": [{"code": "58672", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTRIC", "code_information": [{"code": "43771", "type": "CPT"}, {"code": "3340102393", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2972.2, "maximum": 8334.85, "gross_charge": 4246.0, "discounted_cash": 6369.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3609.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3184.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2972.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4118.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2972.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3184.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3609.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3396.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTRIC", "code_information": [{"code": "43772", "type": "CPT"}, {"code": "3340102381", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2220.4, "maximum": 8334.85, "gross_charge": 3172.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2696.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2379.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2220.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3076.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2220.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2379.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2696.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2537.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY GASTROSTOMY", "code_information": [{"code": "43653", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ISLET CELL TRANS", "code_information": [{"code": "G0342", "type": "HCPCS"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38571", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY LYMPHADENECTOMY", "code_information": [{"code": "38572", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIECTOMY", "code_information": [{"code": "54690", "type": "CPT"}], "standard_charges": [{"minimum": 2109.3, "maximum": 2109.3, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY ORCHIOPE", "code_information": [{"code": "54692", "type": "CPT"}, {"code": "3340102398", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2109.3, "maximum": 18215.63, "gross_charge": 18779.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15962.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14084.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13145.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18215.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13145.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14084.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15962.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15023.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY PYELOPLASTY", "code_information": [{"code": "50544", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SALPINGOSTOMY", "code_information": [{"code": "58673", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SPLENECTOMY", "code_information": [{"code": "38120", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURG COLPOPEXY", "code_information": [{"code": "57425", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY SURG W F", "code_information": [{"code": "58670", "type": "CPT"}, {"code": "3480103050", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY URETEROLITHOTOMY", "code_information": [{"code": "50945", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43651", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VAGUS NERVE", "code_information": [{"code": "43652", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY VENT/ABD", "code_information": [{"code": "49652", "type": "CPT"}, {"code": "3480102010", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 17387.25, "gross_charge": 17925.0, "discounted_cash": 26887.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17387.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14340.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "43770", "type": "CPT"}, {"code": "3480101948", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8334.85, "maximum": 20864.7, "gross_charge": 21510.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20864.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17208.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "43773", "type": "CPT"}, {"code": "3480101949", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2614.5, "maximum": 8334.85, "gross_charge": 3735.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3174.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2801.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2614.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3622.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2614.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2801.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3174.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2988.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "44187", "type": "CPT"}, {"code": "3480101954", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1938.3, "maximum": 2685.93, "gross_charge": 2769.0, "discounted_cash": 4153.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2353.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2076.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1938.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2685.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1938.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2076.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2353.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2215.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "44202", "type": "CPT"}, {"code": "3480101955", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2382.8, "maximum": 5608.78, "gross_charge": 3404.0, "discounted_cash": 5106.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2893.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2553.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2382.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3301.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2382.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2553.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2893.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2723.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "44211", "type": "CPT"}, {"code": "3480101958", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3873.1, "maximum": 5608.78, "gross_charge": 5533.0, "discounted_cash": 8299.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4703.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4149.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3873.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5367.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3873.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4149.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4703.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4426.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "44227", "type": "CPT"}, {"code": "3480101960", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2872.8, "maximum": 5608.78, "gross_charge": 4104.0, "discounted_cash": 6156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3488.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3078.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2872.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3980.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2872.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3078.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3488.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3283.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "47563", "type": "CPT"}, {"code": "3480101992", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5632.81, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "49320", "type": "CPT"}, {"code": "3480101993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "49650", "type": "CPT"}, {"code": "3480102008", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "49651", "type": "CPT"}, {"code": "3480102009", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14206.62, "gross_charge": 14646.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14206.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11716.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "55550", "type": "CPT"}, {"code": "3480102081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2109.3, "maximum": 14206.62, "gross_charge": 14646.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14206.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11716.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "58570", "type": "CPT"}, {"code": "3480102112", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8510.18, "maximum": 12499.89, "gross_charge": 12205.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "58571", "type": "CPT"}, {"code": "3480102113", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8510.18, "maximum": 12499.89, "gross_charge": 12205.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "58660", "type": "CPT"}, {"code": "3480102115", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14206.62, "gross_charge": 14646.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14206.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11716.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "58661", "type": "CPT"}, {"code": "3480102116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "58662", "type": "CPT"}, {"code": "3480102117", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPY, SURGICA", "code_information": [{"code": "58671", "type": "CPT"}, {"code": "3480102118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11838.85, "gross_charge": 12205.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11838.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8543.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9153.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10374.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPAROTOMY ISLET CELL TRANSP", "code_information": [{"code": "G0343", "type": "HCPCS"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPARSCOPIC SX REPAI", "code_information": [{"code": "49657", "type": "CPT"}, {"code": "3480102013", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 20864.7, "gross_charge": 21510.0, "discounted_cash": 32265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20864.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15057.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16132.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18283.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17208.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPEOSCOPY LYMPH NOD", "code_information": [{"code": "38570", "type": "CPT"}, {"code": "3480101896", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4404.17, "maximum": 14206.62, "gross_charge": 14646.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14206.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10252.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10984.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12449.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11716.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPROSCOPIC PROCEDUR", "code_information": [{"code": "47379", "type": "CPT"}, {"code": "3480101990", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2301.1, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ABLTJ UTERINE FIBROIDS", "code_information": [{"code": "58674", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS COLECTOMY PRTL", "code_information": [{"code": "44207", "type": "CPT"}, {"code": "3480101957", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5608.78, "maximum": 17387.25, "gross_charge": 17925.0, "discounted_cash": 26887.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17387.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14340.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ESOPHGL SPHNCTR AGMNTJ", "code_information": [{"code": "43284", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS GSTRC RSTRICTIV", "code_information": [{"code": "43775", "type": "CPT"}, {"code": "3480101950", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4624.44, "maximum": 21737.7, "gross_charge": 22410.0, "discounted_cash": 33615.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19048.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16807.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15687.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 21737.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15687.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16807.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19048.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17928.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS 1LD", "code_information": [{"code": "675T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT ISDSS EA", "code_information": [{"code": "676T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ NW/RPCMT PRM ISDSS", "code_information": [{"code": "674T", "type": "CPT"}], "standard_charges": [{"minimum": 8198.68, "maximum": 8198.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS ISLET CELL TRANSPLANT", "code_information": [{"code": "585T", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS RMVL LEAD ISDSS", "code_information": [{"code": "679T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS SUPRACRV HYSTER", "code_information": [{"code": "58542", "type": "CPT"}, {"code": "3480102105", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8510.18, "maximum": 17387.25, "gross_charge": 17925.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17387.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS SURG PRST8ECT RPBIC RAD", "code_information": [{"code": "55866", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS TOT HYST RESJ MAL", "code_information": [{"code": "58575", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAPS VAGINAL HYSTERE", "code_information": [{"code": "58550", "type": "CPT"}, {"code": "3480102106", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5887.92, "maximum": 17387.25, "gross_charge": 17925.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17387.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12547.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13443.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15236.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/LASER DSTRJ LES", "code_information": [{"code": "31572", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/NJX AUGMENTATION", "code_information": [{"code": "31574", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/REMOVAL LESION", "code_information": [{"code": "31578", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/RMVL FOREIGN BDY(S)", "code_information": [{"code": "31577", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARONIDASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1931", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.44, "maximum": 37.44, "discounted_cash": 60.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY CRICOID SPLIT", "code_information": [{"code": "31587", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY FX RDCTJ FIXJ", "code_information": [{"code": "31584", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31551", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 4566.59, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31553", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31554", "type": "CPT"}], "standard_charges": [{"minimum": 4566.59, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY MEDIALIZATION", "code_information": [{"code": "31591", "type": "CPT"}], "standard_charges": [{"minimum": 4566.59, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/ARYTENOIDECTOM", "code_information": [{"code": "31560", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2624.17, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPE W/VC INJ", "code_information": [{"code": "31570", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY VID", "code_information": [{"code": "92614", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31528", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT,", "code_information": [{"code": "31525", "type": "CPT"}, {"code": "3480101863", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5508.63, "gross_charge": 5679.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4827.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4259.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3975.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5508.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3975.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4259.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4827.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4543.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY DIRECT,", "code_information": [{"code": "31526", "type": "CPT"}, {"code": "3480101864", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4590.04, "gross_charge": 4732.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4590.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3785.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR ASPIRATION", "code_information": [{"code": "31515", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY FOR TREATMENT", "code_information": [{"code": "31527", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W EXC O", "code_information": [{"code": "31540", "type": "CPT"}, {"code": "3340102383", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6384.54, "gross_charge": 6582.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5594.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4936.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4607.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6384.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4607.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4936.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5594.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5265.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP SCOPE", "code_information": [{"code": "31531", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB REMOVAL", "code_information": [{"code": "31530", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2615.71, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31510", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY WITH BIOPSY", "code_information": [{"code": "31576", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY, DIRECT", "code_information": [{"code": "31535", "type": "CPT"}, {"code": "3480101865", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4590.04, "gross_charge": 4732.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4590.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3785.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY, DIRECT", "code_information": [{"code": "31536", "type": "CPT"}, {"code": "3480101866", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5508.63, "gross_charge": 5679.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4827.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4259.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3975.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5508.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3975.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4259.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4827.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4543.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY, DIRECT", "code_information": [{"code": "31541", "type": "CPT"}, {"code": "3480101867", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6881.18, "gross_charge": 7094.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY, DIRECT", "code_information": [{"code": "31571", "type": "CPT"}, {"code": "3480101868", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6881.18, "gross_charge": 7094.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY, FLEXIB", "code_information": [{"code": "31575", "type": "CPT"}, {"code": "3480101869", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 303.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 240.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY, INDIRE", "code_information": [{"code": "31513", "type": "CPT"}, {"code": "3480101862", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "gross_charge": 600.0, "discounted_cash": 625.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 430.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 429.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 416.67, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 495.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 416.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 416.67, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2624.17, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER FIBER 150*TFL-", "code_information": [{"code": "3100206819", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 200*AC-1", "code_information": [{"code": "3100205856", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2750.33, "discounted_cash": 4125.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 200*LSU2", "code_information": [{"code": "3100204153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.15, "discounted_cash": 1444.73, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 200*LSU2", "code_information": [{"code": "3100204474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.15, "discounted_cash": 1444.73, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 200*TFL-", "code_information": [{"code": "3100206820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 273*LSU2", "code_information": [{"code": "3100204154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 986.07, "discounted_cash": 1479.11, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 300 IMPE", "code_information": [{"code": "3100209722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2067.0, "discounted_cash": 3100.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 365*AC-1", "code_information": [{"code": "3100205854", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1675.62, "discounted_cash": 2513.43, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 365*LSU3", "code_information": [{"code": "3100204155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 733.83, "discounted_cash": 1100.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 365*TFL-", "code_information": [{"code": "3100206821", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3783.0, "discounted_cash": 5674.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 500 IMPE", "code_information": [{"code": "3100204784", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3107.0, "discounted_cash": 4660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 500*CO2-", "code_information": [{"code": "3100205185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3107.0, "discounted_cash": 4660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 550*1049", "code_information": [{"code": "3100205328", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 550*AC-1", "code_information": [{"code": "3100205855", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2157.12, "discounted_cash": 3235.68, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 550*LSU5", "code_information": [{"code": "3100204156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 997.53, "discounted_cash": 1496.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 550*TFL-", "code_information": [{"code": "3100206822", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 910*LSU1", "code_information": [{"code": "3100204157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1754.31, "discounted_cash": 2631.47, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER 940*TFL-", "code_information": [{"code": "3100207416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER ELITE EN", "code_information": [{"code": "3100203723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER GREENLIG", "code_information": [{"code": "3100204209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER GREENLIG", "code_information": [{"code": "3100208952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER HLF-S550", "code_information": [{"code": "3100203829", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1143.9, "discounted_cash": 1715.85, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER HOLMIUM", "code_information": [{"code": "3100208182", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 1242.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER OMNIGUID", "code_information": [{"code": "3100204764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 688.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER OMNIGUID", "code_information": [{"code": "3100205113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER OMNIGUID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER FIBER RU 272*8", "code_information": [{"code": "3100207272", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 1611.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBER SU 550*8", "code_information": [{"code": "3100204737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1382.91, "discounted_cash": 2074.37, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBERS* HLF-S5", "code_information": [{"code": "3100203013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1029.51, "discounted_cash": 1544.27, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBERS*HLF-S36", "code_information": [{"code": "3100203012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 791.1, "discounted_cash": 1186.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBERS*HLF-S94", "code_information": [{"code": "3100203014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1704.78, "discounted_cash": 2557.17, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBERS*HLS200-", "code_information": [{"code": "3100203010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 963.09, "discounted_cash": 1444.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER FIBERS*HLS273-", "code_information": [{"code": "3100203011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 791.1, "discounted_cash": 1186.65, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER IN SITU KERATOMILEUSIS", "code_information": [{"code": "S0800", "type": "HCPCS"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF CERVIX", "code_information": [{"code": "57513", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER TREATMENT OF RETINA", "code_information": [{"code": "67040", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LASER TUBE SZ6*10200", "code_information": [{"code": "3100206024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.55, "discounted_cash": 714.83, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER TUBE SZ7*10200", "code_information": [{"code": "3100206025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.55, "discounted_cash": 714.83, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER URETERAL CATH*", "code_information": [{"code": "3100204703", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.64, "discounted_cash": 102.96, "setting": "both", "billing_class": "facility"}]}, {"description": "LAT MENISCUS GRAFT R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAT MENISCUS GRAFT*2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8645.0, "maximum": 11979.5, "gross_charge": 12350.0, "discounted_cash": 18525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11979.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAT PT MODULE*181-70", "code_information": [{"code": "3100208878", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAT PT SYSTEM*181-72", "code_information": [{"code": "3100208879", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LAT RETINACULAR RELE", "code_information": [{"code": "27425", "type": "CPT"}, {"code": "3480103088", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAT THORAX SPINE FUS", "code_information": [{"code": "22532", "type": "CPT"}, {"code": "3480103089", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4125.8, "maximum": 14462.5, "gross_charge": 5894.0, "discounted_cash": 8841.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4420.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5717.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4420.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4715.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAUP", "code_information": [{"code": "S2080", "type": "HCPCS"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAVAGE BY CANNULATIO", "code_information": [{"code": "31000", "type": "CPT"}, {"code": "3480101842", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 249.25, "maximum": 1869.0, "gross_charge": 965.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 820.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 723.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 675.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 936.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 675.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 723.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 820.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAVAGE BY CANNULATIO", "code_information": [{"code": "31002", "type": "CPT"}, {"code": "3480101843", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 2031.18, "gross_charge": 2094.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1570.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1465.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2031.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1465.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1570.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1779.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAYER CLOSURE", "code_information": [{"code": "12044", "type": "CPT"}, {"code": "3340102411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 762.66, "gross_charge": 697.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 592.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 487.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 676.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 487.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 592.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 557.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAYER CLOSURE OF WO", "code_information": [{"code": "12037", "type": "CPT"}, {"code": "3480101349", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2214.46, "gross_charge": 880.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 704.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAYER CLOSURE OF WOU", "code_information": [{"code": "12041", "type": "CPT"}, {"code": "3480101350", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 736.48, "gross_charge": 300.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LAYER CLOSURE OF WOU", "code_information": [{"code": "12042", "type": "CPT"}, {"code": "3480101351", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1024.32, "gross_charge": 1056.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEAD", "code_information": [{"code": "83655", "type": "CPT"}, {"code": "3440100945", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.11, "maximum": 122.22, "gross_charge": 126.0, "discounted_cash": 19.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.97, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEAD", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100104582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9520.0, "maximum": 13192.0, "gross_charge": 13600.0, "discounted_cash": 20400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11560.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9520.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13192.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9520.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11560.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD 65CM*977C265", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100202348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8680.0, "maximum": 12028.0, "gross_charge": 12400.0, "discounted_cash": 18600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD 90CM*977C290", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8400.0, "maximum": 11640.0, "gross_charge": 12000.0, "discounted_cash": 18000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11640.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD ACCESSORY KIT*M", "code_information": [{"code": "3100203508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD ADAPTOR 8-CHANN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2966.6, "maximum": 4110.86, "gross_charge": 4238.0, "discounted_cash": 6357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4110.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD ECG 3 CLIP*LX3-", "code_information": [{"code": "3100203161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD EXTENSION 50*MN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD IMPLANT KIT*18", "code_information": [{"code": "3100205275", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 984.0, "discounted_cash": 1476.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD KIT 085\"*978A12", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100206013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8288.28, "maximum": 11485.18, "gross_charge": 11840.4, "discounted_cash": 17760.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10064.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8880.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8288.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11485.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8288.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8880.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10064.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD KIT 50CM*SC-841", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6300.0, "maximum": 8730.0, "gross_charge": 9000.0, "discounted_cash": 13500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6300.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8730.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6300.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD KIT LAMITRODE 4", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7189.0, "maximum": 9961.9, "gross_charge": 10270.0, "discounted_cash": 15405.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9961.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7189.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7702.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8729.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD KIT NEUROSTIM", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100104286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5851.3, "maximum": 8108.23, "gross_charge": 8359.0, "discounted_cash": 12538.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7105.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6269.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5851.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8108.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5851.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6269.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7105.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6687.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD KIT NEUROSTIM O", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5369.0, "maximum": 7439.9, "gross_charge": 7670.0, "discounted_cash": 11505.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7439.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD MEDTRONIC SPINA", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD NEURO STIM LAMI", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9016.0, "maximum": 12493.6, "gross_charge": 12880.0, "discounted_cash": 19320.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10948.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9016.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12493.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9016.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10948.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD NEUROSTIM LAMIT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6734.0, "maximum": 9331.4, "gross_charge": 9620.0, "discounted_cash": 14430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9331.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD NEUROSTIM OCTRO", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 911.4, "maximum": 1262.94, "gross_charge": 1302.0, "discounted_cash": 1953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1262.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1041.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD NEUROSTIM PENTA", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD NEUROSTIM QUATT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5369.0, "maximum": 7439.9, "gross_charge": 7670.0, "discounted_cash": 11505.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7439.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD NEUROSTIM QUATT", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3549.0, "maximum": 4917.9, "gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4917.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD PADDLE SCS", "code_information": [{"code": "3100102391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD QUATTRODE", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100101026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3549.0, "maximum": 4917.9, "gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4917.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEAD WIRE CLIP ON*27", "code_information": [{"code": "3100202299", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD WIRE*302775-200", "code_information": [{"code": "3100202730", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEAD*3292", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LECTROVAC", "code_information": [{"code": "3100103962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.4, "discounted_cash": 42.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LEEP LOOP", "code_information": [{"code": "3100101027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEEP LOOP", "code_information": [{"code": "3100102881", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LEFORT I-2 PIECE W G", "code_information": [{"code": "21146", "type": "CPT"}, {"code": "3480103083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4153.8, "maximum": 6211.31, "gross_charge": 5934.0, "discounted_cash": 8901.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5043.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4450.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4153.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5755.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4153.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4450.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5043.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4747.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3/> PIECE W/ GRAFT", "code_information": [{"code": "21147", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT I-3> PIECE W/", "code_information": [{"code": "21143", "type": "CPT"}, {"code": "3480103058", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3381.7, "maximum": 7111.29, "gross_charge": 4831.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4106.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3623.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3381.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4686.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3381.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3623.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4106.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT II ANTERIOR INTRUSION", "code_information": [{"code": "21150", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT II W/BONE GRAFTS", "code_information": [{"code": "21151", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/ LEFORT I", "code_information": [{"code": "21155", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHD W/ LEFORT I", "code_information": [{"code": "21160", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/FHDW/O LEFORT I", "code_information": [{"code": "21159", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFORT III W/O LEFORT I", "code_information": [{"code": "21154", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEFT HRT CATH W/VENTRCLGRPHY", "code_information": [{"code": "93452", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEG POSITIONER KIT*1", "code_information": [{"code": "3100205180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEG POSITIONER*11055", "code_information": [{"code": "3100207043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LEG VEIN FUSION", "code_information": [{"code": "34530", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGACY LEVEL 1*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGACY LEVEL 2*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5023.2, "maximum": 6960.72, "gross_charge": 7176.0, "discounted_cash": 10764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6099.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5382.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5023.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6960.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5023.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5382.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6099.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5740.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGACY LEVEL 3*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6588.4, "maximum": 9129.64, "gross_charge": 9412.0, "discounted_cash": 14118.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8000.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7059.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6588.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9129.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6588.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7059.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8000.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7529.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA AMP PROB", "code_information": [{"code": "87541", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA DIR PROB", "code_information": [{"code": "87540", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMO DNA QUANT", "code_information": [{"code": "87542", "type": "CPT"}], "standard_charges": [{"minimum": 41.76, "maximum": 41.83, "discounted_cash": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGION PNEUMOPHILIA AG IF", "code_information": [{"code": "87278", "type": "CPT"}], "standard_charges": [{"minimum": 15.6, "maximum": 24.03, "discounted_cash": 25.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEGIONELLA AB", "code_information": [{"code": "86713", "type": "CPT"}, {"code": "3440101113", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.3, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 24.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEISHMANIA ANTIBODY", "code_information": [{"code": "86717", "type": "CPT"}], "standard_charges": [{"minimum": 12.25, "maximum": 30.26, "discounted_cash": 19.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN METACARPAL/FINGER", "code_information": [{"code": "26568", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS & ULNA", "code_information": [{"code": "25393", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHEN RADIUS OR ULNA", "code_information": [{"code": "25391", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF HAND", "code_information": [{"code": "26478", "type": "CPT"}, {"code": "3340102373", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4245.69, "gross_charge": 4377.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4245.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3501.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42226", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF PALATE", "code_information": [{"code": "42227", "type": "CPT"}], "standard_charges": [{"minimum": 4850.06, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDON", "code_information": [{"code": "27393", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27394", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH TENDONS", "code_information": [{"code": "27395", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OR SHORT", "code_information": [{"code": "27685", "type": "CPT"}, {"code": "3480101725", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OR SHORT", "code_information": [{"code": "27686", "type": "CPT"}, {"code": "3480101726", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF *AU00T0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207494", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF *DFT015", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207542", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF *MA60AC", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100209537", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF *SA60AT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100204896", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF ALCON", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100104005", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF IQ TORI", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100204005", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF IQ TORI", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100204263", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF IQ VIVI", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207321", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ACRYSOF IQ VIVI", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207446", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS ALCON MODEL *MT", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100209629", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100103710", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO MODEL*AR40M", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207393", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO MODEL*ZXT15", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100202530", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 618.1, "maximum": 856.51, "gross_charge": 883.0, "discounted_cash": 1324.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 750.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 662.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 618.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 856.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 618.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 662.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 750.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 706.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO MODEL*ZXT30", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100203946", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 618.1, "maximum": 856.51, "gross_charge": 883.0, "discounted_cash": 1324.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 750.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 662.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 618.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 856.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 618.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 662.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 750.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 706.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO MODEL*ZXT37", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100202284", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZA9003", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100102192", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCB00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100102274", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCT", "code_information": [{"code": "3100102388", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LENS AMO ZCT150", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100102380", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCT300", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100102400", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCT525*ZCT5", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100202358", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCU150*ZCU1", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206036", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCU225*ZCU2", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100205949", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCU300*ZCU3", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100205925", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCU375*ZCU3", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206201", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZCU600*ZCU6", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206092", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZKB00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100104077", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 679.7, "maximum": 941.87, "gross_charge": 971.0, "discounted_cash": 1456.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 825.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 728.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 679.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 941.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 679.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 728.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 825.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 776.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZLB00*ZLU37", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100205837", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZLU150*ZLU1", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100205896", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZLU225*ZLU2", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206115", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZLU300*ZLU3", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206004", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZMB0O", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100103800", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS AMO ZXR00*ZXR00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100202391", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 556.5, "maximum": 771.15, "gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 675.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 596.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 771.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 596.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 675.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS CLAREON*SY60WF", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207994", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS IOL*CT LUCIA 60", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208606", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS IOL*DRN00V", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100209798", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS IOL*DRT150", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100210201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS IOL*DRT225", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100210024", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS RAYONE EMV US*R", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208719", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS RAYONE EMV*RAO2", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208675", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TECNIS*DFW150", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207004", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TECNIS*DFW225", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207097", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TECNIS*DFW300", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207044", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 3350.2, "maximum": 4642.42, "gross_charge": 4786.0, "discounted_cash": 7179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4068.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3589.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3350.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4642.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3350.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3589.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4068.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3828.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TECNIS*DXW225", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207701", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TENCNIS*DFR00V", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206931", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TENCNIS*DIB00", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206523", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 325.5, "maximum": 451.05, "gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 451.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC II DIU150", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206386", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC II DIU225", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207323", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC II DIU300", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100206437", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 501.9, "maximum": 695.49, "gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC II DIU375", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207507", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC II DIU450", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207237", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC II DIU525", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207249", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1018.5, "maximum": 1411.35, "gross_charge": 1455.0, "discounted_cash": 2182.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1411.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC*CNWTT3", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208905", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS TORIC*SA6AT8", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207423", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 808.5, "maximum": 1120.35, "gross_charge": 1155.0, "discounted_cash": 1732.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 981.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1120.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 981.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207549", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207576", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207577", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207592", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207609", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207622", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208220", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208595", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100208596", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENS VIVITY CLAREON*", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100209151", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1847.3, "maximum": 2559.83, "gross_charge": 2639.0, "discounted_cash": 3958.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2559.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1847.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1979.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2243.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2111.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEPIRUDIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1945", "type": "HCPCS"}], "standard_charges": [{"minimum": 444.09, "maximum": 444.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 444.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEPTOSPIRA ANTIBODY", "code_information": [{"code": "86720", "type": "CPT"}], "standard_charges": [{"minimum": 16.2, "maximum": 30.26, "discounted_cash": 26.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LESION DESTRUCTION", "code_information": [{"code": "D7465", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LESION REMOVAL COLON", "code_information": [{"code": "45383", "type": "CPT"}, {"code": "3340102395", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1805.3, "maximum": 2501.63, "gross_charge": 2579.0, "discounted_cash": 3868.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2192.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1934.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1805.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2501.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1805.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1934.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2192.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2063.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUCOVORIN CALCIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0640", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.14, "maximum": 5.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE ASSESSMENT FECAL", "code_information": [{"code": "89055", "type": "CPT"}], "standard_charges": [{"minimum": 4.27, "maximum": 35.16, "discounted_cash": 6.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE HISTAMINE RELEASE", "code_information": [{"code": "86343", "type": "CPT"}], "standard_charges": [{"minimum": 12.46, "maximum": 30.26, "discounted_cash": 20.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE PHAGOCYTOSIS", "code_information": [{"code": "86344", "type": "CPT"}], "standard_charges": [{"minimum": 10.39, "maximum": 30.26, "discounted_cash": 16.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEUKOCYTE TRANSFUSIO", "code_information": [{"code": "86950", "type": "CPT"}, {"code": "3440103012", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 46.2, "maximum": 207.41, "gross_charge": 77.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE /3.75 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1950", "type": "HCPCS"}], "standard_charges": [{"minimum": 1576.12, "maximum": 1576.12, "discounted_cash": 2513.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1576.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9219", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9218", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.02, "maximum": 11.02, "discounted_cash": 22.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE ACETATE SUSPNSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9217", "type": "HCPCS"}], "standard_charges": [{"minimum": 185.66, "maximum": 185.66, "discounted_cash": 291.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE DEPOT CIPLA 7.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1954", "type": "HCPCS"}], "standard_charges": [{"minimum": 281.57, "maximum": 281.57, "discounted_cash": 570.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 281.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEUPROLIDE INJ, CAMCEVI, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1952", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.75, "maximum": 60.75, "discounted_cash": 96.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 60.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7607", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7615", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7612", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.23, "maximum": 0.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVALBUTEROL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7614", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEEN/SHUNT PATENCY EXAM", "code_information": [{"code": "78291", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL 1 ACDF W/IN*LE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 1 ACDF*LEVEL 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 1 KIT*5101-900", "code_information": [{"code": "3100209754", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2715.3, "discounted_cash": 4072.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LEVEL 1 MIS INBODY*L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 1 PCF*LEVEL 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5714.8, "maximum": 7919.08, "gross_charge": 8164.0, "discounted_cash": 12246.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6939.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6123.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5714.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7919.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5714.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6123.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6939.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6531.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 1 TLIF*LEVEL 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 1 TLIFW/INTEBO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8372.0, "maximum": 11601.2, "gross_charge": 11960.0, "discounted_cash": 17940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11601.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 ACDF W/IN*LE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 ACDF W/IN*LE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 ACDF*LEVEL 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 MIS INBODY*L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13020.0, "maximum": 18042.0, "gross_charge": 18600.0, "discounted_cash": 27900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15810.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13020.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18042.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13020.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15810.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 MIS*LEVEL 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8155.0, "maximum": 11300.5, "gross_charge": 11650.0, "discounted_cash": 17475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9902.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8737.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11300.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8737.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9902.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 PCF* LEVEL 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8299.2, "maximum": 11500.32, "gross_charge": 11856.0, "discounted_cash": 17784.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10077.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8892.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8299.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11500.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8299.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8892.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10077.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9484.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 2 TLIF*LEVEL 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 3 ACDF W/IN*LE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 3 ACDF*LEVEL 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 3 PCF*LEVEL 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8372.0, "maximum": 11601.2, "gross_charge": 11960.0, "discounted_cash": 17940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11601.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 4 ACDF W/IN*LE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 4 ACDF*LEVEL 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 4 ACDF*LEVEL 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL 4 PCF*4 LEVEL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10360.0, "maximum": 14356.0, "gross_charge": 14800.0, "discounted_cash": 22200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12580.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10360.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14356.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10360.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12580.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL I SURGICAL PAT", "code_information": [{"code": "88300", "type": "CPT"}, {"code": "3440101226", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 15.15, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL II SURGICAL PA", "code_information": [{"code": "88302", "type": "CPT"}, {"code": "3440101227", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 23.5, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL III SURGICAL P", "code_information": [{"code": "88304", "type": "CPT"}, {"code": "3440101228", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 44.16, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL IV SURGICAL PA", "code_information": [{"code": "88305", "type": "CPT"}, {"code": "3440101229", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 55.3, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL V SURGICAL PAT", "code_information": [{"code": "88307", "type": "CPT"}, {"code": "3440101230", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 174.64, "maximum": 436.49, "gross_charge": 398.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 338.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 298.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 278.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 386.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 278.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 298.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 338.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 318.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL VI SURGICAL PA", "code_information": [{"code": "88309", "type": "CPT"}, {"code": "3440101231", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 182.01, "maximum": 1044.18, "gross_charge": 1033.0, "discounted_cash": 1316.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 907.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1002.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 903.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1044.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 826.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVEL2 TLIF *LEVEL 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11340.0, "maximum": 15714.0, "gross_charge": 16200.0, "discounted_cash": 24300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13770.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11340.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15714.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11340.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13770.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEL3 TLIF *LEVEL 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8260.0, "maximum": 11446.0, "gross_charge": 11800.0, "discounted_cash": 17700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10030.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11446.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10030.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM", "code_information": [{"code": "80177", "type": "CPT"}, {"code": "3440100818", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVOFLOXACIN/D5W", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1956", "type": "HCPCS"}, {"code": "3400300229", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.96, "maximum": 13.77, "gross_charge": 14.2, "discounted_cash": 21.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVONORGESTREL IMPLANT SYS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7306", "type": "HCPCS"}], "standard_charges": [{"minimum": 454.68, "maximum": 454.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 454.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVORPHANOL TARTRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1960", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE HCL", "code_information": [{"code": "3400300023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.2, "discounted_cash": 12.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE HCL", "code_information": [{"code": "3400300112", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.7, "discounted_cash": 10.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE HCL", "code_information": [{"code": "3400300114", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.6, "discounted_cash": 12.9, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE HCL", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300247", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 31.2, "discounted_cash": 46.8, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "LIDOCAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2003", "type": "HCPCS"}, {"code": "3400300122", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 12.2, "discounted_cash": 18.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE HCL/D5W", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2002", "type": "HCPCS"}, {"code": "3400300071", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 15.8, "discounted_cash": 23.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.03, "maximum": 0.03, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPINEPHRIN", "code_information": [{"code": "3400300103", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.7, "discounted_cash": 10.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPINEPHRIN", "code_information": [{"code": "3400300104", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 7.3, "discounted_cash": 10.95, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPINEPHRIN", "code_information": [{"code": "3400300289", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.2, "discounted_cash": 13.8, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPINEPHRIN", "code_information": [{"code": "3400300290", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.6, "discounted_cash": 26.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LIDOCAINE/EPINEPHRIN", "code_information": [{"code": "3400300291", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 15.8, "discounted_cash": 23.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LIF ILLUMIN SYSTEM*2", "code_information": [{"code": "3100208881", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 1ST STAGE", "code_information": [{"code": "S0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 2 OR 3 STAGE", "code_information": [{"code": "S0341", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 4TH STAGE", "code_information": [{"code": "S0342", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGACLIP TITANIUM ME", "code_information": [{"code": "3100205806", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.84, "discounted_cash": 58.26, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGACLIP TITANIUM SM", "code_information": [{"code": "3100205807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.2, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGAMENT AUG REPAIR*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.94, "maximum": 3958.9, "gross_charge": 4081.35, "discounted_cash": 6122.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGAMENTOUS RECONSTR", "code_information": [{"code": "27427", "type": "CPT"}, {"code": "3480101702", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGASURE 44CM*LF1944", "code_information": [{"code": "3100207397", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2115.36, "discounted_cash": 3173.04, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS OPEN", "code_information": [{"code": "37761", "type": "CPT"}], "standard_charges": [{"minimum": 3185.31, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2385.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/DIVIDE/EXCISE VEIN", "code_information": [{"code": "37785", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LE", "code_information": [{"code": "37722", "type": "CPT"}, {"code": "3480101887", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12322.88, "gross_charge": 12704.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10798.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9528.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8892.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12322.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8892.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9528.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10798.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10163.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP SHORT LEG VEIN", "code_information": [{"code": "37718", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION MAJOR ARTER", "code_information": [{"code": "37618", "type": "CPT"}, {"code": "3480103047", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 2718.95, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION NASAL SINUS ARTERY", "code_information": [{"code": "30915", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FIST", "code_information": [{"code": "37607", "type": "CPT"}, {"code": "3340102437", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7262.39, "gross_charge": 7487.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6363.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5615.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5240.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7262.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5240.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5615.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6363.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5989.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37605", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37606", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37615", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK VEIN", "code_information": [{"code": "37565", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SALIVARY DUCT", "code_information": [{"code": "42665", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2319.34, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION OF SHUNT", "code_information": [{"code": "49428", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGATION UPPER JAW ARTERY", "code_information": [{"code": "30920", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIGHT CABLE LLIF*274", "code_information": [{"code": "3100202725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT FIBER SINUS PA", "code_information": [{"code": "3100101030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT HANDLE COVER*0", "code_information": [{"code": "3100203227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "discounted_cash": 14.16, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGHT SHIELD CORNEAL", "code_information": [{"code": "3100101031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LILETTA IUD 52MG*958", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 919.8, "maximum": 1274.58, "gross_charge": 1314.0, "discounted_cash": 1971.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1116.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 985.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 919.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1274.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 919.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 985.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1116.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1051.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LILETTA, 52 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7297", "type": "HCPCS"}], "standard_charges": [{"minimum": 864.97, "maximum": 864.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 864.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMB EXERCISE TEST", "code_information": [{"code": "95875", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMB NERVE SURGERY ADD-ON", "code_information": [{"code": "64783", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [{"code": "956", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29889.54, "maximum": 29889.54, "discounted_cash": 43298.42, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29889.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIMIT ORAL EVAL PROBLM FOCUS", "code_information": [{"code": "D0140", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX ADOLESCENT", "code_information": [{"code": "D8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX ADULT", "code_information": [{"code": "D8040", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX PRIMARY", "code_information": [{"code": "D8010", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMITED DENTAL TX TRANSITION", "code_information": [{"code": "D8020", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIMITED OCCLUSAL ADJUSTMENT", "code_information": [{"code": "D9951", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LINCOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2010", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.33, "maximum": 10.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETA SZ G", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3101.0, "maximum": 4297.1, "gross_charge": 4430.0, "discounted_cash": 6645.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3765.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3322.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3101.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4297.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3101.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3322.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3765.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3544.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETAB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2803.5, "maximum": 3884.85, "gross_charge": 4005.0, "discounted_cash": 6007.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3404.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3003.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2803.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3884.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2803.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3003.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3404.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3204.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETAB 36X24*X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETAB 36X52*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETAB 36X52MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETAB 36X56MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4850.3, "maximum": 6721.13, "gross_charge": 6929.0, "discounted_cash": 10393.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5889.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5196.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4850.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6721.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4850.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5196.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5543.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABU 28MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4850.3, "maximum": 6721.13, "gross_charge": 6929.0, "discounted_cash": 10393.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5889.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5196.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4850.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6721.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4850.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5196.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5543.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2870.7, "maximum": 3977.97, "gross_charge": 4101.0, "discounted_cash": 6151.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3485.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3075.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2870.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3977.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2870.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3075.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3485.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3280.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 32M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8109.92, "maximum": 11238.03, "gross_charge": 11585.6, "discounted_cash": 17378.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9847.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8689.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8109.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11238.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8109.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8689.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9847.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9268.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 50M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 53*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 54M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR 58*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR NEU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9280.6, "maximum": 12860.26, "gross_charge": 13258.0, "discounted_cash": 19887.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11269.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9943.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9280.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12860.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9280.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9943.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11269.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10606.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ACETABULAR*EP-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ALTRX 43/22*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER BOOT", "code_information": [{"code": "3100104218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 337.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER COMPL/PARTIAL REM DENT", "code_information": [{"code": "D5765", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LINER CONT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7954.8, "maximum": 11023.08, "gross_charge": 11364.0, "discounted_cash": 17046.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9659.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8523.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7954.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11023.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7954.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8523.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9659.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9091.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER CONT INSERT", "code_information": [{"code": "3100104704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3926.0, "discounted_cash": 5889.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LINER DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2814.0, "maximum": 3899.4, "gross_charge": 4020.0, "discounted_cash": 6030.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3417.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3015.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3899.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2814.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3015.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3417.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY ACETUBUL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2335.9, "maximum": 3236.89, "gross_charge": 3337.0, "discounted_cash": 5005.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2836.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2502.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2335.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3236.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2335.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2502.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2836.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2669.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY ACETUBUL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3129.7, "maximum": 4336.87, "gross_charge": 4471.0, "discounted_cash": 6706.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3800.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3353.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3129.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4336.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3129.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3353.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3800.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3576.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY ACETUBUL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY ACETUBUL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2842.0, "maximum": 3938.2, "gross_charge": 4060.0, "discounted_cash": 6090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3451.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2842.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3938.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2842.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3451.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY LIPPED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2487.8, "maximum": 3447.38, "gross_charge": 3554.0, "discounted_cash": 5331.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3020.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2665.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2487.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3447.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2487.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2665.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3020.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2843.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY LIPPED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY LIPPED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1493.8, "maximum": 2069.98, "gross_charge": 2134.0, "discounted_cash": 3201.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1813.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1493.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2069.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1493.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1813.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1707.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2335.9, "maximum": 3236.89, "gross_charge": 3337.0, "discounted_cash": 5005.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2836.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2502.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2335.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3236.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2335.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2502.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2836.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2669.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2429.7, "maximum": 3366.87, "gross_charge": 3471.0, "discounted_cash": 5206.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2950.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2603.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2429.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3366.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2429.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2603.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2950.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2776.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3116.4, "maximum": 4318.44, "gross_charge": 4452.0, "discounted_cash": 6678.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3784.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3339.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3116.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4318.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3116.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3339.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3784.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3561.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DEPUY PINNACLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3564.4, "maximum": 4939.24, "gross_charge": 5092.0, "discounted_cash": 7638.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4328.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3819.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3564.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4939.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3564.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3819.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4328.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4073.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER DJO CERAMIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2993.9, "maximum": 4148.69, "gross_charge": 4277.0, "discounted_cash": 6415.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3635.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3207.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2993.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4148.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2993.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3207.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3635.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3421.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER HIP MDM STRYKE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5833.1, "maximum": 8083.01, "gross_charge": 8333.0, "discounted_cash": 12499.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7083.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6249.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5833.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8083.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5833.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6249.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7083.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6666.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER HIP STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER MAR DURAL 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2870.14, "maximum": 3977.19, "gross_charge": 4100.2, "discounted_cash": 6150.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3485.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3075.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2870.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3977.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2870.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3075.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3485.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3280.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER N VE STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER N VE STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER NER STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER NER STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER NEUT ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 693.0, "maximum": 960.3, "gross_charge": 990.0, "discounted_cash": 1485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 742.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 960.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 742.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER NEUTRAL58X36*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5667.48, "maximum": 7853.5, "gross_charge": 8096.4, "discounted_cash": 12144.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6881.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6072.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5667.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7853.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5667.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6072.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6881.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6477.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER POLY 36MM*1220", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3636.63, "maximum": 5039.33, "gross_charge": 5195.19, "discounted_cash": 7792.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4415.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3896.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3636.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5039.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3636.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3896.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4415.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4156.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER POLY 36MM*1220", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3636.63, "maximum": 5039.33, "gross_charge": 5195.19, "discounted_cash": 7792.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4415.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3896.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3636.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5039.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3636.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3896.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4415.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4156.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER REVERSE 32*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER REVERSE 32*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER REVERSE 36*550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER SMITH&NEPHEW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2898.0, "maximum": 4015.8, "gross_charge": 4140.0, "discounted_cash": 6210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3519.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2898.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4015.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2898.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3519.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3312.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER SZ F 28MM*142-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5270.72, "maximum": 7303.71, "gross_charge": 7529.6, "discounted_cash": 11294.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6400.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5647.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5270.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7303.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5270.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5647.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6400.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6023.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER TRILOG 60X36*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7522.2, "maximum": 10423.62, "gross_charge": 10746.0, "discounted_cash": 16119.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9134.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8059.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7522.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10423.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7522.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8059.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9134.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8596.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER VIVACITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER VIVACITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER CONTINU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER CROSS P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5397.7, "maximum": 7479.67, "gross_charge": 7711.0, "discounted_cash": 11566.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6554.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5783.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5397.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7479.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5397.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5783.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6554.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6168.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER E VE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER E VE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER ELV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER ELV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER NEUTRAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINER ZIMMER VIVACIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINEZOLID INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2020", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.62, "maximum": 3.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LINGUAL FRENECTOMY", "code_information": [{"code": "D7962", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPASE", "code_information": [{"code": "83690", "type": "CPT"}, {"code": "3440100946", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.89, "maximum": 62.08, "gross_charge": 64.0, "discounted_cash": 11.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 62.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPECTOMY TRUNK SUCT", "code_information": [{"code": "15877", "type": "CPT"}, {"code": "3480101383", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6151.74, "gross_charge": 6342.0, "discounted_cash": 5491.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3785.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6151.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3770.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4356.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5073.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPID PANEL", "code_information": [{"code": "80061", "type": "CPT"}, {"code": "3440100797", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.39, "maximum": 115.43, "gross_charge": 119.0, "discounted_cash": 21.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 115.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPOPRO BLD ELECTROPHORETIC", "code_information": [{"code": "83700", "type": "CPT"}], "standard_charges": [{"minimum": 11.26, "maximum": 40.05, "discounted_cash": 18.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD HR FRACTION", "code_information": [{"code": "83701", "type": "CPT"}], "standard_charges": [{"minimum": 33.86, "maximum": 53.85, "discounted_cash": 54.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPOPROTEIN BLD QUAN PART", "code_information": [{"code": "83704", "type": "CPT"}], "standard_charges": [{"minimum": 34.19, "maximum": 53.85, "discounted_cash": 54.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIPOPRTN DIR MEAS SD LDL CHL", "code_information": [{"code": "83722", "type": "CPT"}], "standard_charges": [{"minimum": 34.19, "maximum": 53.85, "discounted_cash": 54.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LISOCABTAGENE MARA CAR POS T", "code_information": [{"code": "Q2054", "type": "HCPCS"}], "standard_charges": [{"minimum": 474060.62, "maximum": 474060.62, "discounted_cash": 761245.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 474060.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LISTERIA MONOCYTOGENES", "code_information": [{"code": "86723", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITE PIPEFIBERS", "code_information": [{"code": "3100101047", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LITHIUM", "code_information": [{"code": "80178", "type": "CPT"}, {"code": "3440100819", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.61, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 10.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITHOLAPAXY SMPL<2.5", "code_information": [{"code": "52317", "type": "CPT"}, {"code": "3340102323", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6815.22, "gross_charge": 7026.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5972.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5269.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4918.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6815.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4918.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5269.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5972.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5620.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITHOLAPAXY SMPL<2.5", "code_information": [{"code": "52317", "type": "CPT"}, {"code": "3480103241", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITHOTRIPSY RENAL", "code_information": [{"code": "50575", "type": "CPT"}, {"code": "3340102301", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4163.42, "maximum": 9862.96, "gross_charge": 10168.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8642.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7626.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9862.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7117.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7626.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8642.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LITT ICR MLT TRJ MLT/CPLX LS", "code_information": [{"code": "61737", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER & SPLEEN IMAGE/FLOW", "code_information": [{"code": "78216", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER AND SPLEEN IMAGING", "code_information": [{"code": "78215", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/ASH", "code_information": [{"code": "2M", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 808.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER DIS 10 ASSAYS W/NASH", "code_information": [{"code": "3M", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 808.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER DS 10 BIOCHEM ASY SRM", "code_information": [{"code": "166U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 808.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER DS ALYS 3 BMRK SRM ALG", "code_information": [{"code": "81517", "type": "CPT"}], "standard_charges": [{"minimum": 503.4, "maximum": 503.4, "discounted_cash": 283.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 503.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER ELASTOGRAPHY", "code_information": [{"code": "91200", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING", "code_information": [{"code": "78201", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER IMAGING WITH FLOW", "code_information": [{"code": "78202", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [{"code": "5", "type": "MS-DRG"}], "standard_charges": [{"minimum": 99220.68, "maximum": 99220.68, "discounted_cash": 115553.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 99220.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [{"code": "6", "type": "MS-DRG"}], "standard_charges": [{"minimum": 55812.79, "maximum": 55812.79, "discounted_cash": 54001.88, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55812.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LMTD OPH EXAM GENERAL ANES", "code_information": [{"code": "92019", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LNGVTY&MRTLTY RSK MRNA 18GEN", "code_information": [{"code": "294U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOADING CONE HEMM BA", "code_information": [{"code": "3100101048", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LOBAR LUNG TRANSPLANTATION", "code_information": [{"code": "S2060", "type": "HCPCS"}], "standard_charges": [{"minimum": 19281.41, "maximum": 19281.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19281.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCAL ANESTHESIA", "code_information": [{"code": "D9215", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "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": 10923.14, "maximum": 10923.14, "discounted_cash": 22189.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10923.14, "methodology": "fee schedule"}], "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": 22349.83, "maximum": 22349.83, "discounted_cash": 39982.55, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22349.83, "methodology": "fee schedule"}], "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": 7009.72, "maximum": 7009.72, "discounted_cash": 15936.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7009.72, "methodology": "fee schedule"}], "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": 15893.46, "maximum": 15893.46, "discounted_cash": 29150.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15893.46, "methodology": "fee schedule"}], "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": 6639.59, "maximum": 6639.59, "discounted_cash": 14400.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6639.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCALIZED DELIVERY ANTIMICRO", "code_information": [{"code": "D4381", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOCK SCREW 1.4X11MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCK SLEEVE*03.835.0", "code_information": [{"code": "3100202693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOCKING CAP*148-059", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCKING CAPS*148-003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCKING RING 56/68*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 643.33, "maximum": 891.47, "gross_charge": 919.05, "discounted_cash": 1378.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 781.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 689.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 891.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 689.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 781.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 735.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCKING RING 60/72M*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 643.33, "maximum": 891.47, "gross_charge": 919.05, "discounted_cash": 1378.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 781.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 689.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 891.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 689.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 781.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 735.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCKING RING DYNAMIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.6, "maximum": 871.06, "gross_charge": 898.0, "discounted_cash": 1347.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 871.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCKING RING DYNAMIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCKING RNG DYN 54MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 643.33, "maximum": 891.47, "gross_charge": 919.05, "discounted_cash": 1378.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 781.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 689.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 891.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 643.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 689.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 781.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 735.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCM 100-199MG/ML IODINE,1ML", "code_information": [{"code": "Q9965", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.02, "maximum": 1.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCM 200-299 MG/ML", "code_information": [{"code": "Q9966", "type": "HCPCS"}, {"code": "3290010288", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.39, "maximum": 6.42, "gross_charge": 6.62, "discounted_cash": 9.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCM 300-399 MG/ML", "code_information": [{"code": "Q9967", "type": "HCPCS"}, {"code": "3290100242", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.14, "maximum": 1.01, "gross_charge": 1.05, "discounted_cash": 1.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 0.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 0.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 0.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 0.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 0.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 0.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 0.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOCM >= 400 MG/ML IODINE,1ML", "code_information": [{"code": "Q9951", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LONG CHAIN FATTY ACIDS", "code_information": [{"code": "82726", "type": "CPT"}], "standard_charges": [{"minimum": 19.75, "maximum": 40.05, "discounted_cash": 31.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOOP HF MED", "code_information": [{"code": "3100104754", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1297.0, "discounted_cash": 1945.5, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP HF MED 12 DEG*W", "code_information": [{"code": "3100204704", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1649.28, "discounted_cash": 2473.92, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP LARGE*WA22707S", "code_information": [{"code": "3100207429", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.88, "discounted_cash": 1867.32, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP N TACK IMP*AR16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.14, "maximum": 2150.82, "gross_charge": 2217.35, "discounted_cash": 3326.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2150.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1773.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOPRO SCREW 3.5X65MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORAZEPAM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2060", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.96, "maximum": 0.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORDOTIC 10X8X25*HA1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORDOTIC 10X9X25*HA1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORDOTIC BLOCK 7X14X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORDOTIC BLOCK 8X14X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORDOTIC CERV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LORDOTIC ZERO 10MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5271", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5272", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5273", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5274", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5275", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5276", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5277", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW COST SKIN SUBSTITUTE APP", "code_information": [{"code": "C5278", "type": "HCPCS"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW DENSITY LIPOPROTEIN(LDL)", "code_information": [{"code": "S2120", "type": "HCPCS"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW PROF HINGE FEMAL", "code_information": [{"code": "3100209130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.44, "discounted_cash": 726.66, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE HINGE MA", "code_information": [{"code": "3100209129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.44, "discounted_cash": 726.66, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER TRMT 15 MIN", "code_information": [{"code": "S8948", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "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": 13258.9, "maximum": 13258.9, "discounted_cash": 26813.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13258.9, "methodology": "fee schedule"}], "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": 22253.3, "maximum": 22253.3, "discounted_cash": 38652.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22253.3, "methodology": "fee schedule"}], "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": 9146.89, "maximum": 9146.89, "discounted_cash": 20868.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9146.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER JAW BONE GRAFT", "code_information": [{"code": "21215", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LOXAPINE FOR INHALATION 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2062", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.41, "maximum": 15.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LP SCREW 3.5X55MM*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LPN CARE TRAIN/EDU IN HH", "code_information": [{"code": "G0496", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LPOPRTN BLD W/5 MAJ CLASSES", "code_information": [{"code": "52U", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 53.85, "discounted_cash": 54.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LPP PAD COVER KIT*18", "code_information": [{"code": "3100209225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LSO LOW PROFILE RIGI", "code_information": [{"code": "L0627", "type": "HCPCS"}, {"code": "3100101050", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 355.6, "maximum": 492.76, "gross_charge": 508.0, "discounted_cash": 762.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 431.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 381.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 355.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 492.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 355.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 381.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 431.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 406.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSO LOW PROFILE RIGI", "code_information": [{"code": "L0627", "type": "HCPCS"}, {"code": "3100102894", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 373.1, "maximum": 517.01, "gross_charge": 533.0, "discounted_cash": 799.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 453.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 373.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 517.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 373.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 453.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 426.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSO SLIM PANEL XTR", "code_information": [{"code": "L0631", "type": "HCPCS"}, {"code": "3100101051", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 375.9, "maximum": 520.89, "gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSO SLIM PANEL XTR", "code_information": [{"code": "L0631", "type": "HCPCS"}, {"code": "3100102895", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 386.4, "maximum": 535.44, "gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 469.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 414.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 535.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 414.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 469.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LU GNOTYP BCAM EXON 3", "code_information": [{"code": "196U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUCENT CAGE 12X27X10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUCENT CAGE 12X27X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUCENT CAGE 12X27X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUCENT CAGE 12X27X8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUM SPINE FUSION ANT", "code_information": [{"code": "22558", "type": "CPT"}, {"code": "3480101500", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2655.1, "maximum": 7959.27, "gross_charge": 3793.0, "discounted_cash": 5689.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3224.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2844.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2655.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3679.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2655.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2844.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3224.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3034.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUM SPINE FUSION POS", "code_information": [{"code": "22612", "type": "CPT"}, {"code": "3480101504", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7959.27, "maximum": 22630.21, "gross_charge": 13155.0, "discounted_cash": 28525.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19663.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19587.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22630.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUM SPINE FUSION POS", "code_information": [{"code": "22630", "type": "CPT"}, {"code": "3480101506", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2653.0, "maximum": 22630.21, "gross_charge": 3790.0, "discounted_cash": 28525.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3221.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19663.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2842.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2653.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3676.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2653.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19587.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2842.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22630.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3221.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3032.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUMBAR PUNCTURE DIAG", "code_information": [{"code": "62270", "type": "CPT"}, {"code": "3430100731", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1020.44, "gross_charge": 1052.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1020.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 841.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUMBAR PUNCTURE DX", "code_information": [{"code": "62270", "type": "CPT"}, {"code": "3340100570", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1267.79, "gross_charge": 1307.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1267.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 914.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 980.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1110.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1045.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUMBAR RETRACTOR T H", "code_information": [{"code": "3100101052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 832.0, "discounted_cash": 1248.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LUMIZYME INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.3, "maximum": 197.3, "discounted_cash": 316.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 197.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFERENTL", "code_information": [{"code": "78598", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFERENTIAL", "code_information": [{"code": "78597", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION IMAGING", "code_information": [{"code": "78580", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT", "code_information": [{"code": "7", "type": "MS-DRG"}], "standard_charges": [{"minimum": 94702.27, "maximum": 94702.27, "discounted_cash": 136949.01, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 94702.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT SINGLE", "code_information": [{"code": "32851", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 19281.41, "maximum": 19281.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19281.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 19281.41, "maximum": 19281.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19281.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILAT&PERFUS IMAGING", "code_information": [{"code": "78582", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUTEINIZINF HORMONE(", "code_information": [{"code": "83002", "type": "CPT"}, {"code": "3440100925", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.52, "maximum": 161.02, "gross_charge": 166.0, "discounted_cash": 29.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LUTETIUM LU 177 DOTATAT THER", "code_information": [{"code": "A9513", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 466.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LUTETIUM LU 177 VIPIVOTIDE", "code_information": [{"code": "A9607", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 369.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LW GNOTYP ICAM4 EXON 1", "code_information": [{"code": "197U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LWR XTR VASC STDY BILAT", "code_information": [{"code": "93924", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA AMP PROBE", "code_information": [{"code": "87476", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA DIR PROBE", "code_information": [{"code": "87475", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE AB", "code_information": [{"code": "86618", "type": "CPT"}, {"code": "3440101095", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 17.03, "maximum": 177.51, "gross_charge": 183.0, "discounted_cash": 27.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPH CHORIOMENINGITIS AB", "code_information": [{"code": "86727", "type": "CPT"}], "standard_charges": [{"minimum": 12.87, "maximum": 30.26, "discounted_cash": 20.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPH SYSTEM IMAGING", "code_information": [{"code": "78195", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARM/LEG", "code_information": [{"code": "75801", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARMS/LEGS", "code_information": [{"code": "75803", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75805", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75807", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE CULTURE MIXED", "code_information": [{"code": "86821", "type": "CPT"}], "standard_charges": [{"minimum": 36.56, "maximum": 88.56, "discounted_cash": 58.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE IMMUNE GLOBULIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 3614.8, "maximum": 3614.8, "discounted_cash": 5769.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3614.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTE TRANSFORMATION", "code_information": [{"code": "86353", "type": "CPT"}], "standard_charges": [{"minimum": 49.03, "maximum": 68.53, "discounted_cash": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86805", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 189.51, "discounted_cash": 304.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 189.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOCYTOTOXICITY ASSAY", "code_information": [{"code": "86806", "type": "CPT"}], "standard_charges": [{"minimum": 47.59, "maximum": 88.56, "discounted_cash": 76.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "821", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11464.19, "maximum": 11464.19, "discounted_cash": 24920.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11464.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "820", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34976.68, "maximum": 34976.68, "discounted_cash": 67508.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34976.68, "methodology": "fee schedule"}], "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": 6152.03, "maximum": 6152.03, "discounted_cash": 13830.66, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6152.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [{"code": "841", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8971.04, "maximum": 8971.04, "discounted_cash": 17567.45, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8971.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [{"code": "840", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13857.74, "maximum": 13857.74, "discounted_cash": 34891.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13857.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [{"code": "824", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12521.71, "maximum": 12521.71, "discounted_cash": 24929.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12521.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [{"code": "823", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25617.06, "maximum": 25617.06, "discounted_cash": 50261.76, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25617.06, "methodology": "fee schedule"}], "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": 7649.15, "maximum": 7649.15, "discounted_cash": 14417.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7649.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [{"code": "842", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5796.65, "maximum": 5796.65, "discounted_cash": 11905.89, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5796.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN INIT DAY", "code_information": [{"code": "32561", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSE CHEST FIBRIN SUBQ DAY", "code_information": [{"code": "32562", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS + LAVAGE W CATHETERS", "code_information": [{"code": "D7871", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS INTRANASAL SYN", "code_information": [{"code": "30560", "type": "CPT"}, {"code": "3480101835", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "gross_charge": 965.0, "discounted_cash": 842.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 820.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 580.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 723.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 675.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 936.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 675.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 578.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 723.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 820.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS OF LABIAL LESION(S)", "code_information": [{"code": "56441", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS/EXCISION PENIL", "code_information": [{"code": "54162", "type": "CPT"}, {"code": "3480102053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYSIS/EXCISION PENIL", "code_information": [{"code": "54162", "type": "CPT"}, {"code": "3480103260", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "LYUMJEV FOR INSULIN PUMP USE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1813", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.68, "maximum": 15.68, "discounted_cash": 25.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Laboratory Pathology Cytology", "code_information": [{"code": "311", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory Pathology Histology", "code_information": [{"code": "312", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Bacteriology And Microbiology", "code_information": [{"code": "306", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Chemistry", "code_information": [{"code": "301", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, General Classification", "code_information": [{"code": "300", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Hematology", "code_information": [{"code": "305", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Immunology", "code_information": [{"code": "302", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Pathology Biopsy", "code_information": [{"code": "314", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Pathology General Classification", "code_information": [{"code": "310", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laboratory, Urology", "code_information": [{"code": "307", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Laryngoscopy with injection", "code_information": [{"code": "C9742", "type": "HCPCS"}], "standard_charges": [{"minimum": 2615.71, "maximum": 2615.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Laser Treatment Of Open Wound, Each Additional 20 Sq Cm", "code_information": [{"code": "492T", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Laser Treatment Of Open Wound, First 20 Sq Cm Or Less", "code_information": [{"code": "491T", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Liver And/Or Bone Marrow Biopsy With Removal Of Spleen And Lymph Nodes", "code_information": [{"code": "49220", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Liver Transplant And/Or Intestinal Transplant, Major", "code_information": [{"code": "1.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 129100.87, "maximum": 129100.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 129100.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Liver Transplant And/Or Intestinal Transplant, Minor", "code_information": [{"code": "1.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 96068.93, "maximum": 96068.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 96068.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Liver Transplant And/Or Intestinal Transplant, Moderate", "code_information": [{"code": "1.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 122018.02, "maximum": 122018.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122018.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Liver Transplant And/Or Intestinal Transplant, Severe", "code_information": [{"code": "1.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 260088.11, "maximum": 260088.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 260088.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Low dose ct lung screening", "code_information": [{"code": "S8032", "type": "HCPCS"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lower Extremity Arterial Procedures, Major", "code_information": [{"code": "181.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38434.75, "maximum": 38434.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38434.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lower Extremity Arterial Procedures, Minor", "code_information": [{"code": "181.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17288.72, "maximum": 17288.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17288.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lower Extremity Arterial Procedures, Moderate", "code_information": [{"code": "181.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30188.3, "maximum": 30188.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30188.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lower Extremity Arterial Procedures, Severe", "code_information": [{"code": "181.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 80494.86, "maximum": 80494.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 80494.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior, Major", "code_information": [{"code": "694.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20231.04, "maximum": 20231.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20231.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior, Minor", "code_information": [{"code": "694.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8284.9, "maximum": 8284.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8284.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior, Moderate", "code_information": [{"code": "694.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11105.48, "maximum": 11105.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11105.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphatic And Other Malignancies And Neoplasms Of Uncertain Behavior, Severe", "code_information": [{"code": "694.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27818.8, "maximum": 27818.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27818.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphoma, Myeloma And Non-Acute Leukemia, Major", "code_information": [{"code": "691.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28826.06, "maximum": 28826.06, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28826.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphoma, Myeloma And Non-Acute Leukemia, Minor", "code_information": [{"code": "691.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19869.66, "maximum": 19869.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19869.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphoma, Myeloma And Non-Acute Leukemia, Moderate", "code_information": [{"code": "691.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28346.78, "maximum": 28346.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28346.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Lymphoma, Myeloma And Non-Acute Leukemia, Severe", "code_information": [{"code": "691.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 82779.77, "maximum": 82779.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82779.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M-PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 680.4, "maximum": 942.84, "gross_charge": 972.0, "discounted_cash": 1458.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 942.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 777.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "M. GENITALIUM AMP PROBE", "code_information": [{"code": "87563", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA AMP PROB", "code_information": [{"code": "87561", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA DIR PROB", "code_information": [{"code": "87560", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 27.29, "discounted_cash": 43.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.AVIUM-INTRA DNA QUANT", "code_information": [{"code": "87562", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA AMP PROBE", "code_information": [{"code": "87581", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA DIR PROBE", "code_information": [{"code": "87580", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.PNEUMON DNA QUANT", "code_information": [{"code": "87582", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 302.62, "discounted_cash": 486.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 302.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA AMP PROBE", "code_information": [{"code": "87556", "type": "CPT"}], "standard_charges": [{"minimum": 41.68, "maximum": 41.83, "discounted_cash": 66.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA DIR PROBE", "code_information": [{"code": "87555", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 26.88, "discounted_cash": 43.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M.TUBERCULO DNA QUANT", "code_information": [{"code": "87557", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS ISHQUANT/SEMIQ", "code_information": [{"code": "88373", "type": "CPT"}], "standard_charges": [{"minimum": 66.56, "maximum": 182.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "M/PHMTRC ALYS SKELETAL MUSC", "code_information": [{"code": "88355", "type": "CPT"}], "standard_charges": [{"minimum": 138.38, "maximum": 182.01, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 138.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAC LX 51-67MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2054.5, "maximum": 2846.95, "gross_charge": 2935.0, "discounted_cash": 4402.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2494.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2846.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2054.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2201.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2494.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2348.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAC PGMT OPT DNS MEAS HFP", "code_information": [{"code": "506T", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MACROSCOPIC EXAM ARTHROPOD", "code_information": [{"code": "87168", "type": "CPT"}], "standard_charges": [{"minimum": 4.27, "maximum": 24.03, "discounted_cash": 6.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MACROSCOPIC EXAM PARASITE", "code_information": [{"code": "87169", "type": "CPT"}], "standard_charges": [{"minimum": 4.31, "maximum": 24.03, "discounted_cash": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAG CTRLD CAPSULE ENDOSCOPY", "code_information": [{"code": "651T", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAGNESIUM", "code_information": [{"code": "83735", "type": "CPT"}, {"code": "3440100949", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.7, "maximum": 60.14, "gross_charge": 62.0, "discounted_cash": 10.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 60.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAGNET PATIENT*1210", "code_information": [{"code": "3100209567", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGNET PUTTY.25-1MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4186.0, "maximum": 5800.6, "gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5800.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4186.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5083.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4784.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNET SOFT PADS*841", "code_information": [{"code": "3100203837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGNET SP 3*95773", "code_information": [{"code": "3100203838", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGNET SP 4*95774", "code_information": [{"code": "3100203839", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAGNETIC SOURCE IMAGING", "code_information": [{"code": "S8035", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAGNETOS MIS KIT 5CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4277.0, "maximum": 5926.7, "gross_charge": 6110.0, "discounted_cash": 9165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5926.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4277.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4582.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5193.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETOS PUTTY 1.5*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1383.9, "maximum": 1917.69, "gross_charge": 1977.0, "discounted_cash": 2965.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1680.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1482.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1383.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1917.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1383.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1482.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1680.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1581.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETOS PUTTY 10cc*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6368.18, "maximum": 8824.47, "gross_charge": 9097.4, "discounted_cash": 13646.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7732.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6823.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6368.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8824.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6368.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6823.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7732.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7277.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETOS PUTTY 1cc*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 942.9, "maximum": 1306.59, "gross_charge": 1347.0, "discounted_cash": 2020.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1144.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1010.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 942.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1306.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 942.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1010.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1144.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1077.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETOS PUTTY 2.5*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209959", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1958.04, "maximum": 2713.28, "gross_charge": 2797.2, "discounted_cash": 4195.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2377.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2097.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1958.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2713.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1958.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2097.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2377.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2237.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETOS PUTTY 5cc *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3274.18, "maximum": 4537.07, "gross_charge": 4677.4, "discounted_cash": 7016.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3975.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3508.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3274.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4537.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3274.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3508.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3975.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3741.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAIN/CLEAN MAX PROSTHESIS", "code_information": [{"code": "D5993", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "654", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13032.64, "maximum": 13032.64, "discounted_cash": 30563.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13032.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "653", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20675.02, "maximum": 20675.02, "discounted_cash": 60440.49, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20675.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "655", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13032.64, "maximum": 13032.64, "discounted_cash": 23532.68, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13032.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [{"code": "164", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13793.8, "maximum": 13793.8, "discounted_cash": 28474.11, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13793.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [{"code": "163", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25059.4, "maximum": 25059.4, "discounted_cash": 52625.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25059.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "165", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9932.03, "maximum": 9932.03, "discounted_cash": 20949.2, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9932.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [{"code": "184", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4460.01, "maximum": 4460.01, "discounted_cash": 11744.01, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4460.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [{"code": "183", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6061.65, "maximum": 6061.65, "discounted_cash": 17578.61, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6061.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR CHEST TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "185", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2624.73, "maximum": 2624.73, "discounted_cash": 8437.07, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2624.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [{"code": "369", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6010.0, "maximum": 6010.0, "discounted_cash": 11033.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6010.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [{"code": "368", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10410.98, "maximum": 10410.98, "discounted_cash": 18443.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10410.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "370", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3232.18, "maximum": 3232.18, "discounted_cash": 8303.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3232.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [{"code": "372", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5227.93, "maximum": 5227.93, "discounted_cash": 11636.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5227.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [{"code": "371", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8778.6, "maximum": 8778.6, "discounted_cash": 19512.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8778.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC", "code_information": [{"code": "373", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4876.86, "maximum": 4876.86, "discounted_cash": 7999.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4876.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [{"code": "141", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9805.99, "maximum": 9805.99, "discounted_cash": 23129.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9805.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [{"code": "140", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19641.49, "maximum": 19641.49, "discounted_cash": 42180.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19641.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "142", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6881.84, "maximum": 6881.84, "discounted_cash": 17249.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6881.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [{"code": "809", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5708.12, "maximum": 5708.12, "discounted_cash": 13446.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5708.12, "methodology": "fee schedule"}], "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": 9789.39, "maximum": 9789.39, "discounted_cash": 24451.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9789.39, "methodology": "fee schedule"}], "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": 4702.87, "maximum": 4702.87, "discounted_cash": 11214.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4702.87, "methodology": "fee schedule"}], "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": 15963.55, "maximum": 15963.55, "discounted_cash": 37175.76, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15963.55, "methodology": "fee schedule"}], "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": 12037.83, "maximum": 12037.83, "discounted_cash": 21008.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12037.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [{"code": "483", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14290.59, "maximum": 14290.59, "discounted_cash": 27735.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14290.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITH CC/MCC", "code_information": [{"code": "707", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9608.63, "maximum": 9608.63, "discounted_cash": 21903.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9608.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "708", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7724.77, "maximum": 7724.77, "discounted_cash": 16283.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7724.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC", "code_information": [{"code": "507", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12436.86, "maximum": 12436.86, "discounted_cash": 23799.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12436.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "508", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8696.21, "maximum": 8696.21, "discounted_cash": 16009.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8696.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "595", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12374.15, "maximum": 12374.15, "discounted_cash": 24282.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12374.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "596", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3471.35, "maximum": 3471.35, "discounted_cash": 11265.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3471.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "330", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12652.05, "maximum": 12652.05, "discounted_cash": 26483.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12652.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "329", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20747.57, "maximum": 20747.57, "discounted_cash": 50428.11, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20747.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "331", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9323.96, "maximum": 9323.96, "discounted_cash": 18667.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9323.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [{"code": "506", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6800.68, "maximum": 6800.68, "discounted_cash": 16329.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6800.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33767", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT & GRAFT", "code_information": [{"code": "33764", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAKO BALL BURR 6MM*1", "code_information": [{"code": "3100205154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 333.2, "discounted_cash": 499.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MAKO RIO DRAPE KIT*1", "code_information": [{"code": "3100205160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.6, "discounted_cash": 315.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MALAR EXTEND STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1003.8, "maximum": 1390.98, "gross_charge": 1434.0, "discounted_cash": 2151.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1218.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1075.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1003.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1390.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1003.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1075.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1218.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1147.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIG TUMOR > 1.25 CM", "code_information": [{"code": "D7441", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIG TUMOR EXC TO 1.25 CM", "code_information": [{"code": "D7440", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [{"code": "436", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8680.84, "maximum": 8680.84, "discounted_cash": 12288.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8680.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [{"code": "435", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8680.84, "maximum": 8680.84, "discounted_cash": 19648.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8680.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC", "code_information": [{"code": "437", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5500.92, "maximum": 5500.92, "discounted_cash": 9278.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5500.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "755", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5386.56, "maximum": 5386.56, "discounted_cash": 12110.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5386.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "754", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8047.56, "maximum": 8047.56, "discounted_cash": 20682.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8047.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "756", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5386.56, "maximum": 5386.56, "discounted_cash": 11049.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5386.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [{"code": "723", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6698.0, "maximum": 6698.0, "discounted_cash": 12440.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6698.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [{"code": "722", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10509.97, "maximum": 10509.97, "discounted_cash": 20931.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10509.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "724", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3993.96, "maximum": 3993.96, "discounted_cash": 9037.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3993.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [{"code": "598", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3827.96, "maximum": 3827.96, "discounted_cash": 13384.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3827.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [{"code": "597", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10065.45, "maximum": 10065.45, "discounted_cash": 17868.89, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10065.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "599", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3827.96, "maximum": 3827.96, "discounted_cash": 6937.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3827.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAMMAPLASTY W/PROSTH", "code_information": [{"code": "19325", "type": "CPT"}, {"code": "3480101405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4656.04, "maximum": 18585.2, "gross_charge": 19160.0, "discounted_cash": 14428.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16286.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9946.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14370.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13412.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18585.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9811.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13412.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9907.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14370.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9619.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11446.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16286.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9619.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15328.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9619.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9811.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAMMOMARK TISSUE MAR", "code_information": [{"code": "A4648", "type": "HCPCS"}, {"code": "3100101053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 139.2, "maximum": 139.2, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAMMOPLASTY REDUCT", "code_information": [{"code": "19318", "type": "CPT"}, {"code": "3480101404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 10986.22, "gross_charge": 11326.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10986.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9060.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAMMOTOME APERTURE S", "code_information": [{"code": "3100101054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 100.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MAMMOTOME PROBE GUID", "code_information": [{"code": "3100101055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MAMMOTOME PROBE ST", "code_information": [{"code": "3100101056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 1225.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MAMMOTOME VACUUM REP", "code_information": [{"code": "3100101057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MAMMOTOME VACUUM SET", "code_information": [{"code": "3100101058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MANDIBLE GRAFT", "code_information": [{"code": "D7950", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR DENTURE PROSTH", "code_information": [{"code": "D5935", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR FLANGE PROSTHESIS", "code_information": [{"code": "D5934", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANDIBULAR PART DENTURE FLEX", "code_information": [{"code": "D5226", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANGANESE", "code_information": [{"code": "83785", "type": "CPT"}, {"code": "3440100950", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.03, "maximum": 162.96, "gross_charge": 168.0, "discounted_cash": 42.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 28.54, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULAT PALM CORD POST INJ", "code_information": [{"code": "26341", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE ELBOW WAN", "code_information": [{"code": "24300", "type": "CPT"}, {"code": "3340102372", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3919.77, "gross_charge": 4041.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3434.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3030.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2828.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3919.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2828.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3030.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3434.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3232.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE FINGER W/ANESTH", "code_information": [{"code": "26340", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATE WRIST W/ANESTHES", "code_information": [{"code": "25259", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF HIP JOINT", "code_information": [{"code": "27275", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF KNEE", "code_information": [{"code": "27570", "type": "CPT"}, {"code": "3480101711", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3527.89, "gross_charge": 3637.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3527.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2909.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANIPULATION OF SPINE", "code_information": [{"code": "22505", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANNITOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2150", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.52, "maximum": 4.52, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANOMETER CVP", "code_information": [{"code": "3100101059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MANUAL CELL COUNT EACH", "code_information": [{"code": "85032", "type": "CPT"}], "standard_charges": [{"minimum": 4.31, "maximum": 20.92, "discounted_cash": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANUAL DIFF WBC COUNT B-COAT", "code_information": [{"code": "85009", "type": "CPT"}], "standard_charges": [{"minimum": 5.07, "maximum": 20.92, "discounted_cash": 8.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 4.31, "maximum": 20.92, "discounted_cash": 6.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY 1/> REGIONS", "code_information": [{"code": "97140", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANUAL THERAPY TECHN", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "3330100426", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 183.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "MAP TACHYCARDIA ADD-ON", "code_information": [{"code": "93609", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION BAR", "code_information": [{"code": "56440", "type": "CPT"}, {"code": "3480103037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION OF", "code_information": [{"code": "47300", "type": "CPT"}, {"code": "3480101989", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1936.9, "maximum": 7611.28, "gross_charge": 2767.0, "discounted_cash": 4150.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2351.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2075.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1936.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2683.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1936.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2075.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2351.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2213.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASK COMFORTGEL", "code_information": [{"code": "3100101060", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 483.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK COMFORTGEL", "code_information": [{"code": "3100102896", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 370.0, "discounted_cash": 555.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK IMAGE3", "code_information": [{"code": "3100102196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 132.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 OXYMASK", "code_information": [{"code": "3100101061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK POMELITE*SH1969", "code_information": [{"code": "3100203915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK POMEZ-LITE*SH19", "code_information": [{"code": "3100203914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.32, "discounted_cash": 58.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK SCOPE ACCESS AD", "code_information": [{"code": "3100203913", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK VERASEAL2 M*CPA", "code_information": [{"code": "3100203835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 178.36, "discounted_cash": 267.54, "setting": "both", "billing_class": "facility"}]}, {"description": "MASS SPECT & MS/MS A", "code_information": [{"code": "83789", "type": "CPT"}, {"code": "3440100951", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 24.11, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 38.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASSAGE THERAPY", "code_information": [{"code": "97124", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAST RAD W/PECTORAL", "code_information": [{"code": "19305", "type": "CPT"}, {"code": "3480101401", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1938.3, "maximum": 7541.42, "gross_charge": 2769.0, "discounted_cash": 4153.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2353.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2076.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1938.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2685.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1938.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2076.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2353.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2215.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTCTMY MOD RADICAL", "code_information": [{"code": "19307", "type": "CPT"}, {"code": "3480101402", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6654.38, "maximum": 10986.22, "gross_charge": 11326.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10986.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9060.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY", "code_information": [{"code": "19300", "type": "CPT"}, {"code": "3480101396", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6324.4, "gross_charge": 6520.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6324.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "582", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9616.62, "maximum": 9616.62, "discounted_cash": 18612.45, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9616.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "583", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9552.68, "maximum": 9552.68, "discounted_cash": 16991.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9552.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY PARTIAL", "code_information": [{"code": "19301", "type": "CPT"}, {"code": "3480101397", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6324.4, "gross_charge": 6520.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6324.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY PARTIAL W", "code_information": [{"code": "19302", "type": "CPT"}, {"code": "3480101398", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4656.04, "maximum": 10986.22, "gross_charge": 11326.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10986.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9060.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY SIMPLE CO", "code_information": [{"code": "19303", "type": "CPT"}, {"code": "3480101399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY SUBCUTAN", "code_information": [{"code": "19304", "type": "CPT"}, {"code": "3480101400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 12909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT BLOCK 10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1554.0, "maximum": 2153.4, "gross_charge": 2220.0, "discounted_cash": 3330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1665.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2153.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1665.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT BLOCK 20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT BLOCK 5M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT PUTTY .7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 310.8, "maximum": 430.68, "gross_charge": 444.0, "discounted_cash": 666.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 377.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 333.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 310.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 430.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 310.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 333.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 377.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 355.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT PUTTY 1.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 348.6, "maximum": 483.06, "gross_charge": 498.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 483.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 398.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT PUTTY 3C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 773.89, "maximum": 1072.39, "gross_charge": 1105.56, "discounted_cash": 1658.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 939.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 829.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 773.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1072.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 773.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 829.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 939.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 884.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT PUTTY 6C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1467.9, "maximum": 2034.09, "gross_charge": 2097.0, "discounted_cash": 3145.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1782.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1572.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1467.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2034.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1467.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1572.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1782.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1677.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT PUTTY 9C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1856.4, "maximum": 2572.44, "gross_charge": 2652.0, "discounted_cash": 3978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2572.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1989.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERGRAFT STRIP 24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTERS TWO STEP", "code_information": [{"code": "S3904", "type": "HCPCS"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69601", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69602", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69603", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOID SURGERY REVISION", "code_information": [{"code": "69604", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69501", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOIDECTOMY", "code_information": [{"code": "69502", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASTOPEXY", "code_information": [{"code": "19316", "type": "CPT"}, {"code": "3480101403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 10018.16, "gross_charge": 10328.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8778.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7746.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7229.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10018.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7229.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7746.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8778.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8262.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MATRION 1 SQ CM", "code_information": [{"code": "Q4201", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.22, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 104.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MATRISTEM MICROMATRI", "code_information": [{"code": "Q4118", "type": "HCPCS"}, {"code": "3100104707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2.56, "maximum": 1725.27, "gross_charge": 993.0, "discounted_cash": 1489.5, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MATRIX INDUCED CHOND", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7330", "type": "HCPCS"}, {"code": "3400300808", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 325.04, "maximum": 70721.73, "gross_charge": 72909.0, "discounted_cash": 109363.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 61972.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 54681.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51036.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 70721.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51036.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 54681.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 61972.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 58327.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 325.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MATRL FOR VOCAL CORD", "code_information": [{"code": "C1878", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAX MRI CAPTURE & INTERPRETE", "code_information": [{"code": "D0369", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAX MRI IMAGE CAPTURE", "code_information": [{"code": "D0385", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAX ULTRASOUND CAPT & INTERP", "code_information": [{"code": "D0370", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAX ULTRASOUND IMAGE CAPTURE", "code_information": [{"code": "D0386", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLA OPEN REDUCT COMPOUND", "code_information": [{"code": "D7710", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLA OPEN REDUCT SIMPLE", "code_information": [{"code": "D7610", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLA OR MANDIBLE RESECTIO", "code_information": [{"code": "D7490", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLARY PART DENTURE FLEX", "code_information": [{"code": "D5225", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLARY SINUSOTOMY", "code_information": [{"code": "D7560", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL FIXATION", "code_information": [{"code": "21100", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2895.17, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXILLOFACIAL PROSTHESIS", "code_information": [{"code": "D5999", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAXITROL OPTH OINTME", "code_information": [{"code": "3400300223", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.5, "discounted_cash": 20.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MAXTRIX STRIP 8X1C10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2254.54, "maximum": 3124.15, "gross_charge": 3220.78, "discounted_cash": 4831.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2737.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2415.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2254.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3124.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2254.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2415.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2737.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2576.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAXTRIX STRIP 8X1C20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4131.85, "maximum": 5725.57, "gross_charge": 5902.65, "discounted_cash": 8853.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5017.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4426.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4131.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5725.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4131.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4426.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5017.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4722.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAZOR SCAN&PLAN DISP", "code_information": [{"code": "3100204677", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MAZOR X SPINE DISP K", "code_information": [{"code": "3100204324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MCCD, HOME MONITORING", "code_information": [{"code": "G9006", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, INITIAL RATE", "code_information": [{"code": "G9001", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ HI, INITIAL", "code_information": [{"code": "G9003", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ LO, INITIAL", "code_information": [{"code": "G9004", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 3", "code_information": [{"code": "G9009", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 4", "code_information": [{"code": "G9010", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, LEVEL 5", "code_information": [{"code": "G9011", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, RISK ADJ, MAINTENANCE", "code_information": [{"code": "G9005", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD, SCH TEAM CONF", "code_information": [{"code": "G9007", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD,MAINTENANCE RATE", "code_information": [{"code": "G9002", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCCD,PHYS COOR-CARE OVRSGHT", "code_information": [{"code": "G9008", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCHNL FRAGILITY RBC PRFLG", "code_information": [{"code": "123U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 574.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCOLN1 GENE", "code_information": [{"code": "81290", "type": "CPT"}], "standard_charges": [{"minimum": 39.31, "maximum": 79.66, "discounted_cash": 63.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP DISP PACK*MCP-DI", "code_information": [{"code": "3100205091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 708.0, "discounted_cash": 1062.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY DX", "code_information": [{"code": "29900", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29901", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MCP JOINT ARTHROSCOPY SURG", "code_information": [{"code": "29902", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MD CERTIFICATION HHA PATIENT", "code_information": [{"code": "G0180", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MD HOME VISIT OUTSIDE CAP", "code_information": [{"code": "S0273", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MD RECERTIFICATION HHA PT", "code_information": [{"code": "G0179", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MD/OTH EVAL ACUT KID NO ESRD", "code_information": [{"code": "G0492", "type": "HCPCS"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEAS LUNG VOL THRU 2 YRS", "code_information": [{"code": "94013", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEASURING KIT FEMALE", "code_information": [{"code": "3100204750", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEASURING KIT MALE*M", "code_information": [{"code": "3100204627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEATAL DILATOR*SW001", "code_information": [{"code": "3100203471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEATOTOMY, CUTTING O", "code_information": [{"code": "53020", "type": "CPT"}, {"code": "3480102039", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5228.3, "gross_charge": 5390.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4581.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4042.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3773.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5228.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3773.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4042.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4581.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4312.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEATOTOMY, CUTTING O", "code_information": [{"code": "53020", "type": "CPT"}, {"code": "3480103252", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6666.81, "gross_charge": 6873.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5842.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5154.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4811.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6666.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4811.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5154.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5842.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5498.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECASERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2170", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.69, "maximum": 81.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 81.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH CHESTW OSCIL /", "code_information": [{"code": "94669", "type": "CPT"}, {"code": "3310100285", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 123.2, "maximum": 259.0, "gross_charge": 176.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 170.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1376.83, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1376.83, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECHANICAL TRACTION THERAPY", "code_information": [{"code": "97012", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECHLORETHAMINE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9230", "type": "HCPCS"}], "standard_charges": [{"minimum": 319.04, "maximum": 319.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 319.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECKELS DIVERT EXAM", "code_information": [{"code": "78290", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECP2 FULL GENE ANALYSIS", "code_information": [{"code": "234U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 848.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE DUP/DELET VARIANT", "code_information": [{"code": "81304", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 150.0, "discounted_cash": 240.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE FULL SEQ", "code_information": [{"code": "81302", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 527.87, "discounted_cash": 848.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 527.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MECP2 GENE KNOWN VARIANT", "code_information": [{"code": "81303", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 120.0, "discounted_cash": 192.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ABORTION INC ALL EX DRUG", "code_information": [{"code": "S0199", "type": "HCPCS"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ADMIN, NOT ORAL/INJECT", "code_information": [{"code": "T1503", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX BUPRE ORAL", "code_information": [{"code": "G2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX IMPLANT", "code_information": [{"code": "G2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 257.21, "maximum": 257.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 257.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX INJECT", "code_information": [{"code": "G2069", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX METH WK", "code_information": [{"code": "G2067", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED ASSIST TX NO DRUG", "code_information": [{"code": "G2074", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED FOOD NON INBORN ERR META", "code_information": [{"code": "S9432", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED NUTRITION INDIV SUBSEQ", "code_information": [{"code": "97803", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED PHYSIC DOS EVAL RAD EXPS", "code_information": [{"code": "76145", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED SERV 10PM-8AM 24 HR FAC", "code_information": [{"code": "99053", "type": "CPT"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED SERV EVE/WKEND/HOLIDAY", "code_information": [{"code": "99051", "type": "CPT"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED TRNG & SUPPORT PER 15MIN", "code_information": [{"code": "H0034", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED TX INSERT/REMOVE IMP", "code_information": [{"code": "G2072", "type": "HCPCS"}], "standard_charges": [{"minimum": 257.21, "maximum": 257.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 257.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED TX MEDS NOS", "code_information": [{"code": "G2075", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED TX NALTREXONE", "code_information": [{"code": "G2073", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MED TX REMOVE IMPLANT", "code_information": [{"code": "G2071", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDIAL MENISCUS GRAF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8645.0, "maximum": 11979.5, "gross_charge": 12350.0, "discounted_cash": 18525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11979.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDIAL MENISCUS GRAF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/LMPH NOD BX", "code_information": [{"code": "39402", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDIASTINOSCPY W/MEDSTNL BX", "code_information": [{"code": "39401", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL ADHESIVE*DB-", "code_information": [{"code": "3100208810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [{"code": "551", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8364.82, "maximum": 8364.82, "discounted_cash": 19000.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8364.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [{"code": "552", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3866.69, "maximum": 3866.69, "discounted_cash": 10788.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3866.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDICAL CONFERENCE BY PHYSIC", "code_information": [{"code": "S0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL CONFERENCE, 60 MIN", "code_information": [{"code": "S0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL FOOD ORAL 100% NUTR", "code_information": [{"code": "S9433", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL FOODS FOR INBORN ERR", "code_information": [{"code": "S9435", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME, INITIAL PLAN", "code_information": [{"code": "S0280", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL HOME, MAINTENANCE", "code_information": [{"code": "S0281", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION GROUP", "code_information": [{"code": "97804", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL NUTRITION INDIV IN", "code_information": [{"code": "97802", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL SERVICES AFTER HRS", "code_information": [{"code": "99050", "type": "CPT"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICAL SUPPLIES AND EQUIPME", "code_information": [{"code": "S9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDICATION ADMIN VISIT", "code_information": [{"code": "T1502", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDIENT TURBINATE", "code_information": [{"code": "3100103977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MEDISKIN", "code_information": [{"code": "Q4135", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEDPOR MICRO STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.1, "maximum": 1312.41, "gross_charge": 1353.0, "discounted_cash": 2029.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1014.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1312.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1014.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1082.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDPOR MICRO STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1274.7, "maximum": 1766.37, "gross_charge": 1821.0, "discounted_cash": 2731.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1547.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1365.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1274.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1766.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1274.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1365.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1547.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1456.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDPOR UTRATHIN*8438", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 928.15, "maximum": 1286.16, "gross_charge": 1325.94, "discounted_cash": 1988.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1127.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 994.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 928.15, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1286.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 928.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 994.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1127.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1060.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDPOR UTRATHIN*8438", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207684", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEDROXYPROGESTERONE ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1050", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.15, "maximum": 0.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEG EVOKED EACH ADDL", "code_information": [{"code": "95967", "type": "CPT"}], "standard_charges": [{"minimum": 486.39, "maximum": 486.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 486.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEG EVOKED SINGLE", "code_information": [{"code": "95966", "type": "CPT"}], "standard_charges": [{"minimum": 486.39, "maximum": 486.39, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 486.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEIER WIRE 260CM*M00", "code_information": [{"code": "3100205151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.6, "discounted_cash": 306.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MELPHALAN ORAL 2 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8600", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.35, "maximum": 10.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEMBRANE COLLAGEN PA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100101065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 698.6, "maximum": 1725.27, "gross_charge": 998.0, "discounted_cash": 1497.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 848.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 748.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 698.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 968.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 698.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 748.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 848.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 798.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEMBRANE DURA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 631.4, "maximum": 1725.27, "gross_charge": 902.0, "discounted_cash": 1353.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 766.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 631.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 874.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 631.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 766.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 721.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEMBRANE GRAFT OR WRAP SQ CM", "code_information": [{"code": "Q4205", "type": "HCPCS"}], "standard_charges": [{"minimum": 1248.21, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1248.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEMODERM/DERMA/TRANZ/INTEGUP", "code_information": [{"code": "Q4126", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.11, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 89.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENACWY-TT VACCINE IM", "code_information": [{"code": "90619", "type": "CPT"}], "standard_charges": [{"minimum": 153.55, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 153.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENACWYD/MENACWYCRM VACC IM", "code_information": [{"code": "90734", "type": "CPT"}], "standard_charges": [{"minimum": 137.99, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENB-4C VACC 2 DOSE IM", "code_information": [{"code": "90620", "type": "CPT"}], "standard_charges": [{"minimum": 190.62, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 190.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENB-FHBP VACC 2/3 DOSE IM", "code_information": [{"code": "90621", "type": "CPT"}], "standard_charges": [{"minimum": 190.62, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 190.62, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENISCAL BEARING INS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2816.8, "maximum": 3903.28, "gross_charge": 4024.0, "discounted_cash": 6036.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3420.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3018.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2816.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3903.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2816.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3018.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3420.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL CINCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL CINCH*AR-45", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 829.5, "maximum": 1149.45, "gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1149.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 829.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 888.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1007.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL ROOT KT*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENISCAL STITCHER", "code_information": [{"code": "3100101068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1032.0, "discounted_cash": 1548.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MENISCAL TRNSPL KNEE W/SCPE", "code_information": [{"code": "29868", "type": "CPT"}], "standard_charges": [{"minimum": 7500.92, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC", "code_information": [{"code": "760", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4113.24, "maximum": 4113.24, "discounted_cash": 11113.22, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4113.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "761", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2370.8, "maximum": 2370.8, "discounted_cash": 6761.27, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2370.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MENTAL HEALTH SERVICE, NOS", "code_information": [{"code": "H0046", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE HYDROCHL /100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2175", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.9, "maximum": 6.9, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPERIDINE/PROMETHAZINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2180", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.52, "maximum": 19.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEPIVACAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0670", "type": "HCPCS"}, {"code": "3400300277", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 3.56, "maximum": 24.92, "gross_charge": 25.7, "discounted_cash": 38.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MERIT DRAINAGE DEPOT", "code_information": [{"code": "3100206338", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.4, "discounted_cash": 53.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MEROPENEM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2185", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.39, "maximum": 0.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH 3D MAX LARGE R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH 3D MAX LT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH 3D MAX LT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.8, "maximum": 925.38, "gross_charge": 954.0, "discounted_cash": 1431.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 810.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 925.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 715.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 810.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 763.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH C-QUR V-PATCH", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH DIAMOND EXTEND", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 427.7, "maximum": 592.67, "gross_charge": 611.0, "discounted_cash": 916.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 519.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 458.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 427.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 592.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 427.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 458.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 519.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 488.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 68.6, "maximum": 95.06, "gross_charge": 98.0, "discounted_cash": 147.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 95.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 68.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 508.9, "maximum": 705.19, "gross_charge": 727.0, "discounted_cash": 1090.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 617.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 545.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 508.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 705.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 508.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 545.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 617.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 581.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA COMPOSIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3196.2, "maximum": 4429.02, "gross_charge": 4566.0, "discounted_cash": 6849.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3881.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3424.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3196.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4429.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3196.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3424.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3881.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3652.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA MARLEX M", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 499.8, "maximum": 692.58, "gross_charge": 714.0, "discounted_cash": 1071.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 692.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PATCH VE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1451.1, "maximum": 2010.81, "gross_charge": 2073.0, "discounted_cash": 3109.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1762.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1554.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1451.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2010.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1451.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1554.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1762.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1658.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PATCH VE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1896.88, "maximum": 2628.54, "gross_charge": 2709.84, "discounted_cash": 4064.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2303.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2032.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1896.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2628.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1896.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2032.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2303.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2167.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PATCH VE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1194.9, "maximum": 1655.79, "gross_charge": 1707.0, "discounted_cash": 2560.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1450.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1280.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1194.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1655.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1194.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1280.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1450.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1365.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PHYSIO C", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2487.8, "maximum": 3447.38, "gross_charge": 3554.0, "discounted_cash": 5331.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3020.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2665.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2487.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3447.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2487.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2665.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3020.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2843.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PHYSIO C", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1842.4, "maximum": 2553.04, "gross_charge": 2632.0, "discounted_cash": 3948.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2237.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1974.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1842.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2553.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1842.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1974.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2237.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2105.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PHYSIO C", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3039.4, "maximum": 4211.74, "gross_charge": 4342.0, "discounted_cash": 6513.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3690.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3256.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3039.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4211.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3039.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3256.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3690.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3473.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PHYSIO C", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA PROLENE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 509.6, "maximum": 706.16, "gross_charge": 728.0, "discounted_cash": 1092.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 509.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 706.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 509.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 546.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 582.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 329.7, "maximum": 456.87, "gross_charge": 471.0, "discounted_cash": 706.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 400.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 353.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 329.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 456.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 329.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 353.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 400.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 376.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 181.3, "maximum": 251.23, "gross_charge": 259.0, "discounted_cash": 388.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 220.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 194.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 181.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 251.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 181.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 194.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 220.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA ULTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 329.72, "maximum": 456.9, "gross_charge": 471.04, "discounted_cash": 706.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 400.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 353.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 456.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 329.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 353.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 400.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 376.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA UNTRAPRO", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.5, "maximum": 198.85, "gross_charge": 205.0, "discounted_cash": 307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 198.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH HERNIA VENTRAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH LPM OSTEOMED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100103825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH LPM OSTEOMED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100103826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8736.0, "maximum": 12105.6, "gross_charge": 12480.0, "discounted_cash": 18720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10608.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12105.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10608.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9984.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH LPM OSTEOMED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100103827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6661.2, "maximum": 9230.52, "gross_charge": 9516.0, "discounted_cash": 14274.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8088.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7137.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6661.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9230.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6661.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7137.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8088.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7612.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH LPM OSTEOMED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100103828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH ORBIT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1717.1, "maximum": 2379.41, "gross_charge": 2453.0, "discounted_cash": 3679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2085.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1839.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1717.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2379.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1717.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1839.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2085.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1962.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH ORBITAL 0.3MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH ORBITAL RT*25-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2800.98, "maximum": 3881.35, "gross_charge": 4001.4, "discounted_cash": 6002.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3401.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3001.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2800.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3881.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2800.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3001.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3401.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3201.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH OSTEOMED", "code_information": [{"code": "3100103841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1926.0, "discounted_cash": 2889.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH OSTEOMED", "code_information": [{"code": "3100103842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2696.0, "discounted_cash": 4044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MESH PARIETEX*TET303", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.63, "maximum": 581.49, "gross_charge": 599.48, "discounted_cash": 899.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 509.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 449.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 419.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 581.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 419.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 449.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 509.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 479.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PELVISOFT TISSU", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1896.3, "maximum": 2627.73, "gross_charge": 2709.0, "discounted_cash": 4063.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2302.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2031.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2627.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2031.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2302.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2167.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PERMACOL / SQ C", "code_information": [{"code": "C9364", "type": "HCPCS"}, {"code": "3100101080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 25608.0, "gross_charge": 26400.0, "discounted_cash": 39600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22440.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18480.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25608.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18480.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22440.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21120.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MESH PHASIX 15CM*121", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7170.25, "maximum": 9935.92, "gross_charge": 10243.22, "discounted_cash": 15364.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8706.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7682.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7170.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9935.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7170.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7682.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8706.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8194.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PLUG PERFIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 585.9, "maximum": 811.89, "gross_charge": 837.0, "discounted_cash": 1255.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 811.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 669.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PLUG PERFIX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 690.9, "maximum": 957.39, "gross_charge": 987.0, "discounted_cash": 1480.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 957.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROCEED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2121.7, "maximum": 2940.07, "gross_charge": 3031.0, "discounted_cash": 4546.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2576.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2273.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2121.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2940.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2121.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2273.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2576.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2424.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROCEED", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.9, "maximum": 2160.19, "gross_charge": 2227.0, "discounted_cash": 3340.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1670.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2160.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1670.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1781.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROCEED SM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 827.4, "maximum": 1146.54, "gross_charge": 1182.0, "discounted_cash": 1773.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1004.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 886.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 827.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1146.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 827.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 886.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1004.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 945.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROCEED SM", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100103763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 861.7, "maximum": 1194.07, "gross_charge": 1231.0, "discounted_cash": 1846.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1046.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 923.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 861.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1194.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 861.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 923.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1046.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 984.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROLENE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 117.6, "maximum": 162.96, "gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROLENE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30.1, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 64.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROLENE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 246.4, "maximum": 341.44, "gross_charge": 352.0, "discounted_cash": 528.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 299.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 246.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 341.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 246.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 299.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 281.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROLENE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 159.43, "maximum": 220.92, "gross_charge": 227.76, "discounted_cash": 341.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 193.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 159.43, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 159.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 193.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 182.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH PROLITE", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 95.9, "maximum": 132.89, "gross_charge": 137.0, "discounted_cash": 205.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 132.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 95.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH RESTORELLE 24X4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1803.2, "maximum": 2498.72, "gross_charge": 2576.0, "discounted_cash": 3864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1803.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2498.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1803.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2060.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH STRYKER DYNAMIC", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2998.1, "maximum": 4154.51, "gross_charge": 4283.0, "discounted_cash": 6424.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3640.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3212.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2998.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4154.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2998.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3212.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3640.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3426.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH STRYKER DYNAMIC", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4852.4, "maximum": 6724.04, "gross_charge": 6932.0, "discounted_cash": 10398.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5892.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4852.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6724.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4852.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5199.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5892.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5545.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH STRYKER DYNAMIC", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100102909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2856.7, "maximum": 3958.57, "gross_charge": 4081.0, "discounted_cash": 6121.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3468.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3060.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3060.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3468.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3264.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH V-PATCH", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100101087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 609.0, "maximum": 843.9, "gross_charge": 870.0, "discounted_cash": 1305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRAL", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2311.4, "maximum": 3202.94, "gross_charge": 3302.0, "discounted_cash": 4953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2806.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2311.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3202.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2311.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2806.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2641.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRALEX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1323.84, "maximum": 1834.46, "gross_charge": 1891.2, "discounted_cash": 2836.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1607.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1418.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1323.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1834.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1323.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1418.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1607.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1512.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRALEX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 795.9, "maximum": 1102.89, "gross_charge": 1137.0, "discounted_cash": 1705.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 966.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 852.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 795.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1102.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 795.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 852.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 966.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 909.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRALEX", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 665.7, "maximum": 922.47, "gross_charge": 951.0, "discounted_cash": 1426.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 808.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 713.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 665.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 922.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 665.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 713.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 808.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 760.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRALIGH", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1813.0, "maximum": 2512.3, "gross_charge": 2590.0, "discounted_cash": 3885.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1942.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1813.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2512.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1813.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1942.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRALIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3039.4, "maximum": 4211.74, "gross_charge": 4342.0, "discounted_cash": 6513.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3690.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3256.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3039.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4211.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3039.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3256.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3690.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3473.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESH VENTRALIGHT", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "3100104010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4823.0, "maximum": 6683.3, "gross_charge": 6890.0, "discounted_cash": 10335.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5856.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5167.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4823.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6683.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4823.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5167.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5856.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5512.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESHED WOUND MATRIX*", "code_information": [{"code": "3100207111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8347.95, "discounted_cash": 12521.93, "setting": "both", "billing_class": "facility"}]}, {"description": "MESHED WOUND MATRIX*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8784.02, "maximum": 12172.14, "gross_charge": 12548.6, "discounted_cash": 18822.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10666.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9411.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8784.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12172.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8784.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9411.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10666.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10038.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESHED WOUND MATRIX*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2509.96, "maximum": 3478.09, "gross_charge": 3585.66, "discounted_cash": 5378.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3047.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2689.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2509.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3478.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2509.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2689.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3047.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2868.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESHED WOUND MATRIX*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209577", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3137.46, "maximum": 4347.62, "gross_charge": 4482.09, "discounted_cash": 6723.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3809.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3361.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3137.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4347.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3137.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3361.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3809.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3585.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MESNA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9209", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.76, "maximum": 1.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPAL 30X6.0*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPAL 30X7.0*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPAL 5.0*120-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPAL IMP 30*MC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPAL REAMER*12", "code_information": [{"code": "3100209209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 891.0, "discounted_cash": 1336.5, "setting": "both", "billing_class": "facility"}]}, {"description": "METACARPOPHALANG MD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPOPHALANG XL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPOPHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2735.46, "maximum": 3790.56, "gross_charge": 3907.8, "discounted_cash": 5861.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3790.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3126.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METACARPOPHALANGEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2735.46, "maximum": 3790.56, "gross_charge": 3907.8, "discounted_cash": 5861.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3790.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3126.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METANEPHRINES", "code_information": [{"code": "83835", "type": "CPT"}, {"code": "3440100952", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.94, "maximum": 136.77, "gross_charge": 141.0, "discounted_cash": 27.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 136.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7667", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7670", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL NON-COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7668", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METAPROTERENOL NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7669", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METERED DOSE INHALER DRUG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3535", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.44, "maximum": 34.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHACHOLINE CHLORIDE, NEB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7674", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.12, "maximum": 1.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHADONE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1230", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.61, "maximum": 20.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHOCARBAMOL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2800", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.17, "maximum": 6.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHOTREXATE ORAL 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8610", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.24, "maximum": 0.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHOTREXATE SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9260", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.57, "maximum": 2.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYL AMINOLEVULINATE, TOP", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7309", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLDOPATE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0210", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.64, "maximum": 40.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLENE BLUE", "code_information": [{"code": "Q9968", "type": "HCPCS"}, {"code": "3400300214", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 6.72, "maximum": 16.29, "gross_charge": 16.8, "discounted_cash": 12.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11.76, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12.6, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14.28, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLENE BLUE", "code_information": [{"code": "Q9968", "type": "HCPCS"}, {"code": "3400300215", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 8.51, "maximum": 23.95, "gross_charge": 24.7, "discounted_cash": 12.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.99, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLENEDIOXYAMPHETAMINES", "code_information": [{"code": "80359", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "METHYLERGONOVIN MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2210", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.87, "maximum": 20.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLNALTREXONE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2212", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "discounted_cash": 1.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPHENIDATE", "code_information": [{"code": "80360", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE 40 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1030", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE A", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1010", "type": "HCPCS"}, {"code": "3400300013", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.13, "maximum": 0.13, "gross_charge": 22.36, "discounted_cash": 33.54, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METHYLPREDNISOLONE ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METOCLOPRAMIDE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2765", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.04, "maximum": 1.04, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "METYRAPONE PANEL", "code_information": [{"code": "80436", "type": "CPT"}], "standard_charges": [{"minimum": 68.09, "maximum": 91.16, "discounted_cash": 146.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 91.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MGMT GENE PRMTR MTHYLTN ALYS", "code_information": [{"code": "81287", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 124.64, "discounted_cash": 200.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 124.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MH HEALTH ASSESS BY NON-MD", "code_information": [{"code": "H0031", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MH PARTIAL HOSP TX UNDER 24H", "code_information": [{"code": "H0035", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MH SVC PLAN DEV BY NON-MD", "code_information": [{"code": "H0032", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICAFUNGIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2248", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.7, "maximum": 0.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICRO EXAM, PREP & REPORT", "code_information": [{"code": "D0473", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICRO KERRISON", "code_information": [{"code": "3100101088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2370.0, "discounted_cash": 3555.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRO W EXAM OF SURG MARGINS", "code_information": [{"code": "D0474", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MACROBROTH", "code_information": [{"code": "87188", "type": "CPT"}], "standard_charges": [{"minimum": 6.64, "maximum": 24.03, "discounted_cash": 10.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPT MYCOBACTERI", "code_information": [{"code": "87190", "type": "CPT"}], "standard_charges": [{"minimum": 7.31, "maximum": 24.03, "discounted_cash": 11.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROBE SUSCEPTIBLE MLC", "code_information": [{"code": "87187", "type": "CPT"}], "standard_charges": [{"minimum": 40.17, "maximum": 41.83, "discounted_cash": 64.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROCUVETTE HEM HB", "code_information": [{"code": "3100102197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRODEBRIDER ENT", "code_information": [{"code": "3100101089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19938.0, "discounted_cash": 29907.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MICRODISSECTION LASER", "code_information": [{"code": "88380", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 210.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 210.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICRODISSECTION MANUAL", "code_information": [{"code": "88381", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 210.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 210.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROFLUID ANALY TEARS", "code_information": [{"code": "83861", "type": "CPT"}], "standard_charges": [{"minimum": 22.48, "maximum": 40.05, "discounted_cash": 36.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROINTRODUCER KIT*", "code_information": [{"code": "3100209682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROPHONE WIRLESS", "code_information": [{"code": "3100102393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROSATELLITE INSTABILITY", "code_information": [{"code": "81301", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 348.56, "discounted_cash": 559.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 348.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROSOMAL ANTIBODIE", "code_information": [{"code": "86376", "type": "CPT"}, {"code": "3440101086", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.55, "maximum": 152.29, "gross_charge": 157.0, "discounted_cash": 23.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 152.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 133.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 125.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROSURG EPI SPERM ASP", "code_information": [{"code": "S4028", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROSURGICAL BACKGR", "code_information": [{"code": "3100103883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MICROSURGICAL TECHNI", "code_information": [{"code": "69990", "type": "CPT"}, {"code": "3480102236", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 359.8, "maximum": 498.58, "gross_charge": 514.0, "discounted_cash": 771.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 436.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 385.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 359.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 498.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 359.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 385.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 436.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 411.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MICROVOLT T-WAVE ASSESS", "code_information": [{"code": "93025", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICROWAVE BRONCH, 3D, EBUS", "code_information": [{"code": "C9751", "type": "HCPCS"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "discounted_cash": 6025.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MICS IRRIGATION CLIP", "code_information": [{"code": "3100205153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDAS LEGEND BURR*15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 381.02, "maximum": 527.99, "gross_charge": 544.32, "discounted_cash": 816.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 462.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 408.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 381.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 527.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 381.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 408.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 462.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 435.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIDDLE CEREBRAL ARTERY ECHO", "code_information": [{"code": "76821", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MIDDLE EAR SURGERY P", "code_information": [{"code": "69799", "type": "CPT"}, {"code": "3340102360", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 205.8, "maximum": 1869.0, "gross_charge": 294.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 285.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MIDLINE INDICATOR MA", "code_information": [{"code": "3100101090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 895.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MIDLINE IV CATH 20G*", "code_information": [{"code": "3100207175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.2, "discounted_cash": 685.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MINERAL OIL", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300272", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 18.9, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "MINI HUMERAL TRAY*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2866.5, "maximum": 3972.15, "gross_charge": 4095.0, "discounted_cash": 6142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3972.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2866.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3071.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3480.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINI STICK ENVI*35-5", "code_information": [{"code": "3100206424", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2205", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2206", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2207", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2208", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINIMALLY INVASIVE DIRECT CO", "code_information": [{"code": "S2209", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MINIPLATE 12X20*4684", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8623.16, "maximum": 11949.23, "gross_charge": 12318.8, "discounted_cash": 18478.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10470.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9239.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8623.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11949.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8623.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9239.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10470.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9855.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOCYCLINE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2265", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.28, "maximum": 1.28, "discounted_cash": 3.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [{"code": "663", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5753.0, "maximum": 5753.0, "discounted_cash": 16289.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5753.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [{"code": "662", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18018.33, "maximum": 18018.33, "discounted_cash": 33456.86, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18018.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR BLADDER PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "664", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5753.0, "maximum": 5753.0, "discounted_cash": 11852.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5753.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [{"code": "606", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9292.6, "maximum": 9292.6, "discounted_cash": 17704.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9292.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [{"code": "607", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3252.47, "maximum": 3252.47, "discounted_cash": 9975.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3252.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [{"code": "345", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7539.71, "maximum": 7539.71, "discounted_cash": 17200.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7539.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [{"code": "344", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17225.19, "maximum": 17225.19, "discounted_cash": 30595.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17225.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "346", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6391.2, "maximum": 6391.2, "discounted_cash": 14377.73, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6391.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MINOR SURGERY 1ST 30", "code_information": [{"code": "3480103069", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 772.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MINOR SURGERY EA ADD", "code_information": [{"code": "3480103074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 387.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MIRENA IUD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7298", "type": "HCPCS"}, {"code": "3100103862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1098.38, "maximum": 1098.38, "gross_charge": 2728.02, "discounted_cash": 4092.03, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1098.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIRO3D PER CUBIC CM", "code_information": [{"code": "A2025", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MIRODERM", "code_information": [{"code": "Q4175", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.51, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MIRROR FRONT SURFACE", "code_information": [{"code": "3100104720", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 348.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MIRROR LARNGOSCOPE", "code_information": [{"code": "3100101091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MIS POLY HEAD*MM1-00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1471.96, "maximum": 2039.71, "gross_charge": 2102.8, "discounted_cash": 3154.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1787.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1577.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1471.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2039.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1471.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1577.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1787.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1682.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MISC DML REF LAB", "code_information": [{"code": "86335", "type": "CPT"}, {"code": "3440103079", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 29.35, "maximum": 203.7, "gross_charge": 210.0, "discounted_cash": 47.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 178.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 203.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 178.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 31.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISC DML REF LAB QUA", "code_information": [{"code": "87799", "type": "CPT"}, {"code": "3440103052", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 41.83, "maximum": 348.23, "gross_charge": 359.0, "discounted_cash": 68.82, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 348.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 47.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 54.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 287.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISC DML REFERENCE L", "code_information": [{"code": "81405", "type": "CPT"}, {"code": "3440103088", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 1645.12, "gross_charge": 1696.0, "discounted_cash": 484.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1441.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 333.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1272.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1187.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1645.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1187.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 332.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1272.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 322.75, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 384.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1441.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 322.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1356.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 322.75, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISC DML REFERENCE L", "code_information": [{"code": "86215", "type": "CPT"}, {"code": "3440103089", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISC DML REFERENCE L", "code_information": [{"code": "99001", "type": "CPT"}, {"code": "3440103107", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 11.57, "maximum": 185.27, "gross_charge": 191.0, "discounted_cash": 286.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 162.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 143.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 185.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 133.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 143.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 162.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 152.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MISC STERILE SUPPLY", "code_information": [{"code": "3100102115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 22500.0, "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": 6353.69, "maximum": 6353.69, "discounted_cash": 14683.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6353.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [{"code": "641", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3642.89, "maximum": 3642.89, "discounted_cash": 8723.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3642.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL ANTIBODY EACH", "code_information": [{"code": "86381", "type": "CPT"}], "standard_charges": [{"minimum": 25.45, "maximum": 30.26, "discounted_cash": 40.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MITOCHONDRIAL GENE", "code_information": [{"code": "81440", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3324.0, "discounted_cash": 5340.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3324.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MITOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9280", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.03, "maximum": 67.03, "discounted_cash": 101.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOMYCIN INSTILLATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9281", "type": "HCPCS"}], "standard_charges": [{"minimum": 300.59, "maximum": 300.59, "discounted_cash": 483.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 300.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MITOMYCIN-STERILE WA", "code_information": [{"code": "3400300807", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MITOXANTRONE HYDROCHL / 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9293", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.67, "maximum": 42.67, "discounted_cash": 70.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIX ROTARY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3228.4, "maximum": 4473.64, "gross_charge": 4612.0, "discounted_cash": 6918.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3920.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3459.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3228.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4473.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3228.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3459.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3920.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3689.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIX ROTARY BONE VOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5537.0, "maximum": 7672.7, "gross_charge": 7910.0, "discounted_cash": 11865.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6723.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5932.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5537.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7672.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5537.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5932.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6723.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIX ROTARY BONE VOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2816.1, "maximum": 3902.31, "gross_charge": 4023.0, "discounted_cash": 6034.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3419.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3017.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2816.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3902.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2816.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3017.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3419.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3218.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MIXING APL W SPRAY T", "code_information": [{"code": "3100204680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MLG COMPLET, PER SQ CM", "code_information": [{"code": "Q4256", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE", "code_information": [{"code": "81288", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 192.32, "discounted_cash": 308.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 192.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81294", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 202.4, "discounted_cash": 325.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 202.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE FULL SEQ", "code_information": [{"code": "81292", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 675.4, "discounted_cash": 1085.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 675.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MLH1 GENE KNOWN VARIANTS", "code_information": [{"code": "81293", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 331.0, "discounted_cash": 531.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 331.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MLH1 MRNA SEQ ALYS", "code_information": [{"code": "158U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MMR VACCINE SC", "code_information": [{"code": "90707", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 79.5, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MMRV VACCINE SC", "code_information": [{"code": "90710", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 226.64, "discounted_cash": 213.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 226.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ DP RX DLVR DEV", "code_information": [{"code": "20700", "type": "CPT"}], "standard_charges": [{"minimum": 490.39, "maximum": 490.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ I-ARTIC RX DEV", "code_information": [{"code": "20704", "type": "CPT"}], "standard_charges": [{"minimum": 490.39, "maximum": 490.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNL PREP&INSJ IMED RX DEV", "code_information": [{"code": "20702", "type": "CPT"}], "standard_charges": [{"minimum": 490.39, "maximum": 490.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNPJ OF TMJ W/ANESTH", "code_information": [{"code": "21073", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1670.09, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNT SUBS TX FOR CHANGE DX", "code_information": [{"code": "G0270", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG 1ST 2 HRS", "code_information": [{"code": "495T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNTR CDVR DON LNG EA ADDL HR", "code_information": [{"code": "496T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MNTR IO PRESS 24HRS/> UNI/BI", "code_information": [{"code": "329T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3355", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3356", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3375", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3376", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3555", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3556", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206157", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3575", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3576", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3577", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3595", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3596", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3597", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3775", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3776", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8680.0, "maximum": 12028.0, "gross_charge": 12400.0, "discounted_cash": 18600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3777", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 74200.0, "maximum": 102820.0, "gross_charge": 106000.0, "discounted_cash": 159000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 90100.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 79500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 74200.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 102820.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 74200.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 79500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 90100.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3796", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBI-C DISC*MB3797", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7420.0, "maximum": 10282.0, "gross_charge": 10600.0, "discounted_cash": 15900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10282.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9010.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBILITY LINER 52/45", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOBILIZATION OF COLON", "code_information": [{"code": "44139", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOBILIZE ERUPTED/MALPOS TOOT", "code_information": [{"code": "D7282", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOBL CUR STAT 0% IMP", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100296", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "MOBL CUR STAT 0% IMP", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100399", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "MOBL CUR STAT 0% IMP", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330103017", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "MOBL CUR STAT 1-19%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100414", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "MOBL CUR STAT 1-19%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330103018", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "MOBL CUR STAT 100% I", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100302", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "MOBL CUR STAT 100% I", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330100434", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "MOBL CUR STAT 20-39%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100297", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "MOBL CUR STAT 20-39%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100421", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "MOBL CUR STAT 20-39%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330103019", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "MOBL CUR STAT 40-59%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100420", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "MOBL CUR STAT 40-59%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330103020", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "MOBL CUR STAT 60-79%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3320100299", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "MOBL CUR STAT 60-79%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330100431", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "MOBL CUR STAT 80-99%", "code_information": [{"code": "G8978", "type": "HCPCS"}, {"code": "3330100430", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "MOBL D/C STAT 0% IMP", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3320100300", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "MOBL D/C STAT 0% IMP", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330100428", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "MOBL D/C STAT 1-19%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330100429", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "MOBL D/C STAT 100% I", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3320100316", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "MOBL D/C STAT 100% I", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330100448", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "MOBL D/C STAT 20-39%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330100433", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "MOBL D/C STAT 40-59%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3320100310", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "MOBL D/C STAT 40-59%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330100442", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "MOBL D/C STAT 60-79%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3320100313", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "MOBL D/C STAT 60-79%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330100445", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "MOBL D/C STAT 80-99%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3320100315", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "MOBL D/C STAT 80-99%", "code_information": [{"code": "G8980", "type": "HCPCS"}, {"code": "3330103016", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "MOBL GL STAT 1-19% I", "code_information": [{"code": "76998", "type": "CPT"}, {"code": "3480102239", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 130.9, "maximum": 221.17, "gross_charge": 187.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOBL PR STAT 0% IMP", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320100303", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "MOBL PR STAT 0% IMP", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330100435", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "MOBL PR STAT 1-19% I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320103015", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "MOBL PR STAT 1-19% I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330100432", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "MOBL PR STAT 100% IM", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320100309", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "MOBL PR STAT 100% IM", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330100441", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "MOBL PR STAT 20-39%", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320100304", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "MOBL PR STAT 20-39%", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330100436", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "MOBL PR STAT 40-59%I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320100305", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "MOBL PR STAT 40-59%I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330100437", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "MOBL PR STAT 60-79%I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320100306", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "MOBL PR STAT 60-79%I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330100438", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "MOBL PR STAT 80-99%I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3320100308", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "MOBL PR STAT 80-99%I", "code_information": [{"code": "G8979", "type": "HCPCS"}, {"code": "3330103001", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "MOD CONS SED < 5YRS", "code_information": [{"code": "3300100254", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 394.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOD CONS SED < 5YRS", "code_information": [{"code": "3430100726", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 379.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOD CONS SED > 5YRS", "code_information": [{"code": "3300100253", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 263.0, "discounted_cash": 394.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOD CONS SED > 5YRS", "code_information": [{"code": "3430100725", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 253.0, "discounted_cash": 379.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOD CONS SED EA ADD", "code_information": [{"code": "3300100252", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOD CONS SED EA ADD", "code_information": [{"code": "3430100724", "type": "CDM"}, {"code": "371", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP 5/>YRS", "code_information": [{"code": "99156", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SED OTH PHYS/QHP <5 YRS", "code_information": [{"code": "99155", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SED OTHER PHYS/QHP EA", "code_information": [{"code": "99157", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP 5/>YRS", "code_information": [{"code": "99152", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP <5 YRS", "code_information": [{"code": "99151", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SED SAME PHYS/QHP EA", "code_information": [{"code": "99153", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SEDAT ENDO SERVICE >5YRS", "code_information": [{"code": "G0500", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOD SOLID FOOD SUPPL", "code_information": [{"code": "S9434", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 28.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MODERNA VACC ADMIN 1ST DOSE", "code_information": [{"code": "D1703", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MODERNA VACC ADMIN 2ND DOSE", "code_information": [{"code": "D1704", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MODIFICATION OF CONTACT LENS", "code_information": [{"code": "92325", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MODIFY SPEECH AID PROSTHESIS", "code_information": [{"code": "D5960", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MODULAR POST 20MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODULAR POST 25MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODULAR POST 30MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MODULAR POST 35MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB CBA EACH", "code_information": [{"code": "86362", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOG-IGG1 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86363", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 37.73, "discounted_cash": 60.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1078.24, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1078.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE T/A/L", "code_information": [{"code": "17313", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1078.24, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1078.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE", "code_information": [{"code": "17312", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1078.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1078.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1078.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1078.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1078.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1078.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLCLR CYTO INTRP IS", "code_information": [{"code": "88274", "type": "CPT"}, {"code": "3440101195", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 42.38, "maximum": 302.64, "gross_charge": 312.0, "discounted_cash": 68.09, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 302.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 54.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 249.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 45.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 46.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLEC CYTG INTRPHS I", "code_information": [{"code": "88275", "type": "CPT"}, {"code": "3440101189", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 51.19, "maximum": 351.14, "gross_charge": 362.0, "discounted_cash": 82.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 307.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 351.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.82, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 307.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 289.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 54.82, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV 1ST", "code_information": [{"code": "700T", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLEC FLUOR IMG SUS NEV EA", "code_information": [{"code": "701T", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEV 3", "code_information": [{"code": "81402", "type": "CPT"}, {"code": "3440103080", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 845.84, "gross_charge": 872.0, "discounted_cash": 241.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 741.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 166.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 654.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 610.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 845.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 610.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 165.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 654.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 161.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 191.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 741.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 161.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 697.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 161.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLECULAR PATH LEV 4", "code_information": [{"code": "81403", "type": "CPT"}, {"code": "3440103044", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 236.04, "gross_charge": 0.01, "discounted_cash": 297.53, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 205.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.32, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.3, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 198.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 236.04, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 198.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 198.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLECULAR TEST PUB HLTH PATH", "code_information": [{"code": "D0606", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOLECULR CYTOGNTCS D", "code_information": [{"code": "88271", "type": "CPT"}, {"code": "3440101221", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 21.42, "maximum": 187.21, "gross_charge": 193.0, "discounted_cash": 34.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOMETASONE SINUS SINUVA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7402", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.35, "maximum": 11.35, "discounted_cash": 18.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONIT STORE CRYO EMBRYO 30 D", "code_information": [{"code": "S4040", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MONITOR QUICK PRESS", "code_information": [{"code": "3100104738", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MONOBLOCK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1756.3, "maximum": 2433.73, "gross_charge": 2509.0, "discounted_cash": 3763.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2132.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1881.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1756.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2433.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1756.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1881.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2132.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2007.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONOCLONAL ANTIBODIES", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7505", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "MONOFILAMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103711", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 16.8, "maximum": 23.28, "gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONOFILAMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102199", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 17.5, "maximum": 24.25, "gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONONUCLEAR CELL ANTIGEN", "code_information": [{"code": "86356", "type": "CPT"}], "standard_charges": [{"minimum": 26.78, "maximum": 68.53, "discounted_cash": 43.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MONOVISC INJ PER DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7327", "type": "HCPCS"}], "standard_charges": [{"minimum": 711.54, "maximum": 711.54, "discounted_cash": 1147.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 711.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 1", "code_information": [{"code": "81400", "type": "CPT"}], "standard_charges": [{"minimum": 63.96, "maximum": 79.66, "discounted_cash": 102.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 63.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 2", "code_information": [{"code": "81401", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 7", "code_information": [{"code": "81406", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 282.88, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 282.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 846.27, "discounted_cash": 1359.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 846.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 9", "code_information": [{"code": "81408", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2000.0, "discounted_cash": 3213.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2000.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MORCELLATOR RECIPROC", "code_information": [{"code": "3100102910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1497.0, "discounted_cash": 2245.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MORCELLATOR RECIPROC", "code_information": [{"code": "3100102911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2422.0, "discounted_cash": 3633.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MORPH ANYL MULTI PRO", "code_information": [{"code": "88374", "type": "CPT"}, {"code": "3440103049", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 174.29, "maximum": 584.91, "gross_charge": 603.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 512.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 584.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 512.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 275.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2270", "type": "HCPCS"}, {"code": "3400300283", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.46, "maximum": 27.45, "gross_charge": 28.3, "discounted_cash": 42.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 21.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 27.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 22.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHINE SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2274", "type": "HCPCS"}, {"code": "3400300094", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 14.43, "maximum": 14.43, "gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MORPHMTRC ALYS ISH E", "code_information": [{"code": "88367", "type": "CPT"}, {"code": "3440101248", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 103.01, "maximum": 436.49, "gross_charge": 302.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 256.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 226.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 211.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 292.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 211.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 226.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 256.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 241.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 103.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MORPHMTRC ALYS TUMR", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "3440101246", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 161.24, "maximum": 436.49, "gross_charge": 252.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 161.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MORPHMTRC ANLY TUMR", "code_information": [{"code": "88360", "type": "CPT"}, {"code": "3440103011", "type": "CDM"}, {"code": "312", "type": "RC"}], "standard_charges": [{"minimum": 130.05, "maximum": 233.77, "gross_charge": 241.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 233.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MORPHOMETIC ANALYSIS", "code_information": [{"code": "88377", "type": "CPT"}, {"code": "3440103037", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 174.29, "maximum": 342.41, "gross_charge": 353.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 264.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 342.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 264.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 282.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 238.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MORPHOMETRIC ANALYSI", "code_information": [{"code": "88361", "type": "CPT"}, {"code": "3440103116", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 161.24, "maximum": 436.49, "gross_charge": 307.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 260.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 230.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 297.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 230.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 260.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 245.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 161.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOTION ANALYSIS VIDEO/3D", "code_information": [{"code": "96000", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOTION FLUOROSCOPY/SWALLOW", "code_information": [{"code": "92611", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOTION TEST W/FT PRESS MEAS", "code_information": [{"code": "96001", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOTOCLIP 10X10*1442-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTOCLIP 12X12*1412-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTOR &/ SENS NRVE CNDJ TEST", "code_information": [{"code": "95905", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOUTH PROCEDURES WITH CC/MCC", "code_information": [{"code": "137", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5805.88, "maximum": 5805.88, "discounted_cash": 16799.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5805.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOUTH PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "138", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4659.83, "maximum": 4659.83, "discounted_cash": 9665.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4659.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOUTHGAG INSERTS SIL", "code_information": [{"code": "3100101096", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MOXIFLOXACIN HCL", "code_information": [{"code": "3400300029", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 358.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MPFL RECON BIOCOM SC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.2, "maximum": 3750.02, "gross_charge": 3866.0, "discounted_cash": 5799.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3286.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2899.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2706.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3750.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2706.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2899.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3286.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3092.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPL GENE COMMON VARIANTS", "code_information": [{"code": "81338", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 150.33, "discounted_cash": 241.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MPL GENE SEQ ALYS EXON 10", "code_information": [{"code": "81339", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MPSV4 VACCINE SUBQ", "code_information": [{"code": "90733", "type": "CPT"}], "standard_charges": [{"minimum": 128.05, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 128.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MR ANGIO SPINE W/O&W/DYE", "code_information": [{"code": "72159", "type": "CPT"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MR ELASTOGRAPHY", "code_information": [{"code": "76391", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MR SPECTROSCOPY", "code_information": [{"code": "76390", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA ABDOMEN W CONT", "code_information": [{"code": "C8900", "type": "HCPCS"}, {"code": "74185", "type": "CPT"}, {"code": "3280100154", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA ABDOMEN WO CONT", "code_information": [{"code": "C8901", "type": "HCPCS"}, {"code": "74185", "type": "CPT"}, {"code": "3280100155", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA ABDOMEN WO/W CON", "code_information": [{"code": "C8902", "type": "HCPCS"}, {"code": "74185", "type": "CPT"}, {"code": "3280100156", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA CHEST W CONT", "code_information": [{"code": "C8909", "type": "HCPCS"}, {"code": "71555", "type": "CPT"}, {"code": "3280100163", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA CHEST WO CONT", "code_information": [{"code": "C8910", "type": "HCPCS"}, {"code": "71555", "type": "CPT"}, {"code": "3280100164", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA CHEST WO/W CONT", "code_information": [{"code": "C8911", "type": "HCPCS"}, {"code": "71555", "type": "CPT"}, {"code": "3280100165", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA HEAD W CONTRAST", "code_information": [{"code": "70545", "type": "CPT"}, {"code": "3280100110", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA HEAD W/O CONTRAS", "code_information": [{"code": "70544", "type": "CPT"}, {"code": "3280100109", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA HEAD WO / W CONT", "code_information": [{"code": "70546", "type": "CPT"}, {"code": "3280100111", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA LOWER EXTREM W C", "code_information": [{"code": "C8912", "type": "HCPCS"}, {"code": "73725", "type": "CPT"}, {"code": "3280100166", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA LOWER EXTREM WO", "code_information": [{"code": "C8913", "type": "HCPCS"}, {"code": "73725", "type": "CPT"}, {"code": "3280100167", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA LOWER EXTREM WO/", "code_information": [{"code": "C8914", "type": "HCPCS"}, {"code": "73725", "type": "CPT"}, {"code": "3280100168", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA NECK/CAROTIDS W", "code_information": [{"code": "70548", "type": "CPT"}, {"code": "3280100113", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA NECK/CAROTIDS WO", "code_information": [{"code": "70547", "type": "CPT"}, {"code": "3280100112", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA NECK/CAROTIDS WO", "code_information": [{"code": "70549", "type": "CPT"}, {"code": "3280100114", "type": "CDM"}, {"code": "615", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA PELVIS W CONT", "code_information": [{"code": "C8918", "type": "HCPCS"}, {"code": "72198", "type": "CPT"}, {"code": "3280100169", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA PELVIS WO CONT", "code_information": [{"code": "C8919", "type": "HCPCS"}, {"code": "72198", "type": "CPT"}, {"code": "3280100170", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA PELVIS WO/W CONT", "code_information": [{"code": "C8920", "type": "HCPCS"}, {"code": "72198", "type": "CPT"}, {"code": "3280100171", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA UPPER EXTRM W CO", "code_information": [{"code": "C8934", "type": "HCPCS"}, {"code": "73225", "type": "CPT"}, {"code": "3280100172", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA UPPER EXTRM WO C", "code_information": [{"code": "C8935", "type": "HCPCS"}, {"code": "73225", "type": "CPT"}, {"code": "3280100173", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA UPPER EXTRM WO/W", "code_information": [{"code": "C8936", "type": "HCPCS"}, {"code": "73225", "type": "CPT"}, {"code": "3280100174", "type": "CDM"}, {"code": "618", "type": "RC"}], "standard_charges": [{"minimum": 476.15, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, ABD", "code_information": [{"code": "C8900", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, CHEST", "code_information": [{"code": "C8909", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, LWR EXT", "code_information": [{"code": "C8912", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/CONT, PELVIS", "code_information": [{"code": "C8918", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, ABD", "code_information": [{"code": "C8901", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, CHEST", "code_information": [{"code": "C8910", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, LWR EXT", "code_information": [{"code": "C8913", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O CONT, PELVIS", "code_information": [{"code": "C8919", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, ABD", "code_information": [{"code": "C8902", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, CHEST", "code_information": [{"code": "C8911", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, LWR EXT", "code_information": [{"code": "C8914", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA W/O FOL W/CONT, PELVIS", "code_information": [{"code": "C8920", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA, W/DYE, SPINAL CANAL", "code_information": [{"code": "C8931", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA, W/DYE, UPPER EXTREMITY", "code_information": [{"code": "C8934", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA, W/O DYE, SPINAL CANAL", "code_information": [{"code": "C8932", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA, W/O DYE, UPPER EXTR", "code_information": [{"code": "C8935", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, SPINAL CANAL", "code_information": [{"code": "C8933", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRA, W/O&W/DYE, UPPER EXTR", "code_information": [{"code": "C8936", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRCP", "code_information": [{"code": "S8037", "type": "HCPCS"}], "standard_charges": [{"minimum": 476.15, "maximum": 476.15, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 476.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRGFUS STRTCTC LES ABLTJ", "code_information": [{"code": "398T", "type": "CPT"}], "standard_charges": [{"minimum": 8198.68, "maximum": 8198.68, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRH BUMPER INSERT*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1117.87, "maximum": 1549.05, "gross_charge": 1596.96, "discounted_cash": 2395.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1357.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1197.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1117.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1549.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1117.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1197.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1357.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1277.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH BUSH/SLEEVE/BUMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2541.53, "maximum": 3521.84, "gross_charge": 3630.77, "discounted_cash": 5446.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3086.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2723.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2541.53, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3521.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2541.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2723.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3086.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2904.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH FEM COMPONENT*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8489.48, "maximum": 11763.99, "gross_charge": 12127.83, "discounted_cash": 18191.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10308.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9095.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8489.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11763.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8489.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9095.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10308.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9702.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH KNEE INSERT*6481", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1115.73, "maximum": 1546.08, "gross_charge": 1593.9, "discounted_cash": 2390.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1354.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1195.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1115.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1546.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1115.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1195.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1354.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1275.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIB BASEPLATE*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5200.19, "maximum": 7205.98, "gross_charge": 7428.85, "discounted_cash": 11143.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6314.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5571.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5200.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7205.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5200.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5571.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6314.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5943.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIB BASEPLATE*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5206.65, "maximum": 7214.93, "gross_charge": 7438.08, "discounted_cash": 11157.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6322.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5578.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5206.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7214.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5206.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5578.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6322.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5950.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIBIAL INSERT*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1953.33, "maximum": 2706.76, "gross_charge": 2790.48, "discounted_cash": 4185.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2371.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2092.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1953.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2706.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1953.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2092.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2371.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2232.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIBIAL INSERT*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1953.33, "maximum": 2706.76, "gross_charge": 2790.48, "discounted_cash": 4185.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2371.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2092.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1953.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2706.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1953.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2092.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2371.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2232.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIBIAL INSERT*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4659.78, "maximum": 6457.12, "gross_charge": 6656.83, "discounted_cash": 9985.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5658.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4992.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4659.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6457.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4659.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4992.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5658.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5325.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIBIAL INSERT*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1938.98, "maximum": 2686.88, "gross_charge": 2769.98, "discounted_cash": 4154.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2354.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2077.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1938.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2686.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1938.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2077.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2354.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2215.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRH TIBIAL SLEEVE*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 934.41, "maximum": 1294.83, "gross_charge": 1334.88, "discounted_cash": 2002.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1134.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1001.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 934.41, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1294.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 934.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1001.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1134.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1067.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W CONT", "code_information": [{"code": "74182", "type": "CPT"}, {"code": "3280100146", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN W/O CONT", "code_information": [{"code": "74181", "type": "CPT"}, {"code": "3280100145", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI ABDOMEN WO/W CON", "code_information": [{"code": "74183", "type": "CPT"}, {"code": "3280100147", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W CONTRAST", "code_information": [{"code": "70552", "type": "CPT"}, {"code": "3280100116", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/DYE", "code_information": [{"code": "70558", "type": "CPT"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O & W/DYE", "code_information": [{"code": "70559", "type": "CPT"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/O DYE", "code_information": [{"code": "70557", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN WO / W CON", "code_information": [{"code": "70553", "type": "CPT"}, {"code": "3280100117", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN WO CONTRAS", "code_information": [{"code": "70551", "type": "CPT"}, {"code": "3280100115", "type": "CDM"}, {"code": "611", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- BILATERAL", "code_information": [{"code": "77047", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- UNILATERAL", "code_information": [{"code": "77046", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C-+ W/CAD BI", "code_information": [{"code": "77049", "type": "CPT"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C-+ W/CAD UNI", "code_information": [{"code": "77048", "type": "CPT"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST W CONT BI", "code_information": [{"code": "C8906", "type": "HCPCS"}, {"code": "77059", "type": "CPT"}, {"code": "3280100160", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST W CONT UN", "code_information": [{"code": "C8903", "type": "HCPCS"}, {"code": "77058", "type": "CPT"}, {"code": "3280100157", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 4491.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST WO CONT B", "code_information": [{"code": "C8907", "type": "HCPCS"}, {"code": "77059", "type": "CPT"}, {"code": "3280100161", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST WO CONT U", "code_information": [{"code": "C8904", "type": "HCPCS"}, {"code": "77058", "type": "CPT"}, {"code": "3280100158", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST WO/W CONT", "code_information": [{"code": "C8905", "type": "HCPCS"}, {"code": "77058", "type": "CPT"}, {"code": "3280100159", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI BREAST WO/W CONT", "code_information": [{"code": "C8908", "type": "HCPCS"}, {"code": "77059", "type": "CPT"}, {"code": "3280100162", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 5427.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CARDIAC FOR VELO", "code_information": [{"code": "75565", "type": "CPT"}, {"code": "3280100152", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 193.9, "maximum": 521.1, "gross_charge": 277.0, "discounted_cash": 415.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 235.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 207.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 193.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 268.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 193.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 207.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 235.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 221.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CARDIAC MORPH &", "code_information": [{"code": "75557", "type": "CPT"}, {"code": "3280100148", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CARDIAC W/WO CON", "code_information": [{"code": "75561", "type": "CPT"}, {"code": "3280102283", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CARDIAC W/WO CON", "code_information": [{"code": "75563", "type": "CPT"}, {"code": "3280100151", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CARDIAC WO CONT", "code_information": [{"code": "75559", "type": "CPT"}, {"code": "3280100149", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 521.1, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 844.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 582.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 579.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 669.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CHEST W CONTRAST", "code_information": [{"code": "71551", "type": "CPT"}, {"code": "3280100119", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CHEST WO / W CON", "code_information": [{"code": "71552", "type": "CPT"}, {"code": "3280100120", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI CHEST WO CONTRAS", "code_information": [{"code": "71550", "type": "CPT"}, {"code": "3280100118", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI FETAL EA ADDL GESTATION", "code_information": [{"code": "74713", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI FETAL SNGL/1ST GESTATION", "code_information": [{"code": "74712", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI GDN PARNCHYMA TISS ABLTJ", "code_information": [{"code": "77022", "type": "CPT"}], "standard_charges": [{"minimum": 320.4, "maximum": 320.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 320.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI GUIDANCE NDL PLMT RS&I", "code_information": [{"code": "77021", "type": "CPT"}], "standard_charges": [{"minimum": 320.4, "maximum": 320.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 320.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOW FIELD", "code_information": [{"code": "S8042", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTRM JNT", "code_information": [{"code": "73721", "type": "CPT"}, {"code": "3280100142", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTRM JNT", "code_information": [{"code": "73722", "type": "CPT"}, {"code": "3280100143", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTRM JNT", "code_information": [{"code": "73723", "type": "CPT"}, {"code": "3280100144", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTRM NON", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "3280100139", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTRM NON", "code_information": [{"code": "73719", "type": "CPT"}, {"code": "3280100140", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI LOWER EXTRM NON", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "3280100141", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI OF PROSTATE", "code_information": [{"code": "76498", "type": "CPT"}, {"code": "3280102284", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 92.73, "maximum": 521.1, "gross_charge": 323.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 274.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 242.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 313.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 242.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 274.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI ORBIT/FACE/NECK", "code_information": [{"code": "70540", "type": "CPT"}, {"code": "3280100106", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI ORBIT/FACE/NECK", "code_information": [{"code": "70542", "type": "CPT"}, {"code": "3280100107", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI ORBIT/FACE/NECK", "code_information": [{"code": "70543", "type": "CPT"}, {"code": "3280100108", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI PELVIS W CONTRAS", "code_information": [{"code": "72196", "type": "CPT"}, {"code": "3280100131", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI PELVIS WO CONTRA", "code_information": [{"code": "72195", "type": "CPT"}, {"code": "3280100130", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI PELVIS WO/W CONT", "code_information": [{"code": "72197", "type": "CPT"}, {"code": "3280100132", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE CERVICAL W", "code_information": [{"code": "72141", "type": "CPT"}, {"code": "3280100121", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE CERVICAL W", "code_information": [{"code": "72142", "type": "CPT"}, {"code": "3280100122", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE CERVICAL W", "code_information": [{"code": "72156", "type": "CPT"}, {"code": "3280100127", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE LUMBAR W C", "code_information": [{"code": "72149", "type": "CPT"}, {"code": "3280100126", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE LUMBAR WO", "code_information": [{"code": "72148", "type": "CPT"}, {"code": "3280100125", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE LUMBAR WO/", "code_information": [{"code": "72158", "type": "CPT"}, {"code": "3280100129", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE THORACIC W", "code_information": [{"code": "72146", "type": "CPT"}, {"code": "3280100123", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE THORACIC W", "code_information": [{"code": "72147", "type": "CPT"}, {"code": "3280100124", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI SPINE THORACIC W", "code_information": [{"code": "72157", "type": "CPT"}, {"code": "3280100128", "type": "CDM"}, {"code": "612", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI TMJ JOINT(S)", "code_information": [{"code": "70336", "type": "CPT"}, {"code": "3280100104", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTRM JNT", "code_information": [{"code": "73221", "type": "CPT"}, {"code": "3280100136", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTRM JNT", "code_information": [{"code": "73222", "type": "CPT"}, {"code": "3280100137", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 734.25, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTRM JNT", "code_information": [{"code": "73223", "type": "CPT"}, {"code": "3280100138", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTRM NON", "code_information": [{"code": "73218", "type": "CPT"}, {"code": "3280100133", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTRM NON", "code_information": [{"code": "73219", "type": "CPT"}, {"code": "3280100134", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 2904.18, "gross_charge": 2994.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2904.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2095.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2245.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2544.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2395.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI UPPER EXTRM NON", "code_information": [{"code": "73220", "type": "CPT"}, {"code": "3280100135", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 392.44, "maximum": 3509.46, "gross_charge": 3618.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3509.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2532.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2713.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3075.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2894.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI W/CONT, BREAST,  BI", "code_information": [{"code": "C8906", "type": "HCPCS"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI W/CONT, BREAST,  UNI", "code_information": [{"code": "C8903", "type": "HCPCS"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI W/O FOL W/CONT, BREAST,", "code_information": [{"code": "C8908", "type": "HCPCS"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRI W/O FOL W/CONT, BRST, UN", "code_information": [{"code": "C8905", "type": "HCPCS"}], "standard_charges": [{"minimum": 734.25, "maximum": 734.25, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN ACQUISJ DATA", "code_information": [{"code": "609T", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN ALG ALYS DATA", "code_information": [{"code": "611T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MRS DISC PAIN TRANSMIS DATA", "code_information": [{"code": "610T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81297", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 213.3, "discounted_cash": 342.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 213.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE FULL SEQ", "code_information": [{"code": "81295", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 381.7, "discounted_cash": 613.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 381.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH2 GENE KNOWN VARIANTS", "code_information": [{"code": "81296", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 337.73, "discounted_cash": 542.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH2 MRNA SEQ ALYS", "code_information": [{"code": "159U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE DUP/DELETE VARIANT", "code_information": [{"code": "81300", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 238.0, "discounted_cash": 382.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE FULL SEQ", "code_information": [{"code": "81298", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 641.85, "discounted_cash": 1031.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH6 GENE KNOWN VARIANTS", "code_information": [{"code": "81299", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 308.0, "discounted_cash": 494.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MSH6 MRNA SEQ ALYS", "code_information": [{"code": "160U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MT BONE GRAFT MICROVASC", "code_information": [{"code": "20957", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MTHFR GENE", "code_information": [{"code": "81291", "type": "CPT"}], "standard_charges": [{"minimum": 65.34, "maximum": 79.66, "discounted_cash": 104.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MTP DISC 5 X 21MM*PM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4641.0, "maximum": 6431.1, "gross_charge": 6630.0, "discounted_cash": 9945.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5635.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6431.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5635.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUCOPOLYSACCHARIDES", "code_information": [{"code": "83864", "type": "CPT"}], "standard_charges": [{"minimum": 28.5, "maximum": 53.85, "discounted_cash": 45.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUCORMYCOSIS ANTIBODY", "code_information": [{"code": "86732", "type": "CPT"}], "standard_charges": [{"minimum": 15.0, "maximum": 30.26, "discounted_cash": 24.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULT FAM ADAPT BHV TX GDN", "code_information": [{"code": "97157", "type": "CPT"}], "standard_charges": [{"minimum": 62.75, "maximum": 62.75, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIFOCAL ERG W/I&R", "code_information": [{"code": "92274", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE FAMILY GROUP PSYTX", "code_information": [{"code": "90849", "type": "CPT"}], "standard_charges": [{"minimum": 84.55, "maximum": 84.55, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [{"code": "59", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6880.61, "maximum": 6880.61, "discounted_cash": 13254.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6880.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [{"code": "58", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10680.28, "maximum": 10680.28, "discounted_cash": 19291.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10680.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC", "code_information": [{"code": "60", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4614.33, "maximum": 4614.33, "discounted_cash": 10019.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4614.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MULTIPLE SLEEP LATENCY TEST", "code_information": [{"code": "95805", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MULTISYS THER/JUVENILE 15MIN", "code_information": [{"code": "H2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUMPS AB", "code_information": [{"code": "86735", "type": "CPT"}, {"code": "3440101114", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.05, "maximum": 110.58, "gross_charge": 114.0, "discounted_cash": 20.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 96.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 110.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 96.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 91.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MURAMIDASE", "code_information": [{"code": "85549", "type": "CPT"}], "standard_charges": [{"minimum": 18.75, "maximum": 20.92, "discounted_cash": 30.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUS SKIN GRFT HEAD/N", "code_information": [{"code": "15732", "type": "CPT"}, {"code": "3480101374", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6151.74, "gross_charge": 6342.0, "discounted_cash": 9513.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6151.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5073.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSC MYOQ/FSCQ FLP H&N PEDCL", "code_information": [{"code": "15733", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/N TST NONEXT", "code_information": [{"code": "95887", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSC TST DONE W/NERV TST LIM", "code_information": [{"code": "95885", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSC/TDN TRANSFER UPR A/E 1", "code_information": [{"code": "24301", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 3 LIMBS", "code_information": [{"code": "95863", "type": "CPT"}, {"code": "3480103146", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 159.4, "maximum": 571.33, "gross_charge": 589.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 500.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 571.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 500.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 471.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST 4 LIMBS", "code_information": [{"code": "95864", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST CRAN NER", "code_information": [{"code": "95868", "type": "CPT"}, {"code": "3480103340", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 720.71, "gross_charge": 743.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 631.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 557.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 520.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 720.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 520.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 557.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 631.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 594.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST HEMIDIAPHRAGM", "code_information": [{"code": "95866", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST ONE FIBER", "code_information": [{"code": "95872", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TEST THOR PARASPINAL", "code_information": [{"code": "95869", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFER SHOULDER/ARM", "code_information": [{"code": "23395", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE TRANSFERS", "code_information": [{"code": "23397", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT ARM", "code_information": [{"code": "15736", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT LEG", "code_information": [{"code": "15738", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SKIN GRAFT TRUNK", "code_information": [{"code": "15734", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSCLE-SPECIFIC KINASE ANTB", "code_information": [{"code": "86366", "type": "CPT"}], "standard_charges": [{"minimum": 18.4, "maximum": 18.4, "discounted_cash": 29.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MUSCULOSKEL SURG 1ST", "code_information": [{"code": "3480103067", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 9270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MUSCULOSKEL SURG EA", "code_information": [{"code": "3480103072", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 1545.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MUSCULOSKELETAL SURG", "code_information": [{"code": "20999", "type": "CPT"}, {"code": "3480103144", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 5564.89, "gross_charge": 5737.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MUSTANG", "code_information": [{"code": "C1725", "type": "HCPCS"}, {"code": "3100102201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 388.5, "maximum": 538.35, "gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 538.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA AMP PROBE", "code_information": [{"code": "87551", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 48.24, "discounted_cash": 77.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA DIR PROBE", "code_information": [{"code": "87550", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYCOBACTERIA DNA QUANT", "code_information": [{"code": "87552", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYCOPHENOLATE", "code_information": [{"code": "80180", "type": "CPT"}, {"code": "3440100820", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.05, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 29.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.33, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYCOPHENOLATE MOFETIL ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.2, "maximum": 0.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPHENOLIC ACID", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYCOPLASMA AB", "code_information": [{"code": "86738", "type": "CPT"}, {"code": "3440101115", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.24, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYD88 GENE P.LEU265PRO VRNT", "code_information": [{"code": "81305", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 175.4, "discounted_cash": 281.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELIN BASIC PROTEIN", "code_information": [{"code": "83873", "type": "CPT"}, {"code": "3440100953", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.2, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 27.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR I", "code_information": [{"code": "62304", "type": "CPT"}, {"code": "3480103327", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 817.04, "maximum": 1895.38, "gross_charge": 1954.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1660.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1465.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1367.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1895.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1367.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1465.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1660.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1563.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62302", "type": "CPT"}], "standard_charges": [{"minimum": 871.76, "maximum": 871.76, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62303", "type": "CPT"}], "standard_charges": [{"minimum": 871.76, "maximum": 871.76, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOGRAPHY LUMBAR INJECTION", "code_information": [{"code": "62305", "type": "CPT"}], "standard_charges": [{"minimum": 871.76, "maximum": 871.76, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPEROXIDASE MPO", "code_information": [{"code": "83876", "type": "CPT"}, {"code": "3440100955", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 50.86, "maximum": 295.85, "gross_charge": 305.0, "discounted_cash": 81.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 295.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 64.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 54.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 54.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [{"code": "827", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12861.1, "maximum": 12861.1, "discounted_cash": 25870.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12861.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [{"code": "826", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30975.95, "maximum": 30975.95, "discounted_cash": 48999.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30975.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "828", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8672.23, "maximum": 8672.23, "discounted_cash": 18314.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8672.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC", "code_information": [{"code": "829", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12374.15, "maximum": 12374.15, "discounted_cash": 35210.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12374.15, "methodology": "fee schedule"}], "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": 8635.96, "maximum": 8635.96, "discounted_cash": 17653.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8635.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG", "code_information": [{"code": "541T", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCARDIAL IMAGING MCG I&R", "code_information": [{"code": "542T", "type": "CPT"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD CONTRAST PRFUJ ECHO", "code_information": [{"code": "439T", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1 STD W/CT", "code_information": [{"code": "78429", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1STD RST/STRS", "code_information": [{"code": "78491", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER", "code_information": [{"code": "78432", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2972.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 3133.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET MLT RST&STRS", "code_information": [{"code": "78492", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST&STRS CT", "code_information": [{"code": "78431", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 3615.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST/STRS W/CT", "code_information": [{"code": "78430", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET SINGLE STUDY", "code_information": [{"code": "78459", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOCRD STRAIN IMG SPCKL TRCK", "code_information": [{"code": "93356", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOGLOBIN", "code_information": [{"code": "83874", "type": "CPT"}, {"code": "3440100954", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.92, "maximum": 112.52, "gross_charge": 116.0, "discounted_cash": 20.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.84, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM METHOD", "code_information": [{"code": "58140", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY VAG METHOD", "code_information": [{"code": "58145", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5460.6, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYOSURE LITE *30-403", "code_information": [{"code": "3100203074", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2308.6, "discounted_cash": 3462.9, "setting": "both", "billing_class": "facility"}]}, {"description": "MYOSURE REACH *10-40", "code_information": [{"code": "3100203076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2343.6, "discounted_cash": 3515.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MYOSURE XL *50-503XL", "code_information": [{"code": "3100203075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2702.42, "discounted_cash": 4053.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MYOWN HARV PREP PROC SQ CM", "code_information": [{"code": "Q4226", "type": "HCPCS"}], "standard_charges": [{"minimum": 386.49, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 386.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYRINGOPATCH MED*BE1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 777.0, "maximum": 1076.7, "gross_charge": 1110.0, "discounted_cash": 1665.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 943.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 832.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 777.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1076.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 777.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 832.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 943.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYRINGOPLASTY", "code_information": [{"code": "69620", "type": "CPT"}, {"code": "3480102233", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYRINGOT INCL ASP/EU", "code_information": [{"code": "69421", "type": "CPT"}, {"code": "3480102297", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY LASER-ASSIST", "code_information": [{"code": "S2225", "type": "HCPCS"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Brain/Brain Stem", "code_information": [{"code": "611", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) General", "code_information": [{"code": "610", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Head And Neck", "code_information": [{"code": "615", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Other Mra", "code_information": [{"code": "618", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology (Mrt) Spinal Cord/Spine", "code_information": [{"code": "612", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Magnetic Resonance Technology, Other Magnetic Resonance Imaging (MRI)", "code_information": [{"code": "614", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Major Abdominal Vascular Procedures, Major", "code_information": [{"code": "169.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51453.51, "maximum": 51453.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51453.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Abdominal Vascular Procedures, Minor", "code_information": [{"code": "169.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43032.77, "maximum": 43032.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43032.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Abdominal Vascular Procedures, Moderate", "code_information": [{"code": "169.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43612.01, "maximum": 43612.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43612.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Abdominal Vascular Procedures, Severe", "code_information": [{"code": "169.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 105972.36, "maximum": 105972.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 105972.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Biliary Tract Procedures, Major", "code_information": [{"code": "261.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34827.33, "maximum": 34827.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34827.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Biliary Tract Procedures, Minor", "code_information": [{"code": "261.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21377.98, "maximum": 21377.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21377.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Biliary Tract Procedures, Moderate", "code_information": [{"code": "261.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26534.74, "maximum": 26534.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26534.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Biliary Tract Procedures, Severe", "code_information": [{"code": "261.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 76751.6, "maximum": 76751.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76751.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Bladder Procedures, Major", "code_information": [{"code": "441.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36470.21, "maximum": 36470.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36470.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Bladder Procedures, Minor", "code_information": [{"code": "441.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19669.74, "maximum": 19669.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19669.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Bladder Procedures, Moderate", "code_information": [{"code": "441.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26726.96, "maximum": 26726.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26726.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Bladder Procedures, Severe", "code_information": [{"code": "441.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 83207.8, "maximum": 83207.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 83207.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cardiothoracic Repair Of Heart Anomaly, Major", "code_information": [{"code": "160.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53145.09, "maximum": 53145.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53145.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cardiothoracic Repair Of Heart Anomaly, Minor", "code_information": [{"code": "160.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34303.19, "maximum": 34303.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34303.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cardiothoracic Repair Of Heart Anomaly, Moderate", "code_information": [{"code": "160.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36402.29, "maximum": 36402.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36402.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cardiothoracic Repair Of Heart Anomaly, Severe", "code_information": [{"code": "160.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 150059.81, "maximum": 150059.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 150059.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Chest And Respiratory Trauma, Major", "code_information": [{"code": "135.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12657.38, "maximum": 12657.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12657.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Chest And Respiratory Trauma, Minor", "code_information": [{"code": "135.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8175.97, "maximum": 8175.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8175.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Chest And Respiratory Trauma, Moderate", "code_information": [{"code": "135.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8689.85, "maximum": 8689.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8689.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Chest And Respiratory Trauma, Severe", "code_information": [{"code": "135.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21495.88, "maximum": 21495.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21495.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cranial Or Facial Bone Procedures, Major", "code_information": [{"code": "89.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 52358.25, "maximum": 52358.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 52358.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cranial Or Facial Bone Procedures, Minor", "code_information": [{"code": "89.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27012.74, "maximum": 27012.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27012.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cranial Or Facial Bone Procedures, Moderate", "code_information": [{"code": "89.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32739.76, "maximum": 32739.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32739.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Cranial Or Facial Bone Procedures, Severe", "code_information": [{"code": "89.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 92784.44, "maximum": 92784.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 92784.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Depressive Disorders And Other Or Unspecified Psychoses, Major", "code_information": [{"code": "751.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18650.95, "maximum": 18650.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18650.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Depressive Disorders And Other Or Unspecified Psychoses, Minor", "code_information": [{"code": "751.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6606.13, "maximum": 6606.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6606.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Depressive Disorders And Other Or Unspecified Psychoses, Moderate", "code_information": [{"code": "751.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8388.7, "maximum": 8388.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8388.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Depressive Disorders And Other Or Unspecified Psychoses, Severe", "code_information": [{"code": "751.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37884.98, "maximum": 37884.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37884.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Esophageal Disorders, Major", "code_information": [{"code": "242.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17801.32, "maximum": 17801.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17801.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Esophageal Disorders, Minor", "code_information": [{"code": "242.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7305.83, "maximum": 7305.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7305.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Esophageal Disorders, Moderate", "code_information": [{"code": "242.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8870.54, "maximum": 8870.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8870.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Esophageal Disorders, Severe", "code_information": [{"code": "242.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28951.65, "maximum": 28951.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28951.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Gastrointestinal And Peritoneal Infections, Major", "code_information": [{"code": "248.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14554.0, "maximum": 14554.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14554.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Gastrointestinal And Peritoneal Infections, Minor", "code_information": [{"code": "248.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7052.09, "maximum": 7052.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7052.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Gastrointestinal And Peritoneal Infections, Moderate", "code_information": [{"code": "248.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8919.24, "maximum": 8919.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8919.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Gastrointestinal And Peritoneal Infections, Severe", "code_information": [{"code": "248.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32384.79, "maximum": 32384.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32384.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagulation, Major", "code_information": [{"code": "660.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16614.65, "maximum": 16614.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16614.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagulation, Minor", "code_information": [{"code": "660.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8710.36, "maximum": 8710.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8710.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagulation, Moderate", "code_information": [{"code": "660.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10235.34, "maximum": 10235.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10235.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagulation, Severe", "code_information": [{"code": "660.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51579.09, "maximum": 51579.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51579.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Large Bowel Procedures, Major", "code_information": [{"code": "231.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34578.71, "maximum": 34578.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34578.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Large Bowel Procedures, Minor", "code_information": [{"code": "231.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17975.6, "maximum": 17975.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17975.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Large Bowel Procedures, Moderate", "code_information": [{"code": "231.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22822.23, "maximum": 22822.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22822.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Large Bowel Procedures, Severe", "code_information": [{"code": "231.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 52838.81, "maximum": 52838.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 52838.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Male Pelvic Procedures, Major", "code_information": [{"code": "480.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34468.51, "maximum": 34468.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34468.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Male Pelvic Procedures, Minor", "code_information": [{"code": "480.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14939.73, "maximum": 14939.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14939.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Male Pelvic Procedures, Moderate", "code_information": [{"code": "480.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16829.94, "maximum": 16829.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16829.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Male Pelvic Procedures, Severe", "code_information": [{"code": "480.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55841.36, "maximum": 55841.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55841.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Major", "code_information": [{"code": "680.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39530.43, "maximum": 39530.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39530.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Minor", "code_information": [{"code": "680.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20199.0, "maximum": 20199.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20199.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Moderate", "code_information": [{"code": "680.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31385.22, "maximum": 31385.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31385.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Severe", "code_information": [{"code": "680.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 69653.37, "maximum": 69653.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69653.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Pancreas, Liver And Shunt Procedures, Major", "code_information": [{"code": "260.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40904.2, "maximum": 40904.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40904.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Pancreas, Liver And Shunt Procedures, Minor", "code_information": [{"code": "260.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21292.12, "maximum": 21292.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21292.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Pancreas, Liver And Shunt Procedures, Moderate", "code_information": [{"code": "260.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32700.04, "maximum": 32700.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32700.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Pancreas, Liver And Shunt Procedures, Severe", "code_information": [{"code": "260.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 150981.2, "maximum": 150981.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 150981.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory And Chest Procedures, Major", "code_information": [{"code": "120.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46149.38, "maximum": 46149.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46149.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory And Chest Procedures, Minor", "code_information": [{"code": "120.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23553.97, "maximum": 23553.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23553.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory And Chest Procedures, Moderate", "code_information": [{"code": "120.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30007.6, "maximum": 30007.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30007.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory And Chest Procedures, Severe", "code_information": [{"code": "120.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 93831.43, "maximum": 93831.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93831.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory Infections And Inflammations, Major", "code_information": [{"code": "137.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14287.44, "maximum": 14287.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14287.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory Infections And Inflammations, Minor", "code_information": [{"code": "137.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11020.9, "maximum": 11020.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11020.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory Infections And Inflammations, Moderate", "code_information": [{"code": "137.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13510.85, "maximum": 13510.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13510.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Respiratory Infections And Inflammations, Severe", "code_information": [{"code": "137.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23401.47, "maximum": 23401.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23401.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Skin Disorders, Major", "code_information": [{"code": "381.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24472.81, "maximum": 24472.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24472.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Skin Disorders, Minor", "code_information": [{"code": "381.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6207.59, "maximum": 6207.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6207.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Skin Disorders, Moderate", "code_information": [{"code": "381.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7117.45, "maximum": 7117.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7117.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Skin Disorders, Severe", "code_information": [{"code": "381.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36741.89, "maximum": 36741.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36741.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Small Bowel Procedures, Major", "code_information": [{"code": "230.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32555.23, "maximum": 32555.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32555.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Small Bowel Procedures, Minor", "code_information": [{"code": "230.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18169.11, "maximum": 18169.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18169.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Small Bowel Procedures, Moderate", "code_information": [{"code": "230.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23140.05, "maximum": 23140.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23140.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Small Bowel Procedures, Severe", "code_information": [{"code": "230.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 71260.37, "maximum": 71260.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 71260.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Stomach, Esophageal And Duodenal Procedures, Major", "code_information": [{"code": "220.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31841.43, "maximum": 31841.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31841.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Stomach, Esophageal And Duodenal Procedures, Minor", "code_information": [{"code": "220.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16718.45, "maximum": 16718.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16718.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Stomach, Esophageal And Duodenal Procedures, Moderate", "code_information": [{"code": "220.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23601.39, "maximum": 23601.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23601.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Major Stomach, Esophageal And Duodenal Procedures, Severe", "code_information": [{"code": "220.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 85463.24, "maximum": 85463.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85463.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Male Reproductive System Diagnoses Except Malignancy, Major", "code_information": [{"code": "501.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14346.39, "maximum": 14346.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14346.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Male Reproductive System Diagnoses Except Malignancy, Minor", "code_information": [{"code": "501.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7600.58, "maximum": 7600.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7600.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Male Reproductive System Diagnoses Except Malignancy, Moderate", "code_information": [{"code": "501.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10560.84, "maximum": 10560.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10560.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Male Reproductive System Diagnoses Except Malignancy, Severe", "code_information": [{"code": "501.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34119.94, "maximum": 34119.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34119.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction And Complication Of Gastrointestinal Device Or Procedure, Major", "code_information": [{"code": "252.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15116.57, "maximum": 15116.57, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15116.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction And Complication Of Gastrointestinal Device Or Procedure, Minor", "code_information": [{"code": "252.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10005.95, "maximum": 10005.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10005.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction And Complication Of Gastrointestinal Device Or Procedure, Moderate", "code_information": [{"code": "252.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11803.9, "maximum": 11803.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11803.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction And Complication Of Gastrointestinal Device Or Procedure, Severe", "code_information": [{"code": "252.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33195.98, "maximum": 33195.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33195.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Cardiac Or Vascular Device Or Procedure, Major", "code_information": [{"code": "206.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13473.69, "maximum": 13473.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13473.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Cardiac Or Vascular Device Or Procedure, Minor", "code_information": [{"code": "206.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10213.56, "maximum": 10213.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10213.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Cardiac Or Vascular Device Or Procedure, Moderate", "code_information": [{"code": "206.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12125.55, "maximum": 12125.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12125.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Cardiac Or Vascular Device Or Procedure, Severe", "code_information": [{"code": "206.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31316.02, "maximum": 31316.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31316.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure, Major", "code_information": [{"code": "466.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12688.13, "maximum": 12688.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12688.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure, Minor", "code_information": [{"code": "466.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6800.92, "maximum": 6800.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6800.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure, Moderate", "code_information": [{"code": "466.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7663.37, "maximum": 7663.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7663.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Genitourinary Device Or Procedure, Severe", "code_information": [{"code": "466.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19923.48, "maximum": 19923.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19923.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure, Major", "code_information": [{"code": "349.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19158.43, "maximum": 19158.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19158.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure, Minor", "code_information": [{"code": "349.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6411.34, "maximum": 6411.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6411.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure, Moderate", "code_information": [{"code": "349.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13037.98, "maximum": 13037.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13037.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malfunction, Reaction, Complication Of Orthopedic Device Or Procedure, Severe", "code_information": [{"code": "349.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27717.56, "maximum": 27717.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27717.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy Of Hepatobiliary System And Pancreas, Major", "code_information": [{"code": "281.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16590.3, "maximum": 16590.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16590.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy Of Hepatobiliary System And Pancreas, Minor", "code_information": [{"code": "281.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7114.89, "maximum": 7114.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7114.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy Of Hepatobiliary System And Pancreas, Moderate", "code_information": [{"code": "281.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13203.29, "maximum": 13203.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13203.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy Of Hepatobiliary System And Pancreas, Severe", "code_information": [{"code": "281.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28956.77, "maximum": 28956.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28956.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy, Male Reproductive System, Major", "code_information": [{"code": "500.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15864.97, "maximum": 15864.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15864.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy, Male Reproductive System, Minor", "code_information": [{"code": "500.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6872.68, "maximum": 6872.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6872.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy, Male Reproductive System, Moderate", "code_information": [{"code": "500.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10640.29, "maximum": 10640.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10640.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignancy, Male Reproductive System, Severe", "code_information": [{"code": "500.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28218.63, "maximum": 28218.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28218.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignant Breast Disorders, Major", "code_information": [{"code": "382.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14655.23, "maximum": 14655.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14655.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignant Breast Disorders, Minor", "code_information": [{"code": "382.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8391.26, "maximum": 8391.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8391.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignant Breast Disorders, Moderate", "code_information": [{"code": "382.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8392.54, "maximum": 8392.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8392.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malignant Breast Disorders, Severe", "code_information": [{"code": "382.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25390.36, "maximum": 25390.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25390.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malnutrition, Failure To Thrive And Other Nutritional Disorders, Major", "code_information": [{"code": "421.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14427.13, "maximum": 14427.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14427.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malnutrition, Failure To Thrive And Other Nutritional Disorders, Minor", "code_information": [{"code": "421.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10341.71, "maximum": 10341.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10341.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malnutrition, Failure To Thrive And Other Nutritional Disorders, Moderate", "code_information": [{"code": "421.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11026.03, "maximum": 11026.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11026.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Malnutrition, Failure To Thrive And Other Nutritional Disorders, Severe", "code_information": [{"code": "421.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29874.33, "maximum": 29874.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29874.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Management Services For Remote Therapeutic Monitoring Of Standardized Online Digital Cognitive Behavioral Therapy Program, Per 30 Days", "code_information": [{"code": "703T", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mastectomy Procedures, Major", "code_information": [{"code": "362.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32958.9, "maximum": 32958.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32958.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mastectomy Procedures, Minor", "code_information": [{"code": "362.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13164.85, "maximum": 13164.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13164.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mastectomy Procedures, Moderate", "code_information": [{"code": "362.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30652.2, "maximum": 30652.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30652.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mastectomy Procedures, Severe", "code_information": [{"code": "362.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 58523.54, "maximum": 58523.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 58523.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Matristem wound matrix", "code_information": [{"code": "Q4119", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Md mang high risk dx 30", "code_information": [{"code": "G2064", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 100 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "148U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 120 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "143U", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 183.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 120 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "150U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 160 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "144U", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 183.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 60 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "149U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 65 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "145U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 80 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "146U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of 85 Or More Drugs Or Metabolites In Urine Specimen", "code_information": [{"code": "147U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of Diameters Of Pelvis In Female", "code_information": [{"code": "74710", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of Exhaled Carbon Dioxide Gas", "code_information": [{"code": "94770", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of Lung Stretching Capacity", "code_information": [{"code": "94750", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Measurement Of Placental Alpha-Micro Globulin-1 (Pamg-1) In Cervical/Vaginal Fluid To Evaluate Risk Of Premature Rupture Of Membranes", "code_information": [{"code": "66U", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Medical Rehabilitation Day Program Education/Training", "code_information": [{"code": "942", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Intracular Lens", "code_information": [{"code": "276", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Nonsterile", "code_information": [{"code": "271", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Other Implants", "code_information": [{"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Sterile", "code_information": [{"code": "272", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices, Prosthetic/Orthotic Devices", "code_information": [{"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Menstrual And Other Female Reproductive System Disorders, Major", "code_information": [{"code": "532.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10618.51, "maximum": 10618.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10618.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Menstrual And Other Female Reproductive System Disorders, Minor", "code_information": [{"code": "532.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5606.56, "maximum": 5606.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5606.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Menstrual And Other Female Reproductive System Disorders, Moderate", "code_information": [{"code": "532.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7213.56, "maximum": 7213.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7213.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Menstrual And Other Female Reproductive System Disorders, Severe", "code_information": [{"code": "532.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20159.28, "maximum": 20159.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20159.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mental Illness Diagnosis With O.R. Procedure, Major", "code_information": [{"code": "740.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35637.23, "maximum": 35637.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35637.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mental Illness Diagnosis With O.R. Procedure, Minor", "code_information": [{"code": "740.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16685.13, "maximum": 16685.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16685.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mental Illness Diagnosis With O.R. Procedure, Moderate", "code_information": [{"code": "740.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19473.67, "maximum": 19473.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19473.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mental Illness Diagnosis With O.R. Procedure, Severe", "code_information": [{"code": "740.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 86202.66, "maximum": 86202.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 86202.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Migraine And Other Headaches, Major", "code_information": [{"code": "54.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14803.89, "maximum": 14803.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14803.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Migraine And Other Headaches, Minor", "code_information": [{"code": "54.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8101.64, "maximum": 8101.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8101.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Migraine And Other Headaches, Moderate", "code_information": [{"code": "54.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10246.87, "maximum": 10246.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10246.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Migraine And Other Headaches, Severe", "code_information": [{"code": "54.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19564.66, "maximum": 19564.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19564.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mobility d/c status", "code_information": [{"code": "G8980", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mobility goal status", "code_information": [{"code": "G8979", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis, Major", "code_information": [{"code": "951.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37447.99, "maximum": 37447.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37447.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis, Minor", "code_information": [{"code": "951.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14996.11, "maximum": 14996.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14996.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis, Moderate", "code_information": [{"code": "951.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20767.99, "maximum": 20767.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20767.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedure Unrelated To Principal Diagnosis, Severe", "code_information": [{"code": "951.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53178.41, "maximum": 53178.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53178.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedures For Other Complications Of Treatment, Major", "code_information": [{"code": "793.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25724.83, "maximum": 25724.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25724.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedures For Other Complications Of Treatment, Minor", "code_information": [{"code": "793.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16349.38, "maximum": 16349.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16349.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedures For Other Complications Of Treatment, Moderate", "code_information": [{"code": "793.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18536.9, "maximum": 18536.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18536.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderately Extensive O.R. Procedures For Other Complications Of Treatment, Severe", "code_information": [{"code": "793.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62473.13, "maximum": 62473.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62473.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderna Covid-19 Vaccine (Red Cap) (Low Dose) Administration - Booster", "code_information": [{"code": "64A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Moderna Covid-19 Vaccine (Red Cap) Administration \u2013 Third Dose", "code_information": [{"code": "13A", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Molecular Pathology Test For Risk Of Serious Liver Disease Within 5 Years (Enhanced Liver Fibrosis (Elf) Test)", "code_information": [{"code": "14M", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Morphine sulfate injection", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2275", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Mri w/o cont, breast, bi", "code_information": [{"code": "C8907", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mri w/o cont, breast, uni", "code_information": [{"code": "C8904", "type": "HCPCS"}], "standard_charges": [{"minimum": 521.1, "maximum": 521.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 521.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Mrna Gene Analysis Of 108 Genes In Fine Needle Aspiration Thyroid Specimen, Reported As Positive Or Negative For Medullary Thyroid Carcinoma", "code_information": [{"code": "208U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies, Major", "code_information": [{"code": "43.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25724.83, "maximum": 25724.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25724.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies, Minor", "code_information": [{"code": "43.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10873.53, "maximum": 10873.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10873.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies, Moderate", "code_information": [{"code": "43.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12868.82, "maximum": 12868.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12868.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies, Severe", "code_information": [{"code": "43.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46537.67, "maximum": 46537.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46537.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Significant Trauma Without O.R. Procedure, Major", "code_information": [{"code": "930.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14552.71, "maximum": 14552.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14552.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Significant Trauma Without O.R. Procedure, Minor", "code_information": [{"code": "930.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7868.41, "maximum": 7868.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7868.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Significant Trauma Without O.R. Procedure, Moderate", "code_information": [{"code": "930.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9472.85, "maximum": 9472.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9472.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Multiple Significant Trauma Without O.R. Procedure, Severe", "code_information": [{"code": "930.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50708.96, "maximum": 50708.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50708.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal And Other Procedures For Multiple Significant Trauma, Major", "code_information": [{"code": "912.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50605.15, "maximum": 50605.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50605.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal And Other Procedures For Multiple Significant Trauma, Minor", "code_information": [{"code": "912.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28526.19, "maximum": 28526.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28526.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal And Other Procedures For Multiple Significant Trauma, Moderate", "code_information": [{"code": "912.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28931.14, "maximum": 28931.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28931.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal And Other Procedures For Multiple Significant Trauma, Severe", "code_information": [{"code": "912.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 89000.18, "maximum": 89000.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89000.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy, Major", "code_information": [{"code": "343.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21986.7, "maximum": 21986.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21986.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy, Minor", "code_information": [{"code": "343.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12940.59, "maximum": 12940.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12940.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy, Moderate", "code_information": [{"code": "343.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16549.29, "maximum": 16549.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16549.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Musculoskeletal Malignancy And Pathological Fracture Due To Musculoskeletal Malignancy, Severe", "code_information": [{"code": "343.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35184.86, "maximum": 35184.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35184.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ CERVICAL", "code_information": [{"code": "64413", "type": "CPT"}, {"code": "3480103080", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1538.42, "gross_charge": 1586.0, "discounted_cash": 2379.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1348.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1189.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1110.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1538.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1110.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1189.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1348.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1268.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ COMMON DIGIT", "code_information": [{"code": "64632", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ HYPOGAS PLXS", "code_information": [{"code": "64517", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK OTHER PERIPH", "code_information": [{"code": "64450", "type": "CPT"}, {"code": "3480103199", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1773.16, "gross_charge": 1828.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1553.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1371.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1279.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1773.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1279.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1371.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1553.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1462.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK OTHER PERIPH", "code_information": [{"code": "64450", "type": "CPT"}, {"code": "3480103273", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2117.51, "gross_charge": 2183.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1855.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1637.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1528.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2117.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1528.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1637.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1855.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1746.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N-INVAS ARTL PLAQ ALYS", "code_information": [{"code": "710T", "type": "CPT"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS QUAN", "code_information": [{"code": "712T", "type": "CPT"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N. GONORRHOEAE ASSAY W/OPTIC", "code_information": [{"code": "87850", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.56, "discounted_cash": 39.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA DIR PROB", "code_information": [{"code": "87590", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 26.88, "discounted_cash": 43.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA QUANT", "code_information": [{"code": "87592", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 42.84, "discounted_cash": 68.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NA FERRIC GLUCONATE COMPLEX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2916", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.18, "maximum": 2.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NABILONE ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8650", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.45, "maximum": 33.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAGNETOENCEPHALOGRAP", "code_information": [{"code": "95965", "type": "CPT"}, {"code": "3340102430", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 486.39, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 1600.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1103.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1088.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1098.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1269.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1066.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1088.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 486.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL 10 X 240*04.008", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2551.64, "maximum": 3535.84, "gross_charge": 3645.2, "discounted_cash": 5467.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3098.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2733.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2551.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3535.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2551.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2733.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3098.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2916.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL 12 X 240*04.008", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2551.64, "maximum": 3535.84, "gross_charge": 3645.2, "discounted_cash": 5467.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3098.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2733.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2551.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3535.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2551.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2733.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3098.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2916.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL ANKLE 10X200*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5205.62, "maximum": 7213.5, "gross_charge": 7436.6, "discounted_cash": 11154.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7213.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5949.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL ANKLE 11X200*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5205.62, "maximum": 7213.5, "gross_charge": 7436.6, "discounted_cash": 11154.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7213.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5949.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL ANKLE 11X200*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4264.4, "maximum": 5909.24, "gross_charge": 6092.0, "discounted_cash": 9138.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5178.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4569.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4264.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5909.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4264.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4569.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5178.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4873.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL CANN SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4728.5, "maximum": 6552.35, "gross_charge": 6755.0, "discounted_cash": 10132.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5741.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5066.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4728.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6552.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4728.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5066.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5741.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5404.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL ELASTIC 1.5MM*4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 656.77, "maximum": 910.1, "gross_charge": 938.25, "discounted_cash": 1407.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 797.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 703.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 656.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 910.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 656.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 703.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 797.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 750.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL ELASTIC 2.0MM*4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 697.72, "maximum": 966.84, "gross_charge": 996.75, "discounted_cash": 1495.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 847.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 747.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 697.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 966.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 697.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 747.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 847.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 797.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FEMORAL 300*04.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3465.77, "maximum": 4802.56, "gross_charge": 4951.1, "discounted_cash": 7426.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4208.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3713.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3465.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4802.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3465.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3713.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4208.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3960.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FEMORAL 320*04.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3569.47, "maximum": 4946.27, "gross_charge": 5099.25, "discounted_cash": 7648.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4334.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3824.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3569.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4946.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3569.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3824.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4334.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4079.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FEMORAL 340*04.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4092.99, "maximum": 5671.72, "gross_charge": 5847.14, "discounted_cash": 8770.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4970.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4385.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4092.99, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5671.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4092.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4385.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4970.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4677.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA 3.0X130*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA 3.8X180*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA LT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA LT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA LT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5723.44, "maximum": 7931.05, "gross_charge": 8176.35, "discounted_cash": 12264.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6949.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6132.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5723.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7931.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5723.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6132.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6949.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6541.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA LT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL FIBULA RT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL HEADED STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL HEADED STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 296.8, "maximum": 411.28, "gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 360.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 318.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 411.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 296.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 318.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 360.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 339.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IM 1.8X30*IMN1.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2966.6, "maximum": 4110.86, "gross_charge": 4238.0, "discounted_cash": 6357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4110.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IM 2.4X40*IMN2.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2966.6, "maximum": 4110.86, "gross_charge": 4238.0, "discounted_cash": 6357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4110.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IM 2.7X60*IMN2.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2229.5, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IMN 3.0X45*IMN3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2966.6, "maximum": 4110.86, "gross_charge": 4238.0, "discounted_cash": 6357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4110.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IMN 3.0X55*IMN3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2229.5, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IMN 3.0X60*IMN3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2229.5, "maximum": 3089.45, "gross_charge": 3185.0, "discounted_cash": 4777.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3089.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2229.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2388.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2707.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IMN3.0X40*IMN3.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2966.6, "maximum": 4110.86, "gross_charge": 4238.0, "discounted_cash": 6357.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4110.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2966.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3178.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3602.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IMPL MINI 4.0*I", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL IMPL STAND 4.0*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL LT 10 X 200*181", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5205.62, "maximum": 7213.5, "gross_charge": 7436.6, "discounted_cash": 11154.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7213.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5949.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL LT 11 X 200*181", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5205.62, "maximum": 7213.5, "gross_charge": 7436.6, "discounted_cash": 11154.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7213.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5205.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5577.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6321.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5949.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL RF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4812.5, "maximum": 6668.75, "gross_charge": 6875.0, "discounted_cash": 10312.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5843.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5156.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4812.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6668.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4812.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5156.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5843.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5500.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL STYRKER HUMERAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3473.4, "maximum": 4813.14, "gross_charge": 4962.0, "discounted_cash": 7443.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4813.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3473.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3721.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4217.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3969.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL SYNTHES CANN TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3657.5, "maximum": 5068.25, "gross_charge": 5225.0, "discounted_cash": 7837.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4441.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3918.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3657.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5068.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3657.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3918.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4441.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL TI CANN 8X300MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2649.46, "maximum": 3671.4, "gross_charge": 3784.95, "discounted_cash": 5677.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3217.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2838.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2649.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3671.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2649.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2838.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3217.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3027.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2998.8, "maximum": 4155.48, "gross_charge": 4284.0, "discounted_cash": 6426.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3641.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3213.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2998.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4155.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2998.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3213.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3641.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3427.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NAIL VANGUARD BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NALBUPHINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2300", "type": "HCPCS"}, {"code": "3400300085", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.82, "maximum": 39.96, "gross_charge": 41.2, "discounted_cash": 61.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NALOXONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2310", "type": "HCPCS"}, {"code": "3400300090", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 4.97, "maximum": 8.06, "gross_charge": 7.1, "discounted_cash": 10.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NALOXONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2312", "type": "HCPCS"}, {"code": "3400300081", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 19.2, "discounted_cash": 28.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NALTREXONE, DEPOT FORM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2315", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.97, "maximum": 3.97, "discounted_cash": 6.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NANDROLONE DECANOATE 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NANO CANNULA 1.5CM*A", "code_information": [{"code": "3100206210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO CANNULA 3CM*AR1", "code_information": [{"code": "3100205884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO HF SHEATH KIT*A", "code_information": [{"code": "3100205882", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO NEEDLE 125MM*AR", "code_information": [{"code": "3100207810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO NEEDLE KIT *AR-", "code_information": [{"code": "3100207811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO NEEDLE KIT *AR-", "code_information": [{"code": "3100207992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO PERC INSERT KIT", "code_information": [{"code": "3100205883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NANO SPACER 14MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NANO SPACER 16MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NANO SWIVEL 2.5 X 7*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NANOBITER 70 DISP*AR", "code_information": [{"code": "3100206502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 834.75, "discounted_cash": 1252.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOBITER 70 DISP*AR", "code_information": [{"code": "3100206875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 834.75, "discounted_cash": 1252.13, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOBITER 70 DISP*AR", "code_information": [{"code": "3100207067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOBITER STR DISP*A", "code_information": [{"code": "3100208323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOPASS CRESCENT*CA", "code_information": [{"code": "3100209464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 729.57, "discounted_cash": 1094.36, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOSCOPE HANDLE*AR-", "code_information": [{"code": "3100206299", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOSCOPE HANDPIECE*", "code_information": [{"code": "3100205336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1977.0, "discounted_cash": 2965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NANOSCOPE PROBE*AR-1", "code_information": [{"code": "3100206298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NARCOSYNTHESIS", "code_information": [{"code": "90865", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NARROW REAR TIP EXTE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 609.0, "maximum": 843.9, "gross_charge": 870.0, "discounted_cash": 1305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NARROW SAW BLADE*200", "code_information": [{"code": "3100208106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 783.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL AIRWAY", "code_information": [{"code": "3100103987", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL CONTROL OF HEM", "code_information": [{"code": "30901", "type": "CPT"}, {"code": "3480101837", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 277.43, "gross_charge": 273.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 264.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOP PO DEBRID", "code_information": [{"code": "S2342", "type": "HCPCS"}], "standard_charges": [{"minimum": 2615.71, "maximum": 2615.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL ENDOSCOPY, DIA", "code_information": [{"code": "31231", "type": "CPT"}, {"code": "3480101847", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 303.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 240.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL FUNCTION STUDIES", "code_information": [{"code": "92512", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL IMPLANT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL IMPLANT KIT*LA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4358.9, "maximum": 6040.19, "gross_charge": 6227.0, "discounted_cash": 9340.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5292.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4670.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4358.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6040.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4358.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4670.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5292.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4981.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL IMPLANT KIT*LA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3516.24, "maximum": 4872.5, "gross_charge": 5023.2, "discounted_cash": 7534.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4269.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3767.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3516.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4872.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3516.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3767.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4269.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4018.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL PROSTHESIS", "code_information": [{"code": "D5913", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL SEPTAL PROSTHESIS", "code_information": [{"code": "D5922", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL SINUS THERAPY", "code_information": [{"code": "30210", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL SMEAR FOR EOSINOPHILS", "code_information": [{"code": "89190", "type": "CPT"}], "standard_charges": [{"minimum": 5.79, "maximum": 35.16, "discounted_cash": 9.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL SPLINT DENVER", "code_information": [{"code": "3100101104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 271.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL SPLINT DENVER", "code_information": [{"code": "3100104412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 182.0, "discounted_cash": 273.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL SPLINT RHINO", "code_information": [{"code": "3100101105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NASAL VACCINE INHALATION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3530", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NASAL/OROGASTRIC W/TUBE PLMT", "code_information": [{"code": "43752", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31237", "type": "CPT"}, {"code": "3480103035", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4590.04, "gross_charge": 4732.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4590.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3785.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31238", "type": "CPT"}, {"code": "3480101848", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4590.04, "gross_charge": 4732.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4590.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3312.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4022.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3785.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31239", "type": "CPT"}, {"code": "3480101849", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8257.61, "gross_charge": 8513.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8257.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6810.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31240", "type": "CPT"}, {"code": "3480101850", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8257.61, "gross_charge": 8513.0, "discounted_cash": 2597.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1790.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8257.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1783.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2061.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6810.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1731.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1766.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31254", "type": "CPT"}, {"code": "3480101851", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8311.19, "gross_charge": 8513.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8257.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6810.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31255", "type": "CPT"}, {"code": "3480101852", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31256", "type": "CPT"}, {"code": "3480101853", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6881.18, "gross_charge": 7094.0, "discounted_cash": 5732.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3951.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3936.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4547.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3821.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3897.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31267", "type": "CPT"}, {"code": "3480101854", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31287", "type": "CPT"}, {"code": "3480101856", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOP", "code_information": [{"code": "31288", "type": "CPT"}, {"code": "3480101857", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31290", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY SURG", "code_information": [{"code": "31291", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS NDSC SUR", "code_information": [{"code": "31295", "type": "CPT"}, {"code": "3480101858", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2624.17, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS NDSC SUR", "code_information": [{"code": "31296", "type": "CPT"}, {"code": "3480101859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2615.71, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS NDSC SUR", "code_information": [{"code": "31297", "type": "CPT"}, {"code": "3480101860", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2615.71, "maximum": 8311.19, "gross_charge": 8513.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8257.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5959.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6384.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7236.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6810.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NASASTENT *RR1000", "code_information": [{"code": "3100202746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.68, "discounted_cash": 718.02, "setting": "both", "billing_class": "facility"}]}, {"description": "NASOPHARYNGOSCOPY", "code_information": [{"code": "92511", "type": "CPT"}, {"code": "3340102429", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 510.22, "gross_charge": 526.0, "discounted_cash": 303.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 240.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 202.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 206.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NATALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2323", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.23, "maximum": 24.23, "discounted_cash": 39.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NATRIURETIC PEPTIDE", "code_information": [{"code": "83880", "type": "CPT"}, {"code": "3440100956", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 39.26, "maximum": 295.85, "gross_charge": 305.0, "discounted_cash": 63.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 295.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 50.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NAV DRILL BIT 2.4*NA", "code_information": [{"code": "3100203052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NAVIGATION PATIENT M", "code_information": [{"code": "3100101106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.0, "discounted_cash": 1000.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NAVIGATIONAL BRONCHOSCOPY", "code_information": [{"code": "31627", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NB RESUSCITATION", "code_information": [{"code": "99465", "type": "CPT"}], "standard_charges": [{"minimum": 1138.31, "maximum": 1138.31, "discounted_cash": 996.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1138.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL EMG 2 XTR", "code_information": [{"code": "95861", "type": "CPT"}, {"code": "3480102242", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 610.13, "gross_charge": 629.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 534.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 440.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 610.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 440.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 534.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 503.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL EMG CRANIAL NRV", "code_information": [{"code": "95867", "type": "CPT"}, {"code": "3340102341", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 571.33, "gross_charge": 589.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 500.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 571.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 500.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 471.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL EMG LARYNX", "code_information": [{"code": "95865", "type": "CPT"}, {"code": "3480103015", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 414.74, "gross_charge": 262.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 254.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 209.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL EMG LTD 1 XTR/NO", "code_information": [{"code": "95870", "type": "CPT"}, {"code": "3480103013", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 414.74, "gross_charge": 263.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 255.11, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 1 OR 2 MUSC", "code_information": [{"code": "20560", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL INSJ W/O NJX 3+ MUSC", "code_information": [{"code": "20561", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDL OCULOELECTROMYOGRAPHY 1+", "code_information": [{"code": "92265", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 189.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDSC DCMPRN 1 NTRSPC LUMBAR", "code_information": [{"code": "62380", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEAR IFR 2IMG MIBMN GLND I&R", "code_information": [{"code": "507T", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEBULIZER TX INITIAL", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "3310100275", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 259.0, "gross_charge": 231.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEBULIZER TX SUBSEQ", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "3310100276", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 259.0, "gross_charge": 231.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE DISK SURGERY", "code_information": [{"code": "63076", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE FUS AND R", "code_information": [{"code": "22551", "type": "CPT"}, {"code": "3480101496", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7959.27, "maximum": 15981.88, "gross_charge": 13155.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE FUSION BE", "code_information": [{"code": "22554", "type": "CPT"}, {"code": "3480101498", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7959.27, "maximum": 15981.88, "gross_charge": 13155.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NECK SPINE FUSION BE", "code_information": [{"code": "22600", "type": "CPT"}, {"code": "3480101502", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2641.8, "maximum": 7959.27, "gross_charge": 3774.0, "discounted_cash": 5661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3207.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2641.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3660.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2641.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3207.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3019.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE", "code_information": [{"code": "3100101135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE", "code_information": [{"code": "3100104551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 282.0, "discounted_cash": 423.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 11G JAMSHIDI*", "code_information": [{"code": "3100205454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.24, "discounted_cash": 276.36, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 6IN DIAMOND", "code_information": [{"code": "3100101107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS", "code_information": [{"code": "3100102202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS PORT", "code_information": [{"code": "3100101108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACQUIRE 19GA*", "code_information": [{"code": "3100203665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACQUIRE 22GA*", "code_information": [{"code": "3100203664", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACQUIRE 25GA*", "code_information": [{"code": "3100203663", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ANGIO CATH 16", "code_information": [{"code": "3100208362", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.08, "discounted_cash": 76.62, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ARROW", "code_information": [{"code": "3100101109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.5, "discounted_cash": 33.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION", "code_information": [{"code": "3100101110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 504.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION", "code_information": [{"code": "3100104556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY", "code_information": [{"code": "3100101111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY", "code_information": [{"code": "3100102912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY", "code_information": [{"code": "3100102913", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.0, "discounted_cash": 88.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1282.05, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LIVER", "code_information": [{"code": "47001", "type": "CPT"}, {"code": "3340102354", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 239.4, "maximum": 1083.58, "gross_charge": 342.0, "discounted_cash": 513.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 290.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 256.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 239.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 331.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 239.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 256.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 290.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 273.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY LYMPH", "code_information": [{"code": "38505", "type": "CPT"}, {"code": "3480103320", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3729.65, "gross_charge": 3845.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3268.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2691.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3729.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2691.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3268.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY SPINAL CORD", "code_information": [{"code": "62269", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY TRUCUT", "code_information": [{"code": "3100206556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BLADE CUTTING", "code_information": [{"code": "3100101112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BMA 11GA*710.", "code_information": [{"code": "3100202926", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 616.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BMA STRYKER", "code_information": [{"code": "3100101113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BMA STRYKER", "code_information": [{"code": "3100103918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 481.0, "discounted_cash": 721.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BMA SYNTHES", "code_information": [{"code": "3100101114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 411.0, "discounted_cash": 616.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BMA SYNTHES", "code_information": [{"code": "3100102914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 618.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE", "code_information": [{"code": "3100102203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW*7", "code_information": [{"code": "3100203109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BONE MARROW*7", "code_information": [{"code": "3100204828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BOVIE EDGE", "code_information": [{"code": "3100101115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CATHETER*G094", "code_information": [{"code": "3100206888", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.96, "discounted_cash": 95.94, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CERCLAGE PASS", "code_information": [{"code": "3100203872", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CHIBA 22GA*54", "code_information": [{"code": "3100203331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.76, "discounted_cash": 53.64, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COLORADO MICR", "code_information": [{"code": "3100101116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 295.72, "discounted_cash": 443.58, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CONTRAST", "code_information": [{"code": "3100101117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE", "code_information": [{"code": "3100101118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE", "code_information": [{"code": "3100102915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE", "code_information": [{"code": "3100102916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE", "code_information": [{"code": "3100104452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 102.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CURVED", "code_information": [{"code": "3100104662", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE DELIVERY", "code_information": [{"code": "3100101119", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 307.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ELECTROMYGRAP", "code_information": [{"code": "95860", "type": "CPT"}, {"code": "3480103054", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 130.35, "maximum": 414.74, "gross_charge": 232.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 197.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 225.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 197.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 185.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE ELECTROMYGRAP", "code_information": [{"code": "95886", "type": "CPT"}, {"code": "3480103314", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 277.2, "maximum": 414.74, "gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 384.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 316.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEEDLE EPIDURAL", "code_information": [{"code": "3100101120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPIDURAL", "code_information": [{"code": "3100102917", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPIDURAL", "code_information": [{"code": "3100102918", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPIDURAL 14GA", "code_information": [{"code": "3100203860", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EPIDURAL 4IN*", "code_information": [{"code": "3100204762", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EXPECT 22GA*M", "code_information": [{"code": "3100203667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EXPECT 25GA*M", "code_information": [{"code": "3100203666", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE EZ-IO 45MM*90", "code_information": [{"code": "3100206353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.4, "discounted_cash": 819.6, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FENESTRATED D", "code_information": [{"code": "3100101121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FLEX", "code_information": [{"code": "3100104004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 238.0, "discounted_cash": 357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FLEX 70CM 22G", "code_information": [{"code": "3100207984", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 258.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FORAMEN 20GA*", "code_information": [{"code": "3100203373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FORAMEN COATE", "code_information": [{"code": "3100101122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FREE ANCHOR", "code_information": [{"code": "3100101123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE FREE ANCHOR", "code_information": [{"code": "3100102919", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE HOLDER FINE", "code_information": [{"code": "3100104121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE HUBER", "code_information": [{"code": "3100101124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE IMPL SEED 17X", "code_information": [{"code": "3100203085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.8, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE IMPL SEED 17X", "code_information": [{"code": "3100203086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.8, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INFU SET", "code_information": [{"code": "3100101125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INSUFFLATION", "code_information": [{"code": "3100102282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRA OSSEOUS", "code_information": [{"code": "3100101126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRA OSSEOUS", "code_information": [{"code": "3100102920", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE INTRODUCTION", "code_information": [{"code": "3100101127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 181.0, "discounted_cash": 271.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE IRRIG/INJ", "code_information": [{"code": "3100104088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 262.0, "discounted_cash": 393.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE JAM SHIDI", "code_information": [{"code": "3100101128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE KNIFE*M005458", "code_information": [{"code": "3100203683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE LABORIE CYSTO", "code_information": [{"code": "3100101129", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MENISCAL STR", "code_information": [{"code": "3100104138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MODULE NVMS E", "code_information": [{"code": "3100101130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3304.0, "discounted_cash": 4956.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE MTCH-GRD FACE", "code_information": [{"code": "3100101131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NEUROTHERM", "code_information": [{"code": "3100101132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NEUROTHERM", "code_information": [{"code": "3100102921", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NIM BLUNT*PK1", "code_information": [{"code": "3100206009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE NIM TROCAR*PK", "code_information": [{"code": "3100207481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1188.0, "discounted_cash": 1782.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE PNEUMO", "code_information": [{"code": "3100102204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE POWERLOC 20X1", "code_information": [{"code": "3100202924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.8, "discounted_cash": 37.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE REVERSE CUT*A", "code_information": [{"code": "3100204612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.8, "discounted_cash": 119.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RF", "code_information": [{"code": "3100101133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RF ACT TIP", "code_information": [{"code": "3100101134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RF ACT TIP", "code_information": [{"code": "3100102922", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RF ACT TIP", "code_information": [{"code": "3100102924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RF CURVED", "code_information": [{"code": "3100101136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE RF NEUROTHERM", "code_information": [{"code": "3100101137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SCORPIAN", "code_information": [{"code": "3100101138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SCORPIAN", "code_information": [{"code": "3100102926", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 612.3, "discounted_cash": 918.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SCORPIAN", "code_information": [{"code": "3100103803", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SCORPION", "code_information": [{"code": "3100104565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SECLO", "code_information": [{"code": "3100104647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.6, "discounted_cash": 57.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SMK CURVED ST", "code_information": [{"code": "3100103999", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 144.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPEC TECHN", "code_information": [{"code": "3100101139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPECIAL TECH", "code_information": [{"code": "3100101140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL", "code_information": [{"code": "3100101141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL", "code_information": [{"code": "3100102927", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL", "code_information": [{"code": "3100104671", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINAL 20GX6*", "code_information": [{"code": "3100206649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.36, "discounted_cash": 63.54, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPINE", "code_information": [{"code": "3100103963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPROTTE", "code_information": [{"code": "3100101142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPROTTE", "code_information": [{"code": "3100102928", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPROTTE", "code_information": [{"code": "3100102929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPROTTE", "code_information": [{"code": "3100102930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SPROTTE", "code_information": [{"code": "3100102931", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 112.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE STAMEY", "code_information": [{"code": "3100101143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE STIMUPLEX", "code_information": [{"code": "3100101144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE STIMUPLEX", "code_information": [{"code": "3100102932", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE STIMUPLX 20GX", "code_information": [{"code": "3100208479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.04, "discounted_cash": 79.56, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE SYNTHES", "code_information": [{"code": "3100101145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.0, "discounted_cash": 436.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TAPERE CURVED", "code_information": [{"code": "3100203921", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TROCAR 18GA*G", "code_information": [{"code": "3100204893", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.2, "discounted_cash": 85.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TROCAR 2-PART", "code_information": [{"code": "3100205721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.2, "discounted_cash": 85.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TUOHY", "code_information": [{"code": "3100101146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TUOHY", "code_information": [{"code": "3100102933", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TUOHY DELIVER", "code_information": [{"code": "3100101147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE TUOHY DELIVER", "code_information": [{"code": "3100102934", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLES IVAS", "code_information": [{"code": "3100104536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEFF PERC ACCESS SET", "code_information": [{"code": "3100205499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.08, "discounted_cash": 342.12, "setting": "both", "billing_class": "facility"}]}, {"description": "NEG PRESS VENTILATION CNP", "code_information": [{"code": "94662", "type": "CPT"}], "standard_charges": [{"minimum": 1634.49, "maximum": 1634.49, "discounted_cash": 959.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1634.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THER NDME>50SQCM", "code_information": [{"code": "97608", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEG PRS WND THR NDME<=50SQCM", "code_information": [{"code": "97607", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEISSERIA MENINGITIDIS", "code_information": [{"code": "86741", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NELARABINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9261", "type": "HCPCS"}], "standard_charges": [{"minimum": 101.93, "maximum": 101.93, "discounted_cash": 178.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 101.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOGUARD COVER*610-1", "code_information": [{"code": "3100203127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.48, "discounted_cash": 17.22, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMYXIN/D", "code_information": [{"code": "3400300224", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 24.5, "discounted_cash": 36.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [{"code": "794", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2041.25, "maximum": 2041.25, "discounted_cash": 16634.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2041.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [{"code": "789", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1498.97, "maximum": 1498.97, "discounted_cash": 20312.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1498.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOPATCH OR THERION, 1 SQ CM", "code_information": [{"code": "Q4176", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.92, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEOSTIGMINE METHYLSU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2710", "type": "HCPCS"}, {"code": "3400300173", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.57, "maximum": 9.4, "gross_charge": 9.7, "discounted_cash": 14.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIM DL PER SQ CM", "code_information": [{"code": "Q4267", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.5, "maximum": 874.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 874.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEOSTIM PER SQ CM", "code_information": [{"code": "Q4266", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOSTIM TL PER SQ CM", "code_information": [{"code": "Q4265", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NEOX 100 OR CLARIX 100", "code_information": [{"code": "Q4156", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.11, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEOX NEOX RT OR CLARIX CORD", "code_information": [{"code": "Q4148", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.46, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEOXFLO OR CLARIXFLO 1 MG", "code_information": [{"code": "Q4155", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.53, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEPH CKD MULT ECLIA TUM NEC", "code_information": [{"code": "105U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1526.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEPH CKD NUC MRS MEAS GFR", "code_information": [{"code": "259U", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 53.85, "discounted_cash": 84.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEPHELOMETRY EA ANLY", "code_information": [{"code": "83883", "type": "CPT"}, {"code": "3440100957", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.6, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 21.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEPHROSTOMY CATH*M00", "code_information": [{"code": "3100206448", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.64, "discounted_cash": 467.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NEPHROTOMY W/EXPLORATION", "code_information": [{"code": "50045", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE CAP 3 X 15*AGT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3432.52, "maximum": 4756.49, "gross_charge": 4903.6, "discounted_cash": 7355.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4168.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3677.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3432.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4756.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3432.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3677.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4168.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3922.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR 1.5X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2338.7, "maximum": 3240.77, "gross_charge": 3341.0, "discounted_cash": 5011.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2839.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2505.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2338.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3240.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2338.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2505.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2839.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2672.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR 4X15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3503.5, "maximum": 4854.85, "gross_charge": 5005.0, "discounted_cash": 7507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4254.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3503.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4854.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3503.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4254.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR*AGX2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3872.96, "maximum": 5366.81, "gross_charge": 5532.8, "discounted_cash": 8299.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4702.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3872.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5366.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3872.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4702.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4426.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64901", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT ADD-ON", "code_information": [{"code": "64902", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK <4 CM", "code_information": [{"code": "64885", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", "code_information": [{"code": "64886", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY FASCIAL", "code_information": [{"code": "15840", "type": "CPT"}, {"code": "3480103059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7674.64, "gross_charge": 7912.0, "discounted_cash": 5491.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3785.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7674.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3770.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4356.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6329.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MICROSURG GRAFT", "code_information": [{"code": "15842", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PALSY MUSCLE GRAFT", "code_information": [{"code": "15841", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64905", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PROCTECTOR *NW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4159.61, "maximum": 5764.03, "gross_charge": 5942.3, "discounted_cash": 8913.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5050.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4456.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4159.61, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5764.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4159.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4456.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5050.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4753.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROCTECTOR 3.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5412.68, "maximum": 7500.42, "gross_charge": 7732.4, "discounted_cash": 11598.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6572.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5799.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5412.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7500.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5412.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5799.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6572.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6185.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROCTECTOR 3X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3872.96, "maximum": 5366.81, "gross_charge": 5532.8, "discounted_cash": 8299.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4702.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3872.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5366.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3872.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4702.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4426.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROCTECTOR 5X4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4675.58, "maximum": 6479.01, "gross_charge": 6679.4, "discounted_cash": 10019.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5677.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5009.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4675.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6479.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4675.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5009.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5677.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5343.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROCTECTOR 7X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3781.96, "maximum": 5240.71, "gross_charge": 5402.8, "discounted_cash": 8104.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4592.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4052.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3781.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5240.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3781.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4052.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4592.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4322.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR", "code_information": [{"code": "C9364", "type": "HCPCS"}, {"code": "3100104190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 7651.74, "gross_charge": 7888.4, "discounted_cash": 11832.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6705.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5916.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5521.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7651.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5521.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5916.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6705.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6310.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR HA1X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4675.58, "maximum": 6479.01, "gross_charge": 6679.4, "discounted_cash": 10019.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5677.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5009.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4675.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6479.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4675.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5009.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5677.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5343.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR HA2X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4857.58, "maximum": 6731.21, "gross_charge": 6939.4, "discounted_cash": 10409.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5898.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5204.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4857.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6731.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4857.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5204.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5898.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5551.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR HA2X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5969.6, "maximum": 8272.16, "gross_charge": 8528.0, "discounted_cash": 12792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7248.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5969.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8272.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5969.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7248.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6822.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR HA3X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6799.52, "maximum": 9422.19, "gross_charge": 9713.6, "discounted_cash": 14570.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8256.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7285.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6799.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9422.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6799.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7285.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8256.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7770.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE REP W/CONDUIT", "code_information": [{"code": "64910", "type": "CPT"}, {"code": "3480102198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8425.42, "gross_charge": 8686.0, "discounted_cash": 10196.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7383.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7028.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6514.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6080.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8425.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6080.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7001.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6514.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8089.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7383.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6948.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE STIMULATOR", "code_information": [{"code": "3100101148", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 215.0, "discounted_cash": 322.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE SURGERY", "code_information": [{"code": "64859", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVE TESTING PREPAR", "code_information": [{"code": "88362", "type": "CPT"}, {"code": "3440103019", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 182.01, "maximum": 1113.56, "gross_charge": 1148.0, "discounted_cash": 1316.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 975.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 907.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 861.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 803.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1113.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 803.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 903.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 861.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1044.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 975.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 918.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 205.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [{"code": "54", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5415.46, "maximum": 5415.46, "discounted_cash": 16450.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5415.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [{"code": "55", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5415.46, "maximum": 5415.46, "discounted_cash": 11981.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5415.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NESIRITIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2325", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.57, "maximum": 62.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL A-SYNCLN PRTN", "code_information": [{"code": "393U", "type": "CPT"}], "standard_charges": [{"minimum": 540.99, "maximum": 540.99, "discounted_cash": 869.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 540.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEU PRKSN MSFL _-SYNCLN PRTN", "code_information": [{"code": "394U", "type": "CPT"}], "standard_charges": [{"minimum": 198.74, "maximum": 198.74, "discounted_cash": 319.28, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 198.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAGEN NERVE GUID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6253.52, "maximum": 8665.59, "gross_charge": 8933.6, "discounted_cash": 13400.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7593.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6700.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6253.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8665.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6253.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6700.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7593.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7146.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAGEN NERVE GUID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5315.49, "maximum": 7365.75, "gross_charge": 7593.56, "discounted_cash": 11390.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6454.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5695.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5315.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7365.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5315.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5695.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6454.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6074.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURAGEN NERVE GUIDE", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "3100101149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 5889.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURAGEN NERVE GUIDE", "code_information": [{"code": "C9352", "type": "HCPCS"}, {"code": "3100103915", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3455.14, "gross_charge": 3562.0, "discounted_cash": 5343.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3027.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2671.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2493.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3455.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2493.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2671.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3027.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2849.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURAWRAP NERVE PROTECTOR,CM", "code_information": [{"code": "C9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURAXL LBR ANES VAG DLVR", "code_information": [{"code": "1967", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY FOOT", "code_information": [{"code": "28055", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY HAMSTRING", "code_information": [{"code": "27325", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4985.78, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURECTOMY POPLITEAL", "code_information": [{"code": "27326", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURMUSC JUNC TESTIN", "code_information": [{"code": "95937", "type": "CPT"}, {"code": "3480103279", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 159.4, "maximum": 530.59, "gross_charge": 547.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 464.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 410.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 530.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 410.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 464.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 437.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER CELL AGGREGJ", "code_information": [{"code": "206U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 3559.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER MRNA 24 GEN", "code_information": [{"code": "289U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO ALZHEIMER QUAN IMAGING", "code_information": [{"code": "207U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 821.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO ASD MEAS 16 C METBLT", "code_information": [{"code": "263U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1204.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO ASD RNA NEXT GEN SEQ", "code_information": [{"code": "170U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3132.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO AUTISM 32 AMINES ALG", "code_information": [{"code": "63U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1204.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO CHECK BAXANO", "code_information": [{"code": "3100102267", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3627.0, "discounted_cash": 5440.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEURO CSF PRION PRTN QUAL", "code_information": [{"code": "35U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 869.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 12 COM", "code_information": [{"code": "216U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2469.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO INH ATAXIA DNA 51 GENE", "code_information": [{"code": "217U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 3531.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO MON OR, PER 15", "code_information": [{"code": "95940", "type": "CPT"}, {"code": "3340102313", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO MUSC DYS DMD SEQ ALYS", "code_information": [{"code": "218U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3661.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO STIMULATOR INT", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100101150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14721.0, "maximum": 20399.1, "gross_charge": 21030.0, "discounted_cash": 31545.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17875.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20399.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14721.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15772.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17875.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO STIMULATOR INT", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100102935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13328.0, "maximum": 18468.8, "gross_charge": 19040.0, "discounted_cash": 28560.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16184.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13328.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18468.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13328.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16184.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEURO SURGERY 1ST 30", "code_information": [{"code": "3480103115", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6917.0, "discounted_cash": 10375.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEURO SURGERY EA ADD", "code_information": [{"code": "3480103116", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5929.0, "discounted_cash": 8893.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEURO/TRANSPOSE MEDI", "code_information": [{"code": "64721", "type": "CPT"}, {"code": "3480102190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2935.22, "gross_charge": 3026.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2572.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2269.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2118.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2935.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2118.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2269.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2572.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2420.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURO/TRANSPOSE ULNA", "code_information": [{"code": "64719", "type": "CPT"}, {"code": "3480102189", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROELTRD STIM POST TIBIAL", "code_information": [{"code": "64566", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROENDOSCOPY ADD-ON", "code_information": [{"code": "62160", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROLOGICAL EYE DISORDERS", "code_information": [{"code": "123", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5268.51, "maximum": 5268.51, "discounted_cash": 8976.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5268.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMATRIX NERVE CUFF, CM", "code_information": [{"code": "C9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROMEND 12MMX5CM*C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4104.1, "maximum": 5687.11, "gross_charge": 5863.0, "discounted_cash": 8794.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4983.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4397.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4104.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5687.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4104.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4397.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4983.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4690.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMEND 6X2.5CM*CN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2269.47, "maximum": 3144.83, "gross_charge": 3242.1, "discounted_cash": 4863.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2755.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2431.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2269.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3144.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2269.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2431.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2755.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2593.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROMEND NERVE WRAP", "code_information": [{"code": "C9361", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROMUSCULAR REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROPACK OSTEOMED", "code_information": [{"code": "3100103829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1195.0, "discounted_cash": 1792.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROPLASTY BRACHIAL", "code_information": [{"code": "64713", "type": "CPT"}, {"code": "3480102187", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY DIGITAL-", "code_information": [{"code": "64702", "type": "CPT"}, {"code": "3480102183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5478.56, "gross_charge": 5648.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5478.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4518.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY HAND/FOO", "code_information": [{"code": "64704", "type": "CPT"}, {"code": "3480102184", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY LUMBAR P", "code_information": [{"code": "64714", "type": "CPT"}, {"code": "3480102188", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY MAJ PERI", "code_information": [{"code": "64708", "type": "CPT"}, {"code": "3480102185", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5478.56, "gross_charge": 5648.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5478.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4518.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROPLASTY SCIATIC", "code_information": [{"code": "64712", "type": "CPT"}, {"code": "3480102186", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "gross_charge": 5648.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5478.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3953.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4236.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4800.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4518.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEURORRAPHY W/VEIN AUTOGRAFT", "code_information": [{"code": "64911", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [{"code": "882", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3096.92, "maximum": 3096.92, "discounted_cash": 10486.88, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3096.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM LAM IMP EL", "code_information": [{"code": "63655", "type": "CPT"}, {"code": "3480102161", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 16640.4, "maximum": 30305.84, "gross_charge": 23772.0, "discounted_cash": 33484.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20206.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23081.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17829.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16640.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23058.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16640.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22992.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17829.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26563.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20206.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19017.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22322.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22769.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM MEDTRONIC", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100103866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM PATIENT PR", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "3100101152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1949.5, "maximum": 2701.45, "gross_charge": 2785.0, "discounted_cash": 4177.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2367.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2088.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1949.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2701.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1949.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2088.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2367.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM PERC IMP P", "code_information": [{"code": "64555", "type": "CPT"}, {"code": "3430100766", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15385.17, "gross_charge": 15861.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13481.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11895.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11102.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15385.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11102.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11895.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13481.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12688.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM PERC IMP S", "code_information": [{"code": "64561", "type": "CPT"}, {"code": "3480102175", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15385.17, "gross_charge": 15861.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13481.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11895.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11102.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15385.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11102.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11895.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13481.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12688.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM PRIME ADVA", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100101153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17942.4, "maximum": 24863.04, "gross_charge": 25632.0, "discounted_cash": 38448.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21787.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19224.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17942.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24863.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17942.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19224.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21787.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20505.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIM REV/REM PE", "code_information": [{"code": "63660", "type": "CPT"}, {"code": "3430100744", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 12101.6, "maximum": 16769.36, "gross_charge": 17288.0, "discounted_cash": 25932.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14694.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12966.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12101.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16769.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12101.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12966.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14694.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13830.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULAR BRAIN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30800.0, "maximum": 42680.0, "gross_charge": 44000.0, "discounted_cash": 66000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37400.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42680.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULAR BRAIN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35000.0, "maximum": 48500.0, "gross_charge": 50000.0, "discounted_cash": 75000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 42500.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 37500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 35000.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 48500.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 35000.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 37500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 42500.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 40000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR BELT", "code_information": [{"code": "3100206116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR BRAI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25886.0, "maximum": 35870.6, "gross_charge": 36980.0, "discounted_cash": 55470.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31433.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27735.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25886.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35870.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25886.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27735.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31433.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR EXTE", "code_information": [{"code": "3100208077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR INTE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 20776.0, "maximum": 28789.6, "gross_charge": 29680.0, "discounted_cash": 44520.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25228.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22260.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20776.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28789.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20776.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22260.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR INTE", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100206012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16352.0, "maximum": 22659.2, "gross_charge": 23360.0, "discounted_cash": 35040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19856.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17520.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16352.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22659.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16352.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17520.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19856.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18688.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR R20*", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100208089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13869.8, "maximum": 19219.58, "gross_charge": 19814.0, "discounted_cash": 29721.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16841.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14860.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13869.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19219.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13869.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14860.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16841.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15851.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR*1101", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100205341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14281.4, "maximum": 19789.94, "gross_charge": 20402.0, "discounted_cash": 30603.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17341.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15301.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14281.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19789.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14281.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15301.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17341.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16321.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTIMULATOR*4101", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100207257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14813.4, "maximum": 20527.14, "gross_charge": 21162.0, "discounted_cash": 31743.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17987.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15871.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14813.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20527.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14813.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15871.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17987.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16929.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUROSTM INS/REP GEN", "code_information": [{"code": "63685", "type": "CPT"}, {"code": "3430100746", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 55660.54, "gross_charge": 57382.0, "discounted_cash": 47530.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 48774.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32764.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43036.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40167.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 55660.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32320.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40167.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32637.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43036.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31686.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 37707.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 48774.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31686.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 45905.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 31686.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32320.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSTM PERC IMP EL", "code_information": [{"code": "63650", "type": "CPT"}, {"code": "3430100743", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8536.0, "gross_charge": 8800.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7480.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6600.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6160.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8536.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6160.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6600.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7480.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7040.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROSTM REV/REM GEN", "code_information": [{"code": "63688", "type": "CPT"}, {"code": "3430100747", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8821.18, "gross_charge": 9094.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7729.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6820.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6365.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8821.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6365.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6820.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7729.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7275.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUROVASCULAR PEDICLE FLAP", "code_information": [{"code": "15750", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUTRAL PINN DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3073.0, "maximum": 4258.3, "gross_charge": 4390.0, "discounted_cash": 6585.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3731.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3292.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3073.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4258.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3073.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3292.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3731.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3512.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEUTRALIZATION TEST VIRAL", "code_information": [{"code": "86382", "type": "CPT"}], "standard_charges": [{"minimum": 16.91, "maximum": 30.26, "discounted_cash": 27.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 SCR", "code_information": [{"code": "86408", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 42.13, "discounted_cash": 67.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUTRLZG ANTB SARSCOV2 TITER", "code_information": [{"code": "86409", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 83.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 83.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEUTRON BEAM TX COMPLEX", "code_information": [{"code": "77423", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEW EYE EXAM & TREAT", "code_information": [{"code": "92018", "type": "CPT"}, {"code": "3500102298", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6114.88, "gross_charge": 6304.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5358.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4412.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6114.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4412.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5358.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5043.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEW PT LEVEL 1 PROF", "code_information": [{"code": "99201", "type": "CPT"}, {"code": "3500102248", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 183.4, "maximum": 254.14, "gross_charge": 262.0, "discounted_cash": 393.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 254.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 209.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEW PT LEVEL 2 PROF", "code_information": [{"code": "99202", "type": "CPT"}, {"code": "3500102249", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEW PT LEVEL 3 PROF", "code_information": [{"code": "99203", "type": "CPT"}, {"code": "3500102250", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 253.4, "maximum": 351.14, "gross_charge": 362.0, "discounted_cash": 543.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 307.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 351.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 253.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 271.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 307.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 289.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEW PT LEVEL 4 PROF", "code_information": [{"code": "99204", "type": "CPT"}, {"code": "3500102251", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 385.7, "maximum": 534.47, "gross_charge": 551.0, "discounted_cash": 826.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 440.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEW PT LEVEL 5 PROF", "code_information": [{"code": "99205", "type": "CPT"}, {"code": "3500102252", "type": "CDM"}, {"code": "983", "type": "RC"}], "standard_charges": [{"minimum": 567.7, "maximum": 786.67, "gross_charge": 811.0, "discounted_cash": 1216.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 786.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEWBORN METABOLIC SCREENING", "code_information": [{"code": "S3620", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.72, "maximum": 99.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NEXGEN DISTAL AUGM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2716.35, "maximum": 3764.08, "gross_charge": 3880.5, "discounted_cash": 5820.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3298.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2910.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2716.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3764.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2716.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2910.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3298.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3104.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEXGEN LCCK FEM SF*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12915.0, "maximum": 17896.5, "gross_charge": 18450.0, "discounted_cash": 27675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15682.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12915.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17896.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12915.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15682.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEXGEN LCK ART SRF*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEXGEN STEM16X100*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3043.95, "maximum": 4218.04, "gross_charge": 4348.5, "discounted_cash": 6522.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3696.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3261.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3043.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4218.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3043.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3261.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3696.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3478.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEXPLANON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7307", "type": "HCPCS"}, {"code": "3100104663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.48, "maximum": 1092.48, "gross_charge": 2160.0, "discounted_cash": 3240.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1092.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGENT DETECTION GI", "code_information": [{"code": "87505", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 128.29, "discounted_cash": 206.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 128.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS CMV", "code_information": [{"code": "87910", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 257.45, "discounted_cash": 413.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HEP B", "code_information": [{"code": "87912", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 257.45, "discounted_cash": 413.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS HIV1", "code_information": [{"code": "87906", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 128.73, "discounted_cash": 206.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 128.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS SARSCOV2", "code_information": [{"code": "87913", "type": "CPT"}], "standard_charges": [{"minimum": 257.45, "maximum": 257.45, "discounted_cash": 413.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 257.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT HIV GNRJ SEQ ALYS", "code_information": [{"code": "219U", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 1164.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "202U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 531.18, "discounted_cash": 669.56, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 461.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 455.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 459.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 446.37, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 531.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 446.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 446.37, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 455.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "223U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 416.78, "discounted_cash": 669.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 251.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 251.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 82.77, "discounted_cash": 321.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 142.63, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 262.99, "discounted_cash": 422.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 262.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS CHRNC HCV 6 ASSAYS", "code_information": [{"code": "81596", "type": "CPT"}], "standard_charges": [{"minimum": 72.19, "maximum": 79.66, "discounted_cash": 115.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 72.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA UNTRGT NGNRJ SEQ", "code_information": [{"code": "152U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 3415.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS DNA&RNA 21 SARSCOV2", "code_information": [{"code": "225U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 416.78, "discounted_cash": 669.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS FUNGI DNA 15 TRGT", "code_information": [{"code": "140U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "discounted_cash": 251.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 686.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 3 TRGT", "code_information": [{"code": "240U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 142.63, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 4 TRGT", "code_information": [{"code": "241U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 181.78, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 157.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 155.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 157.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 152.76, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 181.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 152.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 152.76, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 155.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFROS NFROT W/DRG", "code_information": [{"code": "50040", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NICOTINE", "code_information": [{"code": "83887", "type": "CPT"}, {"code": "3440100958", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 148.4, "maximum": 205.64, "gross_charge": 212.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 205.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NICOTINE DEFINITIVE", "code_information": [{"code": "G0480", "type": "HCPCS"}, {"code": "3440103119", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 78.77, "maximum": 145.83, "gross_charge": 121.0, "discounted_cash": 183.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 126.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 126.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 145.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 122.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 125.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC", "code_information": [{"code": "33782", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIKAIDOH PROC W/OSTIA IMPLT", "code_information": [{"code": "33783", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NIM XPAK PROBE*94500", "code_information": [{"code": "3100204045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 619.5, "discounted_cash": 929.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NIPPLE EXPLORATION", "code_information": [{"code": "19110", "type": "CPT"}, {"code": "3340102303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6702.7, "gross_charge": 6910.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5873.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5182.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4837.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6702.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4837.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5182.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5873.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5528.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NITINOL GUIDWIRE*HW-", "code_information": [{"code": "3100203335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL PILOT WIRE*5", "code_information": [{"code": "3100204969", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.2, "discounted_cash": 126.3, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL STONE EXTRAC", "code_information": [{"code": "3100203112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL STONE EXTRAC", "code_information": [{"code": "3100203113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 1314.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL WIRE GUIDE*B", "code_information": [{"code": "3100203044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.24, "discounted_cash": 261.36, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL WIRE GUIDE*H", "code_information": [{"code": "3100203045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.96, "discounted_cash": 178.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NITINOL WIRE GUIDE*H", "code_information": [{"code": "3100203046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.92, "discounted_cash": 280.38, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROBLUE TETRAZOLIUM DYE", "code_information": [{"code": "86384", "type": "CPT"}], "standard_charges": [{"minimum": 13.61, "maximum": 30.26, "discounted_cash": 21.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NITROGEN N-13 AMMONIA", "code_information": [{"code": "A9526", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NITROGLYCERIN", "code_information": [{"code": "3400300160", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.8, "discounted_cash": 16.2, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROGLYCERIN/D5W", "code_information": [{"code": "3400300086", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.3, "discounted_cash": 18.45, "setting": "both", "billing_class": "facility"}]}, {"description": "NITROPRUSSIDE SODIUM", "code_information": [{"code": "3400300102", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NIVESTYM", "code_information": [{"code": "Q5110", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.29, "discounted_cash": 0.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD AX NERVE IMG", "code_information": [{"code": "64417", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD BRCH PL NFS IMG", "code_information": [{"code": "64416", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD FEM NRV NFS IMG", "code_information": [{"code": "64448", "type": "CPT"}], "standard_charges": [{"minimum": 1385.29, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD GNCLR N", "code_information": [{"code": "64454", "type": "CPT"}, {"code": "3480103306", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 448.56, "maximum": 2121.39, "gross_charge": 2187.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1858.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1640.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1530.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2121.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1530.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1640.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1858.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1749.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD LMBR PLEX NFS", "code_information": [{"code": "64449", "type": "CPT"}], "standard_charges": [{"minimum": 1385.29, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD NRV NRV", "code_information": [{"code": "64451", "type": "CPT"}, {"code": "3480103304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 705.68, "maximum": 2121.39, "gross_charge": 2187.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1858.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1640.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1530.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2121.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1530.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1640.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1858.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1749.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 720.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD PARACRV NRV", "code_information": [{"code": "64435", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD SC NRV NFS IMG", "code_information": [{"code": "64446", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1385.29, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX ANES&/STEROID PL", "code_information": [{"code": "64455", "type": "CPT"}, {"code": "3480102030", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 302.24, "maximum": 924.41, "gross_charge": 953.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 810.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 810.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": "481T", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX B1 SUB MTRL SBCHDRL DFCT", "code_information": [{"code": "707T", "type": "CPT"}], "standard_charges": [{"minimum": 456.57, "maximum": 456.57, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH NSLC P-ART ANGRP", "code_information": [{"code": "93568", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV LV/LA ANG", "code_information": [{"code": "93565", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SLCTV RV/RA ANG", "code_information": [{"code": "93566", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CAR CTH SPRVLV AORTGRPHY", "code_information": [{"code": "93567", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CATH SLCTV OPAC", "code_information": [{"code": "93564", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CGEN CAR CTH SLCTV C ANG", "code_information": [{"code": "93563", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CHEMONUCLEOLYSIS LMBR", "code_information": [{"code": "62292", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX CNTRST KNE ARTHG/CT/MRI", "code_information": [{"code": "27369", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62320", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62324", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR CRV/THRC", "code_information": [{"code": "62325", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX INTERLAMINAR LMBR/SAC", "code_information": [{"code": "62326", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT 1 VEIN", "code_information": [{"code": "36465", "type": "CPT"}], "standard_charges": [{"minimum": 1369.71, "maximum": 1369.71, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX NONCMPND SCLRSNT MLT VN", "code_information": [{"code": "36466", "type": "CPT"}], "standard_charges": [{"minimum": 1369.71, "maximum": 1369.71, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "213T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "214T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US CER/THOR", "code_information": [{"code": "215T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "216T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "217T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PARAVERT W/US LUMB/SAC", "code_information": [{"code": "218T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PLTLT PLASMA", "code_information": [{"code": "232T", "type": "CPT"}, {"code": "3480101287", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 149.8, "maximum": 483.83, "gross_charge": 214.0, "discounted_cash": 609.87, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 181.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 160.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 149.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 207.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 149.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 160.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 483.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 181.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 171.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PST CHMBR EYE MEDICATION", "code_information": [{"code": "699T", "type": "CPT"}], "standard_charges": [{"minimum": 902.02, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRAM/URT", "code_information": [{"code": "50431", "type": "CPT"}, {"code": "3480103169", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 434.32, "maximum": 1865.31, "gross_charge": 1923.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1634.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1442.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1346.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1865.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1346.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1442.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1634.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1538.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRAM/URT", "code_information": [{"code": "50431", "type": "CPT"}, {"code": "3480103214", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 434.32, "maximum": 2294.05, "gross_charge": 2365.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2010.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1773.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1655.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2294.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1655.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1773.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2010.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1892.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX NFROSGRM &/URTRGRM", "code_information": [{"code": "50430", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX PX ONLY MAM DUCTO/GLCTO", "code_information": [{"code": "19030", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT 1 INCMPTNT VEIN", "code_information": [{"code": "36470", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1369.71, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1369.71, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT SPIDER VEINS", "code_information": [{"code": "36468", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1369.71, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NK CELLS TOTAL COUNT", "code_information": [{"code": "86357", "type": "CPT"}], "standard_charges": [{"minimum": 37.73, "maximum": 68.53, "discounted_cash": 60.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL REMOVAL CALCULUS", "code_information": [{"code": "50060", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOCARDIA ANTIBODY", "code_information": [{"code": "86744", "type": "CPT"}], "standard_charges": [{"minimum": 15.99, "maximum": 30.26, "discounted_cash": 25.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-AUTO GRAFT 1ST TOOTH", "code_information": [{"code": "D4275", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "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": 7815.77, "maximum": 7815.77, "discounted_cash": 24054.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7815.77, "methodology": "fee schedule"}], "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": 12872.16, "maximum": 12872.16, "discounted_cash": 40604.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12872.16, "methodology": "fee schedule"}], "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": 5456.04, "maximum": 5456.04, "discounted_cash": 14739.47, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5456.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-BLIND INTERATRIAL SHUNT", "code_information": [{"code": "C9760", "type": "HCPCS"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 44179.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-COV SURG PROC,CLIN TRIAL", "code_information": [{"code": "G0293", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-EXTENSIVE BURNS", "code_information": [{"code": "935", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3465.82, "maximum": 3465.82, "discounted_cash": 22788.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3465.82, "methodology": "fee schedule"}], "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": 10599.74, "maximum": 10599.74, "discounted_cash": 18946.26, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10599.74, "methodology": "fee schedule"}], "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": 14583.25, "maximum": 14583.25, "discounted_cash": 37699.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14583.25, "methodology": "fee schedule"}], "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": 4590.97, "maximum": 4590.97, "discounted_cash": 12061.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4590.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-HEU TC-99M ADD-ON/DOSE", "code_information": [{"code": "Q9969", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 16.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-IMAGING HEART FUNCTION", "code_information": [{"code": "78414", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-INHALATION DRUG FOR DME", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7799", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-IONIZING DIAG PROC", "code_information": [{"code": "D0600", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITH CC/MCC", "code_information": [{"code": "600", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6123.75, "maximum": 6123.75, "discounted_cash": 11449.26, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6123.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "601", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2373.87, "maximum": 2373.87, "discounted_cash": 6951.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2373.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NON-OPHTHALMIC FVA", "code_information": [{"code": "C9733", "type": "HCPCS"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-RAD CONTRAST MATERIALNOC", "code_information": [{"code": "A9698", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NON-ROUTINE BL DRAW 3/> YRS", "code_information": [{"code": "36410", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 300.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-SPEECH DEVICE SERVICE", "code_information": [{"code": "92606", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-SURG TX ROOT CANAL OBS", "code_information": [{"code": "D3331", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NON-SURGICAL SIALOLITHOTOMY", "code_information": [{"code": "D7979", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONFAMILY HC TRAIN/SESSION", "code_information": [{"code": "S5116", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONFAMILY HOMECARE TRAIN/15M", "code_information": [{"code": "S5115", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONMED FAMILY PLANNING ED", "code_information": [{"code": "H1010", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [{"code": "71", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5007.82, "maximum": 5007.82, "discounted_cash": 11854.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5007.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [{"code": "70", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9622.77, "maximum": 9622.77, "discounted_cash": 19979.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9622.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "72", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4061.59, "maximum": 4061.59, "discounted_cash": 8741.85, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4061.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [{"code": "67", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8758.93, "maximum": 8758.93, "discounted_cash": 15819.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8758.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [{"code": "68", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5981.72, "maximum": 5981.72, "discounted_cash": 9724.34, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5981.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [{"code": "80", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12865.4, "maximum": 12865.4, "discounted_cash": 24659.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12865.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [{"code": "81", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3369.29, "maximum": 3369.29, "discounted_cash": 10154.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3369.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOONAN SPECTRUM DISORDERS", "code_information": [{"code": "81442", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2143.6, "discounted_cash": 3443.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2143.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NORMAL NEWBORN", "code_information": [{"code": "795", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1776.87, "maximum": 1776.87, "discounted_cash": 2251.89, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1776.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL SALINE SOLUTION INFUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7030", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.61, "maximum": 2.61, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL SALINE SOLUTION INFUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.3, "maximum": 1.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORMAL SALINE SOLUTION INFUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7050", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.65, "maximum": 0.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NORTRIPLYLINE", "code_information": [{"code": "80182", "type": "CPT"}, {"code": "3440100821", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 84.7, "maximum": 117.37, "gross_charge": 121.0, "discounted_cash": 181.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NOS QUANT SENSORY TEST", "code_information": [{"code": "110T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOSE ALLERGY TEST", "code_information": [{"code": "95065", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOVACHOR 1 SQ CM", "code_information": [{"code": "Q4194", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOVAFIX DL PER SQ CM", "code_information": [{"code": "Q4254", "type": "HCPCS"}], "standard_charges": [{"minimum": 355.88, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 355.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOVAFIX PER SQ CM", "code_information": [{"code": "Q4208", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NOVAGOLD .018 480*M0", "code_information": [{"code": "3100203692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NOVASURE", "code_information": [{"code": "3100104311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3331.0, "discounted_cash": 4996.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NOZZLE 90DEG", "code_information": [{"code": "3100101155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NOZZLE 90DEG BA", "code_information": [{"code": "3100101156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NPM1 GENE", "code_information": [{"code": "81310", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 246.52, "discounted_cash": 396.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 246.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NPM1 GENE ANALYSIS QUAN", "code_information": [{"code": "49U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 654.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE BI", "code_information": [{"code": "69706", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NPS SURG DILAT EUST TUBE UNI", "code_information": [{"code": "69705", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRAS GENE VARIANTS EXON 2&3", "code_information": [{"code": "81311", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 295.79, "discounted_cash": 475.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 295.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRPLSY/TRANSP ULN NR", "code_information": [{"code": "64718", "type": "CPT"}, {"code": "3430100781", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96132", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRPSYC TST EVAL PHYS/QHP EA", "code_information": [{"code": "96133", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 11-12 STUDIES", "code_information": [{"code": "95912", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 13/> STUDIES", "code_information": [{"code": "95913", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 7-8 STUDIES", "code_information": [{"code": "95910", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TEST 9-10 STUDIES", "code_information": [{"code": "95911", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 3-4 STUDIES", "code_information": [{"code": "95908", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV CNDJ TST 5-6 STUDIES", "code_information": [{"code": "95909", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG <4CM", "code_information": [{"code": "64892", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND ARM/LEG >4 CM", "code_information": [{"code": "64893", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT <4CM", "code_information": [{"code": "64890", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF 1STRND HND/FOOT >4CM", "code_information": [{"code": "64891", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG <4 CM", "code_information": [{"code": "64897", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST ARM/LEG >4 CM", "code_information": [{"code": "64898", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT <4 CM", "code_information": [{"code": "64895", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV GRF MLTST HND/FOOT >4 CM", "code_information": [{"code": "64896", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT 1ST", "code_information": [{"code": "64912", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NRV RPR W/NRV ALGRFT EA ADDL", "code_information": [{"code": "64913", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX MAX SINUSC", "code_information": [{"code": "31233", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2615.71, "discounted_cash": 625.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC DX SPHN SINUSC", "code_information": [{"code": "31235", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2624.17, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED&INF DCMPRN", "code_information": [{"code": "31293", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC MED/INF DCMPRN", "code_information": [{"code": "31292", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SPHN TISS RMVL", "code_information": [{"code": "31259", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 8311.19, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG FRNT&SPHN", "code_information": [{"code": "31298", "type": "CPT"}], "standard_charges": [{"minimum": 2615.71, "maximum": 2615.71, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC SURG ON DCMPRN", "code_information": [{"code": "31294", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOT W/SPHENDT", "code_information": [{"code": "31257", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 8311.19, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOTAL", "code_information": [{"code": "31253", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 8311.19, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC LIG SPHNPTN ART", "code_information": [{"code": "31241", "type": "CPT"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "discounted_cash": 2597.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NSNARE STENT RET *NS", "code_information": [{"code": "3100203008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NSNARE STENT RETRIEV", "code_information": [{"code": "3100203995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NTRK TRANSLOCATION ANALYSIS", "code_information": [{"code": "81194", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 518.28, "discounted_cash": 832.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 518.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRK1 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81191", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRK2 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81192", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTRK3 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81193", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR CPLX", "code_information": [{"code": "77386", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR SMPL", "code_information": [{"code": "77385", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHY/QHP EA ADDL HR", "code_information": [{"code": "96121", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHYS/QHP 1ST HR", "code_information": [{"code": "96116", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR EXAM OF TEAR FLOW", "code_information": [{"code": "78660", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR MATRIX PROTEIN 22", "code_information": [{"code": "86386", "type": "CPT"}], "standard_charges": [{"minimum": 21.78, "maximum": 30.26, "discounted_cash": 35.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTERIAL", "code_information": [{"code": "79445", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRA-ARTICULAR", "code_information": [{"code": "79440", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX INTRACAV ADMIN", "code_information": [{"code": "79200", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX IV ADMIN", "code_information": [{"code": "79101", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX ORAL ADMIN", "code_information": [{"code": "79005", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUCLR RX INTERSTIT COLLOID", "code_information": [{"code": "79300", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUDT15 GENE COMMON VARIANTS", "code_information": [{"code": "81306", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 291.36, "discounted_cash": 468.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 291.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUDT15&TPMT GENE COM VRNT", "code_information": [{"code": "169U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 748.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUDYN DL OR DL MESH PR SQ CM", "code_information": [{"code": "Q4285", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NUDYN SL OR SLW, PER SQ CM", "code_information": [{"code": "Q4286", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99379", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99380", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUSHIELD 1 SQUARE CM", "code_information": [{"code": "Q4160", "type": "HCPCS"}], "standard_charges": [{"minimum": 94.92, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 94.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUT 10 PACK* 03.311.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.35, "maximum": 231.9, "gross_charge": 239.08, "discounted_cash": 358.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 203.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 179.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 167.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 231.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 167.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 179.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 203.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 191.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUT COMPRESS JUNC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 315.0, "maximum": 436.5, "gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 337.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 436.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 337.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUT*03.311.061", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16.85, "maximum": 23.35, "gross_charge": 24.08, "discounted_cash": 36.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUTRI COUNSEL-CONTROL CARIES", "code_information": [{"code": "D1310", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUTRITION CLASS", "code_information": [{"code": "S9452", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NUTRITIONAL COUNSELING, DIET", "code_information": [{"code": "S9470", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NVR CNDJ TST 1-2 STUDIES", "code_information": [{"code": "95907", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nasal endo eustachian tube", "code_information": [{"code": "C9745", "type": "HCPCS"}], "standard_charges": [{"minimum": 2615.71, "maximum": 2615.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Needle Biopsy Of Lung Or Chest Tissue, Accessed Through The Skin", "code_information": [{"code": "32405", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1282.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonatal Aftercare, Major", "code_information": [{"code": "863.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50168.16, "maximum": 50168.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50168.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonatal Aftercare, Minor", "code_information": [{"code": "863.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13814.57, "maximum": 13814.57, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13814.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonatal Aftercare, Moderate", "code_information": [{"code": "863.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43049.43, "maximum": 43049.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43049.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonatal Aftercare, Severe", "code_information": [{"code": "863.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 101278.23, "maximum": 101278.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 101278.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition, Major", "code_information": [{"code": "603.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 107502.47, "maximum": 107502.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 107502.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition, Minor", "code_information": [{"code": "603.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50052.83, "maximum": 50052.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50052.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition, Moderate", "code_information": [{"code": "603.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55058.37, "maximum": 55058.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55058.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition, Severe", "code_information": [{"code": "603.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 198477.44, "maximum": 198477.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198477.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Major", "code_information": [{"code": "602.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 146356.27, "maximum": 146356.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 146356.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Minor", "code_information": [{"code": "602.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20939.71, "maximum": 20939.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20939.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Moderate", "code_information": [{"code": "602.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 102200.91, "maximum": 102200.91, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102200.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Severe", "code_information": [{"code": "602.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 191317.7, "maximum": 191317.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 191317.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition, Major", "code_information": [{"code": "608.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 78284.27, "maximum": 78284.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78284.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition, Minor", "code_information": [{"code": "608.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30361.3, "maximum": 30361.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30361.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition, Moderate", "code_information": [{"code": "608.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55481.26, "maximum": 55481.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55481.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition, Severe", "code_information": [{"code": "608.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 86074.51, "maximum": 86074.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 86074.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Major", "code_information": [{"code": "607.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 114835.22, "maximum": 114835.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 114835.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Minor", "code_information": [{"code": "607.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33895.68, "maximum": 33895.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33895.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Moderate", "code_information": [{"code": "607.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 107888.2, "maximum": 107888.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 107888.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition Or Major Anomaly, Severe", "code_information": [{"code": "607.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 126320.02, "maximum": 126320.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126320.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection, Major", "code_information": [{"code": "613.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 63679.02, "maximum": 63679.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63679.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection, Minor", "code_information": [{"code": "613.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21052.48, "maximum": 21052.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21052.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection, Moderate", "code_information": [{"code": "613.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 45340.75, "maximum": 45340.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45340.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection, Severe", "code_information": [{"code": "613.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 96921.13, "maximum": 96921.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 96921.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Major Anomaly, Major", "code_information": [{"code": "611.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 84266.31, "maximum": 84266.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 84266.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Major Anomaly, Minor", "code_information": [{"code": "611.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20974.31, "maximum": 20974.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20974.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Major Anomaly, Moderate", "code_information": [{"code": "611.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 69167.68, "maximum": 69167.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69167.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Major Anomaly, Severe", "code_information": [{"code": "611.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 158108.91, "maximum": 158108.91, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 158108.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition, Major", "code_information": [{"code": "614.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 74883.17, "maximum": 74883.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 74883.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition, Minor", "code_information": [{"code": "614.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23291.26, "maximum": 23291.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23291.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition, Moderate", "code_information": [{"code": "614.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53584.64, "maximum": 53584.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53584.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition, Severe", "code_information": [{"code": "614.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 77887.01, "maximum": 77887.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 77887.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Major", "code_information": [{"code": "612.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 66750.77, "maximum": 66750.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 66750.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Minor", "code_information": [{"code": "612.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33786.75, "maximum": 33786.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33786.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Moderate", "code_information": [{"code": "612.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51691.87, "maximum": 51691.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51691.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Severe", "code_information": [{"code": "612.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 97340.18, "maximum": 97340.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 97340.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-2499 Grams With Major Procedure, Major", "code_information": [{"code": "609.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 101838.24, "maximum": 101838.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 101838.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-2499 Grams With Major Procedure, Minor", "code_information": [{"code": "609.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53261.7, "maximum": 53261.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53261.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-2499 Grams With Major Procedure, Moderate", "code_information": [{"code": "609.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 56064.34, "maximum": 56064.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56064.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 1500-2499 Grams With Major Procedure, Severe", "code_information": [{"code": "609.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 259020.62, "maximum": 259020.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 259020.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection, Major", "code_information": [{"code": "623.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48412.51, "maximum": 48412.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48412.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection, Minor", "code_information": [{"code": "623.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18222.93, "maximum": 18222.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18222.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection, Moderate", "code_information": [{"code": "623.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22003.36, "maximum": 22003.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22003.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Congenital Or Perinatal Infection, Severe", "code_information": [{"code": "623.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 58708.08, "maximum": 58708.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 58708.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Major Anomaly, Major", "code_information": [{"code": "621.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 57181.81, "maximum": 57181.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 57181.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Major Anomaly, Minor", "code_information": [{"code": "621.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9622.78, "maximum": 9622.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9622.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Major Anomaly, Moderate", "code_information": [{"code": "621.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 41803.81, "maximum": 41803.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41803.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Major Anomaly, Severe", "code_information": [{"code": "621.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 98423.04, "maximum": 98423.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 98423.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Other Significant Condition, Major", "code_information": [{"code": "625.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39404.84, "maximum": 39404.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39404.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Other Significant Condition, Minor", "code_information": [{"code": "625.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28198.13, "maximum": 28198.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28198.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Other Significant Condition, Moderate", "code_information": [{"code": "625.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38343.76, "maximum": 38343.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38343.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Other Significant Condition, Severe", "code_information": [{"code": "625.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 54084.43, "maximum": 54084.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 54084.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Major", "code_information": [{"code": "622.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40965.71, "maximum": 40965.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40965.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Minor", "code_information": [{"code": "622.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24151.15, "maximum": 24151.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24151.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Moderate", "code_information": [{"code": "622.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36122.92, "maximum": 36122.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36122.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Severe", "code_information": [{"code": "622.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 59783.26, "maximum": 59783.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59783.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Problem, Major", "code_information": [{"code": "626.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15363.9, "maximum": 15363.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15363.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Problem, Minor", "code_information": [{"code": "626.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4167.44, "maximum": 4167.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4167.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Problem, Moderate", "code_information": [{"code": "626.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5134.97, "maximum": 5134.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5134.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 2000-2499 Grams, Normal Newborn Or Neonate With Other Problem, Severe", "code_information": [{"code": "626.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36101.14, "maximum": 36101.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36101.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 500-749 Grams Without Major Procedure, Major", "code_information": [{"code": "591.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 160120.86, "maximum": 160120.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 160120.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 500-749 Grams Without Major Procedure, Minor", "code_information": [{"code": "591.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 88638.79, "maximum": 88638.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88638.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 500-749 Grams Without Major Procedure, Moderate", "code_information": [{"code": "591.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 97502.93, "maximum": 97502.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 97502.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 500-749 Grams Without Major Procedure, Severe", "code_information": [{"code": "591.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 490101.99, "maximum": 490101.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490101.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 750-999 Grams Without Major Procedure, Major", "code_information": [{"code": "593.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 219937.44, "maximum": 219937.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 219937.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 750-999 Grams Without Major Procedure, Minor", "code_information": [{"code": "593.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 131174.34, "maximum": 131174.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 131174.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 750-999 Grams Without Major Procedure, Moderate", "code_information": [{"code": "593.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 144291.77, "maximum": 144291.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 144291.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight 750-999 Grams Without Major Procedure, Severe", "code_information": [{"code": "593.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 246460.64, "maximum": 246460.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 246460.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 1500 Grams With Major Procedure, Major", "code_information": [{"code": "588.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 243505.5, "maximum": 243505.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 243505.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 1500 Grams With Major Procedure, Minor", "code_information": [{"code": "588.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 157206.73, "maximum": 157206.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157206.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 1500 Grams With Major Procedure, Moderate", "code_information": [{"code": "588.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 238829.31, "maximum": 238829.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 238829.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 1500 Grams With Major Procedure, Severe", "code_information": [{"code": "588.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 378620.46, "maximum": 378620.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 378620.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention, Major", "code_information": [{"code": "589.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 475521.08, "maximum": 475521.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 475521.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention, Minor", "code_information": [{"code": "589.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 87480.32, "maximum": 87480.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 87480.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention, Moderate", "code_information": [{"code": "589.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 432292.24, "maximum": 432292.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 432292.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational Age <24 Weeks, Or Birth Weight 500-749 Grams With Major Anomaly Or Without Life Sustaining Intervention, Severe", "code_information": [{"code": "589.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 523073.7, "maximum": 523073.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 523073.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection, Major", "code_information": [{"code": "636.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36593.23, "maximum": 36593.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36593.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection, Minor", "code_information": [{"code": "636.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14778.26, "maximum": 14778.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14778.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection, Moderate", "code_information": [{"code": "636.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21884.18, "maximum": 21884.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21884.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Congenital Or Perinatal Infection, Severe", "code_information": [{"code": "636.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46738.87, "maximum": 46738.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46738.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Anomaly, Major", "code_information": [{"code": "633.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38074.65, "maximum": 38074.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38074.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Anomaly, Minor", "code_information": [{"code": "633.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6161.45, "maximum": 6161.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6161.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Anomaly, Moderate", "code_information": [{"code": "633.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11179.81, "maximum": 11179.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11179.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Anomaly, Severe", "code_information": [{"code": "633.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 98590.92, "maximum": 98590.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 98590.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure, Major", "code_information": [{"code": "630.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 125612.63, "maximum": 125612.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 125612.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure, Minor", "code_information": [{"code": "630.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32784.61, "maximum": 32784.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32784.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure, Moderate", "code_information": [{"code": "630.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 78813.53, "maximum": 78813.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78813.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure, Severe", "code_information": [{"code": "630.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 136028.66, "maximum": 136028.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136028.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Major Procedure, Major", "code_information": [{"code": "631.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 72289.42, "maximum": 72289.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 72289.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Major Procedure, Minor", "code_information": [{"code": "631.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32943.52, "maximum": 32943.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32943.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Major Procedure, Moderate", "code_information": [{"code": "631.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36238.26, "maximum": 36238.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36238.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Major Procedure, Severe", "code_information": [{"code": "631.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 140542.11, "maximum": 140542.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 140542.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Significant Condition, Major", "code_information": [{"code": "639.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24565.07, "maximum": 24565.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24565.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Significant Condition, Minor", "code_information": [{"code": "639.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7448.08, "maximum": 7448.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7448.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Significant Condition, Moderate", "code_information": [{"code": "639.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10032.86, "maximum": 10032.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10032.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Other Significant Condition, Severe", "code_information": [{"code": "639.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32716.7, "maximum": 32716.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32716.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Major", "code_information": [{"code": "634.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17793.63, "maximum": 17793.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17793.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Minor", "code_information": [{"code": "634.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11866.69, "maximum": 11866.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11866.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Moderate", "code_information": [{"code": "634.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15758.61, "maximum": 15758.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15758.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Major Respiratory Condition, Severe", "code_information": [{"code": "634.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 57843.07, "maximum": 57843.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 57843.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem, Major", "code_information": [{"code": "640.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7093.1, "maximum": 7093.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7093.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem, Minor", "code_information": [{"code": "640.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2164.45, "maximum": 2164.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2164.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem, Moderate", "code_information": [{"code": "640.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3065.35, "maximum": 3065.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3065.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate Birth Weight > 2499 Grams, Normal Newborn Or Neonate With Other Problem, Severe", "code_information": [{"code": "640.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29788.47, "maximum": 29788.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29788.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate With Ecmo, Major", "code_information": [{"code": "583.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 365554.28, "maximum": 365554.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 365554.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate With Ecmo, Minor", "code_information": [{"code": "583.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 232949.79, "maximum": 232949.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 232949.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate With Ecmo, Moderate", "code_information": [{"code": "583.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 270015.89, "maximum": 270015.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 270015.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate With Ecmo, Severe", "code_information": [{"code": "583.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 480780.36, "maximum": 480780.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 480780.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Born Here, Major", "code_information": [{"code": "581.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3731.73, "maximum": 3731.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3731.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Born Here, Minor", "code_information": [{"code": "581.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2214.43, "maximum": 2214.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2214.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Born Here, Moderate", "code_information": [{"code": "581.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3011.53, "maximum": 3011.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3011.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Born Here, Severe", "code_information": [{"code": "581.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6280.63, "maximum": 6280.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6280.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Not Born Here, Major", "code_information": [{"code": "580.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9481.82, "maximum": 9481.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9481.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Not Born Here, Minor", "code_information": [{"code": "580.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6189.65, "maximum": 6189.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6189.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Not Born Here, Moderate", "code_information": [{"code": "580.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7915.83, "maximum": 7915.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7915.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Neonate, Transferred < 5 Days Old, Not Born Here, Severe", "code_information": [{"code": "580.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15647.12, "maximum": 15647.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15647.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nephritis And Nephrosis, Major", "code_information": [{"code": "462.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18952.1, "maximum": 18952.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18952.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nephritis And Nephrosis, Minor", "code_information": [{"code": "462.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6865.0, "maximum": 6865.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6865.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nephritis And Nephrosis, Moderate", "code_information": [{"code": "462.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10041.83, "maximum": 10041.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10041.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nephritis And Nephrosis, Severe", "code_information": [{"code": "462.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38940.94, "maximum": 38940.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38940.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nervous System Malignancy, Major", "code_information": [{"code": "41.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15129.39, "maximum": 15129.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15129.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nervous System Malignancy, Minor", "code_information": [{"code": "41.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8434.83, "maximum": 8434.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8434.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nervous System Malignancy, Moderate", "code_information": [{"code": "41.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11454.05, "maximum": 11454.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11454.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nervous System Malignancy, Severe", "code_information": [{"code": "41.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35578.28, "maximum": 35578.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35578.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Bacterial Infections Of Nervous System Except Viral Meningitis, Major", "code_information": [{"code": "50.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36049.88, "maximum": 36049.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36049.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Bacterial Infections Of Nervous System Except Viral Meningitis, Minor", "code_information": [{"code": "50.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9412.62, "maximum": 9412.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9412.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Bacterial Infections Of Nervous System Except Viral Meningitis, Moderate", "code_information": [{"code": "50.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19446.76, "maximum": 19446.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19446.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Bacterial Infections Of Nervous System Except Viral Meningitis, Severe", "code_information": [{"code": "50.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 78805.84, "maximum": 78805.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78805.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Hip Joint Replacement, Major", "code_information": [{"code": "323.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34984.95, "maximum": 34984.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34984.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Hip Joint Replacement, Minor", "code_information": [{"code": "323.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24552.26, "maximum": 24552.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24552.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Hip Joint Replacement, Moderate", "code_information": [{"code": "323.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28059.72, "maximum": 28059.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28059.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Hip Joint Replacement, Severe", "code_information": [{"code": "323.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46107.09, "maximum": 46107.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46107.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Knee Joint Replacement, Major", "code_information": [{"code": "325.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51348.42, "maximum": 51348.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51348.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Knee Joint Replacement, Minor", "code_information": [{"code": "325.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28972.15, "maximum": 28972.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28972.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Knee Joint Replacement, Moderate", "code_information": [{"code": "325.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33725.24, "maximum": 33725.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33725.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Elective Or Complex Knee Joint Replacement, Severe", "code_information": [{"code": "325.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 63748.22, "maximum": 63748.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63748.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedure Unrelated To Principal Diagnosis, Major", "code_information": [{"code": "952.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26961.48, "maximum": 26961.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26961.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedure Unrelated To Principal Diagnosis, Minor", "code_information": [{"code": "952.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13383.99, "maximum": 13383.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13383.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedure Unrelated To Principal Diagnosis, Moderate", "code_information": [{"code": "952.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17232.33, "maximum": 17232.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17232.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedure Unrelated To Principal Diagnosis, Severe", "code_information": [{"code": "952.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 106884.79, "maximum": 106884.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 106884.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedures For Other Complications Of Treatment, Major", "code_information": [{"code": "794.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20134.93, "maximum": 20134.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20134.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedures For Other Complications Of Treatment, Minor", "code_information": [{"code": "794.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11542.47, "maximum": 11542.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11542.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedures For Other Complications Of Treatment, Moderate", "code_information": [{"code": "794.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16974.75, "maximum": 16974.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16974.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Extensive O.R. Procedures For Other Complications Of Treatment, Severe", "code_information": [{"code": "794.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39639.36, "maximum": 39639.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39639.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Hypovolemic Sodium Disorders, Major", "code_information": [{"code": "426.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13326.32, "maximum": 13326.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13326.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Hypovolemic Sodium Disorders, Minor", "code_information": [{"code": "426.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6398.53, "maximum": 6398.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6398.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Hypovolemic Sodium Disorders, Moderate", "code_information": [{"code": "426.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8506.6, "maximum": 8506.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8506.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Non-Hypovolemic Sodium Disorders, Severe", "code_information": [{"code": "426.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28686.38, "maximum": 28686.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28686.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nonspecific Cva And Precerebral Occlusion Without Infarction, Major", "code_information": [{"code": "46.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10485.23, "maximum": 10485.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10485.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nonspecific Cva And Precerebral Occlusion Without Infarction, Minor", "code_information": [{"code": "46.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5420.75, "maximum": 5420.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5420.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nonspecific Cva And Precerebral Occlusion Without Infarction, Moderate", "code_information": [{"code": "46.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6834.24, "maximum": 6834.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6834.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nonspecific Cva And Precerebral Occlusion Without Infarction, Severe", "code_information": [{"code": "46.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25527.48, "maximum": 25527.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25527.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nsl/sins cryo post nasal tis", "code_information": [{"code": "C9771", "type": "HCPCS"}], "standard_charges": [{"minimum": 2624.17, "maximum": 2624.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine Study Of Red Blood Cell, Red Cell Survival, Organ Specific", "code_information": [{"code": "78135", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Nursing facility conference", "code_information": [{"code": "G9686", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [{"code": "620", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9092.78, "maximum": 9092.78, "discounted_cash": 18111.15, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9092.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [{"code": "619", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15507.34, "maximum": 15507.34, "discounted_cash": 28899.48, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15507.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC", "code_information": [{"code": "621", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8777.37, "maximum": 8777.37, "discounted_cash": 16940.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8777.37, "methodology": "fee schedule"}], "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": 6544.29, "maximum": 6544.29, "discounted_cash": 24189.15, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6544.29, "methodology": "fee schedule"}], "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": 20825.04, "maximum": 20825.04, "discounted_cash": 35897.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20825.04, "methodology": "fee schedule"}], "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": 5540.88, "maximum": 5540.88, "discounted_cash": 20721.44, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5540.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [{"code": "876", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7414.9, "maximum": 7414.9, "discounted_cash": 41660.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7414.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OASIS BURN MATRIX", "code_information": [{"code": "Q4103", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.56, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OASIS BURN MATRIX*82", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3185.0, "maximum": 4413.5, "gross_charge": 4550.0, "discounted_cash": 6825.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4413.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OASIS TRI-LAYER WOUND MATRIX", "code_information": [{"code": "Q4124", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.97, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.97, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OASIS WOUND MATRIX", "code_information": [{"code": "Q4102", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.42, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OAT DISP KIT 15MM*AB", "code_information": [{"code": "3100207563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT DISP KIT 20MM*AB", "code_information": [{"code": "3100208620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT DISP KIT 22.5*AB", "code_information": [{"code": "3100209690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT DISP KIT 25MM*AB", "code_information": [{"code": "3100208700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT DISP KIT 27.5*AB", "code_information": [{"code": "3100209691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT DISP KIT 30MM*AB", "code_information": [{"code": "3100209692", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT PATELLA KIT L*AB", "code_information": [{"code": "3100209695", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT PATELLA KIT M*AB", "code_information": [{"code": "3100209694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT PATELLA KIT SM*A", "code_information": [{"code": "3100209693", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3276.0, "discounted_cash": 4914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT SET 4MM SINGLE*A", "code_information": [{"code": "3100202552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT SET 6MM SINGLE*A", "code_information": [{"code": "3100202553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT SET 8MM SINGLE*A", "code_information": [{"code": "3100202554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OAT SET SINGLE", "code_information": [{"code": "3100104176", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OATS KIT 12MM*ABS-89", "code_information": [{"code": "3100208344", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OATS KIT 16MM*ABS-19", "code_information": [{"code": "3100206152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2278.5, "discounted_cash": 3417.75, "setting": "both", "billing_class": "facility"}]}, {"description": "OB PE BIOCHEM ASSAY PGF ALG", "code_information": [{"code": "243U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 103.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB PE KDR ENG&RBP4 IA ALG", "code_information": [{"code": "390U", "type": "CPT"}], "standard_charges": [{"minimum": 64.41, "maximum": 64.41, "discounted_cash": 103.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB PREIMPLTJ TST 300000 DNA", "code_information": [{"code": "396U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OB PRTRM BRTH IBP4 SHBG MEAS", "code_information": [{"code": "247U", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "discounted_cash": 1204.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS ADDL FETUS", "code_information": [{"code": "76802", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS SINGLE FETUS", "code_information": [{"code": "76801", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS ADDL FETUS", "code_information": [{"code": "76810", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS SNGL FETUS", "code_information": [{"code": "76805", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED ADDL FETUS", "code_information": [{"code": "76812", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED SNGL FETUS", "code_information": [{"code": "76811", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US FOLLOW-UP PER FETUS", "code_information": [{"code": "76816", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US LIMITED FETUS(S)", "code_information": [{"code": "76815", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS 1 GEST", "code_information": [{"code": "76813", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS ADD-ON", "code_information": [{"code": "76814", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBINUTUZUMAB INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9301", "type": "HCPCS"}], "standard_charges": [{"minimum": 70.22, "maximum": 70.22, "discounted_cash": 113.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBL CONVEX 11X31*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBL CONVEX 11X31*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBL CONVEX 11X31*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBL CONVEX 11X31*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBLIQUE CONVEX 11X31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBLIQUE CONVEX 12X31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS CARE DISCHRGE MA", "code_information": [{"code": "99217", "type": "CPT"}, {"code": "3500102261", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 190.4, "maximum": 263.84, "gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 263.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS DIRECT REFRL TO", "code_information": [{"code": "G0379", "type": "HCPCS"}, {"code": "3340100596", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 567.7, "maximum": 786.67, "gross_charge": 811.0, "discounted_cash": 983.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 677.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 786.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 668.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 675.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 608.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 655.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 779.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 689.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 655.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 655.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 668.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS INJ TX/PR/DX SUB", "code_information": [{"code": "96372", "type": "CPT"}, {"code": "3340100584", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 153.26, "gross_charge": 158.0, "discounted_cash": 107.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 153.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 85.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV HYDRATION >30", "code_information": [{"code": "96360", "type": "CPT"}, {"code": "3340100578", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 212.1, "maximum": 447.23, "gross_charge": 303.0, "discounted_cash": 328.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 226.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 227.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 212.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 293.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 212.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 227.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 260.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 242.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV HYDRATION EA", "code_information": [{"code": "96361", "type": "CPT"}, {"code": "3340100579", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 48.47, "maximum": 429.43, "gross_charge": 109.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV INFUS CONCURR", "code_information": [{"code": "96368", "type": "CPT"}, {"code": "3340100583", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 43.4, "maximum": 447.23, "gross_charge": 62.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 60.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV INFUS INITL 1", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "3340102292", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 218.72, "maximum": 690.64, "gross_charge": 712.0, "discounted_cash": 328.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 605.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 226.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 534.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 690.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 534.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 260.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 605.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 569.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV INFUSION EA A", "code_information": [{"code": "96366", "type": "CPT"}, {"code": "3340100581", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 48.47, "maximum": 429.43, "gross_charge": 109.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV INFUSION SEQ", "code_information": [{"code": "96367", "type": "CPT"}, {"code": "3340100582", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 71.89, "maximum": 447.23, "gross_charge": 190.0, "discounted_cash": 107.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 161.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 184.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 85.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 161.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 152.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV PUSH EA ADDL", "code_information": [{"code": "96376", "type": "CPT"}, {"code": "3340100587", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 306.52, "gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 306.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV PUSH EA NEW D", "code_information": [{"code": "96375", "type": "CPT"}, {"code": "3340100586", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 153.26, "gross_charge": 158.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 153.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS IV PUSH SINGL/1S", "code_information": [{"code": "96374", "type": "CPT"}, {"code": "3340100557", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 260.28, "gross_charge": 158.0, "discounted_cash": 328.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 226.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 153.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 118.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 260.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 134.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 126.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS OBSERVATION PER", "code_information": [{"code": "G0378", "type": "HCPCS"}, {"code": "3340100595", "type": "CDM"}, {"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 43.4, "maximum": 954.97, "gross_charge": 62.0, "discounted_cash": 93.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 60.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 954.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBS/IP HOSP CARE 40", "code_information": [{"code": "99234", "type": "CPT"}, {"code": "3500102274", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 423.5, "maximum": 586.85, "gross_charge": 605.0, "discounted_cash": 907.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 423.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 586.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 423.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS/IP HOSP CARE 50", "code_information": [{"code": "99235", "type": "CPT"}, {"code": "3500102275", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 442.4, "maximum": 613.04, "gross_charge": 632.0, "discounted_cash": 948.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 537.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 474.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 442.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 613.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 442.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 474.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 537.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 505.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBS/IP HOSP CARE 55", "code_information": [{"code": "99236", "type": "CPT"}, {"code": "3500102276", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 572.6, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80055", "type": "CPT"}, {"code": "3440100796", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 42.72, "maximum": 640.2, "gross_charge": 660.0, "discounted_cash": 76.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 640.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 60.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 528.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBSTETRIC PANEL", "code_information": [{"code": "80081", "type": "CPT"}], "standard_charges": [{"minimum": 42.72, "maximum": 74.86, "discounted_cash": 120.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 74.86, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59400", "type": "CPT"}], "standard_charges": [{"minimum": 3298.79, "maximum": 3298.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3298.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59409", "type": "CPT"}], "standard_charges": [{"minimum": 3298.79, "maximum": 3298.79, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3298.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBSTETRICAL CARE", "code_information": [{"code": "59410", "type": "CPT"}], "standard_charges": [{"minimum": 3298.79, "maximum": 3298.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3298.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBTAINING SCREEN PAP SMEAR", "code_information": [{"code": "Q0091", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OBTURATOR FLEXIBLE", "code_information": [{"code": "3100104117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OCC DUAL TULIP*18502", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCC GUARD, HARD, FULL ARCH", "code_information": [{"code": "D9944", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCC GUARD, HARD, PART ARCH", "code_information": [{"code": "D9946", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCC GUARD, SOFT, FULL ARCH", "code_information": [{"code": "D9945", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCC ORTHOTIC DEVICE ADJUST", "code_information": [{"code": "D7881", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCIP SCREW 4.5X14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCIP SCREW 4.5X8MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCIPITAL TULIP*1950", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCLUDE FALLOPIAN TUBE(S)", "code_information": [{"code": "58615", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCLUDER COLPO-PNEUM", "code_information": [{"code": "3100101157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 448.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OCCLUSAL GUARD ADJUSTMENT", "code_information": [{"code": "D9943", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCLUSAL ORTHOTIC APPLIANCE", "code_information": [{"code": "D7880", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCLUSION ANALYSIS", "code_information": [{"code": "D9950", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCULT BLD FECES 1-3 TESTS", "code_information": [{"code": "82272", "type": "CPT"}], "standard_charges": [{"minimum": 4.23, "maximum": 20.92, "discounted_cash": 6.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCULT BLOOD OTHER SOURCES", "code_information": [{"code": "82271", "type": "CPT"}], "standard_charges": [{"minimum": 5.32, "maximum": 20.92, "discounted_cash": 8.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCCUPATIONAL THERAPY, IN THE", "code_information": [{"code": "S9129", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.38, "maximum": 122.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R BILATERAL", "code_information": [{"code": "486T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCT MID EAR I&R UNILATERAL", "code_information": [{"code": "485T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCTAGAM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1568", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.98, "maximum": 46.98, "discounted_cash": 72.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE INJ, NON-DEPOT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2354", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.12, "maximum": 1.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCTREOTIDE INJECTION, DEPOT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2353", "type": "HCPCS"}], "standard_charges": [{"minimum": 210.56, "maximum": 210.56, "discounted_cash": 338.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 210.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCULAR BLOOD FLOW MEASURE", "code_information": [{"code": "198T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR PHOTODYNAMIC THER", "code_information": [{"code": "67221", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR PROSTHESIS", "code_information": [{"code": "D5916", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR PROSTHESIS INTERIM", "code_information": [{"code": "D5923", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65780", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65781", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OCULAR RECONST TRANSPLANT", "code_information": [{"code": "65782", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTICS ENDOSTEAL IMPLANT", "code_information": [{"code": "D6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTICS EPOSTEAL IMPLANT", "code_information": [{"code": "D6040", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTICS REPR ABUTMENT", "code_information": [{"code": "D6095", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTICS TRANSOSTEAL IMPLNT", "code_information": [{"code": "D6050", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ODONTOPLASTY PER TOOTH", "code_information": [{"code": "D9971", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OFATUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9302", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.16, "maximum": 67.16, "discounted_cash": 102.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX 70MIN", "code_information": [{"code": "G2086", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, 60 M", "code_information": [{"code": "G2087", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OFF BASE OPIOID TX, ADD30", "code_information": [{"code": "G2088", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OFFICE CONS NEW/EST", "code_information": [{"code": "99241", "type": "CPT"}, {"code": "3500102287", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 91.7, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE CONS NEW/EST", "code_information": [{"code": "99242", "type": "CPT"}, {"code": "3500102288", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 138.6, "maximum": 192.06, "gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 192.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 158.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE CONS NEW/EST", "code_information": [{"code": "99243", "type": "CPT"}, {"code": "3500102289", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 184.1, "maximum": 255.11, "gross_charge": 263.0, "discounted_cash": 394.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 255.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 184.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 197.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 223.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 210.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE CONS NEW/EST", "code_information": [{"code": "99244", "type": "CPT"}, {"code": "3500102290", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 231.0, "maximum": 320.1, "gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 320.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE CONS NEW/EST", "code_information": [{"code": "99245", "type": "CPT"}, {"code": "3500102291", "type": "CDM"}, {"code": "988", "type": "RC"}], "standard_charges": [{"minimum": 277.2, "maximum": 384.12, "gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 384.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 316.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OFFICE EMERGENCY CARE", "code_information": [{"code": "99058", "type": "CPT"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OFFICE VISIT AFTER HOURS", "code_information": [{"code": "D9440", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OFFICE VISIT DURING HOURS", "code_information": [{"code": "D9430", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OLANZAPINE LONG-ACTING INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2358", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.92, "maximum": 2.92, "discounted_cash": 4.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OLIGOCLONAL IMMUNE", "code_information": [{"code": "83916", "type": "CPT"}, {"code": "3440100959", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 27.39, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 44.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OLIVE-1.6/100*OLIVE-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 319.2, "maximum": 442.32, "gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 442.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMALIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2357", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.81, "maximum": 36.81, "discounted_cash": 63.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP EXTRA-ABDOM", "code_information": [{"code": "49904", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OMENTAL FLAP INTRA-ABDOM", "code_information": [{"code": "49905", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OMNICARDIOGRAM/CARDIOINTEGRA", "code_information": [{"code": "S9025", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OMNIPAQUE", "code_information": [{"code": "3100102206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 73.0, "discounted_cash": 109.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ONC AML DNA DETCJ/NONDETCJ", "code_information": [{"code": "23U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 399.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC B CLL LYMPHM MRNA 58 GEN", "code_information": [{"code": "120U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4032.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BLADDER MRNA 219 GEN ALG", "code_information": [{"code": "16M", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 5606.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 101 GENES", "code_information": [{"code": "153U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 5075.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 12 GENES", "code_information": [{"code": "81522", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 58 GENES", "code_information": [{"code": "81520", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2510.21, "discounted_cash": 4032.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2510.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BREAST MRNA 70 GENES", "code_information": [{"code": "81521", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRN SPHRD CLL 12 RX PNL", "code_information": [{"code": "248U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 4873.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST ALYS 32 PHSPRTN ALG", "code_information": [{"code": "249U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 3565.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA AI ASSMT 12 FEAT", "code_information": [{"code": "220U", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 43.61, "discounted_cash": 1134.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA 11", "code_information": [{"code": "177U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA DNA PIK3CA GENE", "code_information": [{"code": "155U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST CA ERBB2 AMP/NONAMP", "code_information": [{"code": "9U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 171.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST DUX CARC 7 PROTEINS", "code_information": [{"code": "295U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 8731.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST DUX CARC IS 12 GENE", "code_information": [{"code": "45U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST IMHCHEM PRFL 4 BMRK", "code_information": [{"code": "67U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3047.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 11 GENES", "code_information": [{"code": "81518", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST MRNA 70 CNT 31 GENE", "code_information": [{"code": "81523", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC BRST SEMIQ MEAS THYM KN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1429", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.31, "maximum": 164.31, "discounted_cash": 267.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 164.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC BRST SEMIQ MEAS THYM KN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2404", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC CHEMO RX CYTOTOX CSC 14", "code_information": [{"code": "564T", "type": "CPT"}], "standard_charges": [{"minimum": 41.39, "maximum": 41.39, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT 3 UR METAB ALG PLP", "code_information": [{"code": "2U", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "discounted_cash": 40.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT CA IMG ALYS W/AI", "code_information": [{"code": "261U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 7952.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT MICRORNA MIR-31-3P", "code_information": [{"code": "69U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 610.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR 3 PRTN ALG", "code_information": [{"code": "163U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 627.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CLRCT SCR WHL BLD ALG", "code_information": [{"code": "91U", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC COLON CA KRAS&NRAS ALYS", "code_information": [{"code": "111U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1096.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 23 GENE", "code_information": [{"code": "90U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3132.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC CUTAN MLNMA MRNA 31 GENE", "code_information": [{"code": "81529", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 7193.0, "discounted_cash": 11555.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7193.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC DLBCL MRNA 20 GENES ALG", "code_information": [{"code": "17M", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4032.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC GASTRO 51 GENE NOMOGRAM", "code_information": [{"code": "7M", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 602.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC HEP GENE RISK CLASSIFIER", "code_information": [{"code": "6M", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 240.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO JAK2 MUT DNA", "code_information": [{"code": "17U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 147.26, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC HMTLMF NEO RNA BCR/ABL1", "code_information": [{"code": "16U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 263.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC LNCH SYN GEN DNA SEQ ALY", "code_information": [{"code": "238U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 939.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC LNG 3 PRTN BMRK PLSM ALG", "code_information": [{"code": "92U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3996.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC LNG 5 CLIN RSK FACTR ALG", "code_information": [{"code": "80U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5654.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC LNG MULTIOMICS PLSM ALG", "code_information": [{"code": "401U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC LUNG MRNA QUAN PCR 11&3", "code_information": [{"code": "288U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM +/-", "code_information": [{"code": "59U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 518.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC MERKEL CLL CARC SRM QUAN", "code_information": [{"code": "58U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 518.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA AMBRA1&AMLO", "code_information": [{"code": "387U", "type": "CPT"}], "standard_charges": [{"minimum": 948.5, "maximum": 948.5, "discounted_cash": 1523.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 948.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC MLNMA PRAME & LINC00518", "code_information": [{"code": "89U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RECR URTHL CA", "code_information": [{"code": "13M", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC MRNA 5 GEN RSK URTHL CA", "code_information": [{"code": "12M", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA 37 GEN", "code_information": [{"code": "388U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONC NONSM CLL LNG CA ALYS 23", "code_information": [{"code": "179U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 3121.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC ORL&/OROP CA 20 MLC FEAT", "code_information": [{"code": "296U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 3132.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC OVAR 5 PRTN SER ALG SCOR", "code_information": [{"code": "3U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1526.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN OPT MAPG", "code_information": [{"code": "299U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2993.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ DNA", "code_information": [{"code": "297U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL GEN SEQ&OPT", "code_information": [{"code": "300U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 6720.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PAN TUM WHL TRNS SEQ RNA", "code_information": [{"code": "298U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PAN-TUM DNA&RNA GNRJ SEQ", "code_information": [{"code": "211U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 13582.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC 59 MTHLTN BLK MRK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9358", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.27, "maximum": 27.27, "discounted_cash": 43.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PNCRTC 59 MTHLTN BLK MRK", "code_information": [{"code": "M0220", "type": "HCPCS"}], "standard_charges": [{"minimum": 150.5, "maximum": 150.5, "discounted_cash": 241.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE 3 GENES", "code_information": [{"code": "81551", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2030.0, "discounted_cash": 3261.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2030.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE MRNA 22 CNT GEN", "code_information": [{"code": "81542", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PROSTATE MRNA 46 GENES", "code_information": [{"code": "81541", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 CA MRNA 12 GEN ALG", "code_information": [{"code": "11M", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 DETCJ 8 AUTOANTB", "code_information": [{"code": "21U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MA MOLEC PRFL ALG", "code_information": [{"code": "228U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 277.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 17 GENE ALG", "code_information": [{"code": "47U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 MRNA 18 GEN DRE UR", "code_information": [{"code": "G0465", "type": "HCPCS"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC PRST8 PCA3&TMPRSS2-ERG", "code_information": [{"code": "113U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC RNA TISS PREDICT ALG", "code_information": [{"code": "19U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5903.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC RSPS RADJ CLL FR DNA TOX", "code_information": [{"code": "285U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 712.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC RSPSE CHEMO CNTRST TOMOG", "code_information": [{"code": "83U", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 112.14, "discounted_cash": 268.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORG NEO DNA 468 GENE", "code_information": [{"code": "48U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC SLD ORG NEO DNA 505 GENE", "code_information": [{"code": "250U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM ALYS BRCA1 BRCA2", "code_information": [{"code": "172U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4867.7, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM DNA&RNA 437 GEN", "code_information": [{"code": "391U", "type": "CPT"}], "standard_charges": [{"minimum": 3600.0, "maximum": 3600.0, "discounted_cash": 5783.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONC SLD TUM RT-PCR 7 GEN", "code_information": [{"code": "262U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 5140.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC SOLID ORGN DNA 257 GENES", "code_information": [{"code": "244U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 5622.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC SOLID TUMOR 30 PRTN TRGT", "code_information": [{"code": "174U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2097.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC THYR 10 MICRORNA SEQ ALG", "code_information": [{"code": "18U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4822.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "26U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5783.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC THYR DNA&MRNA 112 GENES", "code_information": [{"code": "287U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 5783.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC THYR MRNA 10,196 GEN ALG", "code_information": [{"code": "81546", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3600.0, "discounted_cash": 5783.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3600.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC THYR MRNA XPRSN ALYS 593", "code_information": [{"code": "204U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC THYR MUT ALYS 10 GEN&37", "code_information": [{"code": "245U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 2033.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC URTHL CA RNA FGFR3 GENE", "code_information": [{"code": "154U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 774.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONC UVEAL MLNMA MRNA 15 GENE", "code_information": [{"code": "81552", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 7776.0, "discounted_cash": 12492.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7776.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCO (OVAR) FIVE PROTEINS", "code_information": [{"code": "81503", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 897.0, "discounted_cash": 1441.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 897.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCO (OVAR) TWO PROTEINS", "code_information": [{"code": "81500", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 260.5, "discounted_cash": 418.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 260.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCO PRST8 3 GENE UR ALG", "code_information": [{"code": "5U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY BREAST MRNA", "code_information": [{"code": "81519", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3873.0, "discounted_cash": 6221.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3873.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY COLON MRNA", "code_information": [{"code": "81525", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3116.0, "discounted_cash": 5005.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3116.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY COLORECTAL SCR", "code_information": [{"code": "81528", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 508.87, "discounted_cash": 817.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 508.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY GYNECOLOGIC", "code_information": [{"code": "81535", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 579.46, "discounted_cash": 930.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 579.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY GYNECOLOGIC", "code_information": [{"code": "81536", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 177.56, "discounted_cash": 285.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 177.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY LUNG", "code_information": [{"code": "81538", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2871.0, "discounted_cash": 4612.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2871.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY PROSTATE PROB SCORE", "code_information": [{"code": "81539", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 760.0, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 760.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TISSUE OF ORIGIN", "code_information": [{"code": "81504", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 520.0, "discounted_cash": 835.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 520.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOLOGY TUM UNKNOWN ORIGIN", "code_information": [{"code": "81540", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 3750.0, "discounted_cash": 6024.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3750.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOPROTEIN DCP", "code_information": [{"code": "83951", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 64.41, "discounted_cash": 103.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONCOPROTEIN HER-2/NEU", "code_information": [{"code": "83950", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 64.41, "discounted_cash": 103.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON 4 MG", "code_information": [{"code": "S0119", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2405", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.1, "maximum": 0.1, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONDANSETRON ORAL", "code_information": [{"code": "Q0162", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.02, "maximum": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ONE-WAY ALLOW PRORATED MILES", "code_information": [{"code": "P9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONE-WAY ALLOW PRORATED TRIP", "code_information": [{"code": "P9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY CST BASE MTL 2 SURFACE", "code_information": [{"code": "D6612", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY CST BASE MTL >=3 SURFA", "code_information": [{"code": "D6613", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY CST HGH NBL MTL 2 SRFC", "code_information": [{"code": "D6610", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY CST HGH NBL MTL >=3SRF", "code_information": [{"code": "D6611", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY CST NBL MTL 2 SURFACES", "code_information": [{"code": "D6614", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY CST NBL MTL >=3 SURFAC", "code_information": [{"code": "D6615", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY PORC/CRMC 2 SURFACES", "code_information": [{"code": "D6608", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY PORC/CRMC >=3 SURFACES", "code_information": [{"code": "D6609", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY REPAIR", "code_information": [{"code": "D2982", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ONLAY TITANIUM", "code_information": [{"code": "D6634", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OOCYTE IDENTIFICATION", "code_information": [{"code": "89254", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OOPHORECTOMY PART/TO", "code_information": [{"code": "58940", "type": "CPT"}, {"code": "3340102344", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 3553.77, "gross_charge": 1770.0, "discounted_cash": 2655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1504.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1327.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1239.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1716.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1239.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1327.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1504.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1416.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR CRYO", "code_information": [{"code": "47381", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN ABLATE LIVER TUMOR RF", "code_information": [{"code": "47380", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN AORTIC TUBE PROSTH REPR", "code_information": [{"code": "34830", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOFEMOR PROSTH REPR", "code_information": [{"code": "34832", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN AORTOILIAC PROSTH REPR", "code_information": [{"code": "34831", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN BIOPSY OF LUNG PLEURA", "code_information": [{"code": "32098", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN BX/EXC INGUINOFEM NODES", "code_information": [{"code": "38531", "type": "CPT"}], "standard_charges": [{"minimum": 3504.82, "maximum": 3504.82, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CARPAL FX W/WO", "code_information": [{"code": "25628", "type": "CPT"}, {"code": "3480101612", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15334.73, "gross_charge": 15809.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15334.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CLAVICLE DISL W", "code_information": [{"code": "23552", "type": "CPT"}, {"code": "3480101547", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CLAVICLE DISLOC", "code_information": [{"code": "23550", "type": "CPT"}, {"code": "3480101546", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN DISTAL RAD FX W", "code_information": [{"code": "25607", "type": "CPT"}, {"code": "3480101609", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN HUMERUS FX W/ P", "code_information": [{"code": "23616", "type": "CPT"}, {"code": "3480101550", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 22630.21, "gross_charge": 21169.0, "discounted_cash": 28525.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17993.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19663.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15876.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14818.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20533.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14818.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19587.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15876.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22630.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17993.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16935.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN HUMERUS FX-PROX", "code_information": [{"code": "23615", "type": "CPT"}, {"code": "3480101549", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN ISLET CELL TRANSPLANT", "code_information": [{"code": "586T", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN MEDIAL MALL FX", "code_information": [{"code": "27766", "type": "CPT"}, {"code": "3340102331", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 14003.89, "gross_charge": 14437.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14003.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11549.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/ FIXJ", "code_information": [{"code": "21339", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN NASOETHMOID FX W/O FIXJ", "code_information": [{"code": "21338", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN OSTEOCHOND ALLO", "code_information": [{"code": "27415", "type": "CPT"}, {"code": "3340102300", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7500.92, "maximum": 22090.78, "gross_charge": 22774.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19357.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17080.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15941.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22090.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15941.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17080.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19357.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18219.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN RED COMP MALAR/ZYGMA FX", "code_information": [{"code": "D7750", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMP MALAR/ZYGOM FX", "code_information": [{"code": "D7650", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN RED SIMPL MANDIBLE FX", "code_information": [{"code": "D7630", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN REDUC COMPD ALVEOLUS FX", "code_information": [{"code": "D7770", "type": "HCPCS"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN REDUCT COMPD MANDBLE FX", "code_information": [{"code": "D7730", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61312", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61313", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61314", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61315", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61320", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR DRAINAGE", "code_information": [{"code": "61321", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61304", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN SKULL FOR EXPLORATION", "code_information": [{"code": "61305", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN THROMBECT AV FISTULA", "code_information": [{"code": "36831", "type": "CPT"}], "standard_charges": [{"minimum": 5104.6, "maximum": 5104.6, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TMT HUM FX W/O", "code_information": [{"code": "24545", "type": "CPT"}, {"code": "3480101574", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TMT HUM FX W/WO", "code_information": [{"code": "24575", "type": "CPT"}, {"code": "3480101575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREAT HUMERUS F", "code_information": [{"code": "24515", "type": "CPT"}, {"code": "3480101571", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATM OF NASAL", "code_information": [{"code": "21335", "type": "CPT"}, {"code": "3480101467", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATM OF NASAL", "code_information": [{"code": "21336", "type": "CPT"}, {"code": "3480101468", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7776.49, "gross_charge": 8017.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7776.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6413.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATM OF ORBIT", "code_information": [{"code": "21386", "type": "CPT"}, {"code": "3480101469", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATM OF ORBIT", "code_information": [{"code": "21390", "type": "CPT"}, {"code": "3480101470", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF AR", "code_information": [{"code": "26746", "type": "CPT"}, {"code": "3480101651", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF BI", "code_information": [{"code": "27814", "type": "CPT"}, {"code": "3480101734", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF CO", "code_information": [{"code": "21470", "type": "CPT"}, {"code": "3480101471", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF DI", "code_information": [{"code": "26765", "type": "CPT"}, {"code": "3480101653", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7776.49, "gross_charge": 8017.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7776.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6413.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF DI", "code_information": [{"code": "27792", "type": "CPT"}, {"code": "3480101733", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF DI", "code_information": [{"code": "27829", "type": "CPT"}, {"code": "3480101739", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 15334.73, "gross_charge": 15809.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15334.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF FR", "code_information": [{"code": "27827", "type": "CPT"}, {"code": "3480101737", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF FR", "code_information": [{"code": "27828", "type": "CPT"}, {"code": "3480101738", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6155.24, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF IN", "code_information": [{"code": "26785", "type": "CPT"}, {"code": "3480101655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF IN", "code_information": [{"code": "27540", "type": "CPT"}, {"code": "3480101710", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1427.3, "maximum": 6155.24, "gross_charge": 2039.0, "discounted_cash": 3058.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1733.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1529.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1427.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1977.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1427.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1529.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1733.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1631.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF ME", "code_information": [{"code": "26615", "type": "CPT"}, {"code": "3480101645", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF ME", "code_information": [{"code": "28485", "type": "CPT"}, {"code": "3480101773", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF PA", "code_information": [{"code": "27524", "type": "CPT"}, {"code": "3480101708", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF PH", "code_information": [{"code": "26735", "type": "CPT"}, {"code": "3480101650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF TA", "code_information": [{"code": "28585", "type": "CPT"}, {"code": "3480101774", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 6681.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF TA", "code_information": [{"code": "28615", "type": "CPT"}, {"code": "3480101775", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15334.73, "gross_charge": 15809.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15334.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF TI", "code_information": [{"code": "27535", "type": "CPT"}, {"code": "3480101709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1884.4, "maximum": 6155.24, "gross_charge": 2692.0, "discounted_cash": 4038.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2288.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2019.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1884.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2611.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1884.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2019.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2288.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2153.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF TI", "code_information": [{"code": "27759", "type": "CPT"}, {"code": "3480101731", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 20533.93, "gross_charge": 21169.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17993.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15876.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14818.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20533.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14818.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15876.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17993.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16935.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TREATMENT OF TR", "code_information": [{"code": "27823", "type": "CPT"}, {"code": "3480101735", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TRMT CLAVICLE F", "code_information": [{"code": "23515", "type": "CPT"}, {"code": "3480101545", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TRMT SHLD BLADE", "code_information": [{"code": "23585", "type": "CPT"}, {"code": "3480101548", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX DIST RAD FX", "code_information": [{"code": "25608", "type": "CPT"}, {"code": "3480101610", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX DPRSD FRONT SINUS FX", "code_information": [{"code": "21343", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX FEM FX PROX", "code_information": [{"code": "27236", "type": "CPT"}, {"code": "3480101675", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2097.9, "maximum": 6155.24, "gross_charge": 2997.0, "discounted_cash": 4495.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2547.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2247.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2097.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2907.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2097.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2247.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2547.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2397.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX HUM CONDYL F", "code_information": [{"code": "24579", "type": "CPT"}, {"code": "3480101576", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX ILIAC SPINE UNI/BIL", "code_information": [{"code": "G0412", "type": "HCPCS"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX MANDBLR FX W", "code_information": [{"code": "21462", "type": "CPT"}, {"code": "3480103052", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX MANDIBULAR C", "code_information": [{"code": "21465", "type": "CPT"}, {"code": "3480103053", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX UNCOMPLICATD", "code_information": [{"code": "21325", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX NOSE FX W/SKELE FIXJ", "code_information": [{"code": "21330", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX OF ULNAR STY", "code_information": [{"code": "25652", "type": "CPT"}, {"code": "3480101615", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6155.24, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX ORBIT FX W/I", "code_information": [{"code": "21407", "type": "CPT"}, {"code": "3480103139", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST ANKLE F", "code_information": [{"code": "27769", "type": "CPT"}, {"code": "3480103137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6155.24, "maximum": 14003.89, "gross_charge": 14437.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14003.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11549.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX POST PELVIC FXCTURE", "code_information": [{"code": "G0415", "type": "HCPCS"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX TRIMALLEOLAR", "code_information": [{"code": "27822", "type": "CPT"}, {"code": "3480103042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN TX W/INT FIX RA", "code_information": [{"code": "25609", "type": "CPT"}, {"code": "3480101611", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG NODULE", "code_information": [{"code": "32097", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPERATION FOR CORREC", "code_information": [{"code": "53440", "type": "CPT"}, {"code": "3480102041", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 25922.28, "gross_charge": 26724.0, "discounted_cash": 19648.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22715.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13544.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20043.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18706.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25922.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13361.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18706.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13492.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20043.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13099.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15588.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22715.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13099.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21379.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13099.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13361.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH AMD ALYS 3 GENE VARIANTS", "code_information": [{"code": "205U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 75.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN", "code_information": [{"code": "76512", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPH US DX QUAN A-SCAN ONLY", "code_information": [{"code": "76511", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC MITOMYCIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7315", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPIATES 1 OR MORE", "code_information": [{"code": "80361", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPIOID &OPIATE ANALOG 5/MORE", "code_information": [{"code": "80364", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 1/2", "code_information": [{"code": "80362", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPIOIDS & OPIATE ANALOGS 3/4", "code_information": [{"code": "80363", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPIUM/BELLADONNA ALK", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300163", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 60.7, "discounted_cash": 91.05, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "OPN AX/SUBCLA ART EXPOS", "code_information": [{"code": "34715", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN BRACH ART EXPOS", "code_information": [{"code": "34834", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN FEM ART EXPOS", "code_information": [{"code": "34812", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ CRNL NRV NEA&PG", "code_information": [{"code": "64568", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "discounted_cash": 47530.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA NEUROMUSCULAR", "code_information": [{"code": "64580", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 30305.84, "discounted_cash": 33484.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN IMPLTJ NEA PERPH NERVE", "code_information": [{"code": "64575", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 30305.84, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN MPLTJ HPGLSL NSTM ARY PG", "code_information": [{"code": "64582", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "discounted_cash": 47530.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR FX", "code_information": [{"code": "21365", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX COMPLX MALAR W/GRFT", "code_information": [{"code": "21366", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD MALAR FRACTURE", "code_information": [{"code": "21360", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX DPRSD ZYGOMATIC ARCH", "code_information": [{"code": "21356", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX MULTPLE", "code_information": [{"code": "21347", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/FIXJ", "code_information": [{"code": "21346", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX NASOMAX FX W/GRAFT", "code_information": [{"code": "21348", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX COMBINED", "code_information": [{"code": "21387", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX TRANSANTRAL", "code_information": [{"code": "21385", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/BONE GRFT", "code_information": [{"code": "21408", "type": "CPT"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT FX W/O IMPLANT", "code_information": [{"code": "21406", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPN TX ORBIT PERIORBT W/GRFT", "code_information": [{"code": "21395", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPPS SERVICE,SCHED TEAM CONF", "code_information": [{"code": "G0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 677.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPPS/PHP/IOP; ACTIVITY THRPY", "code_information": [{"code": "G0176", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPPS/PHP/IOP; TRAIN & EDUC", "code_information": [{"code": "G0177", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPRELVEKIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2355", "type": "HCPCS"}], "standard_charges": [{"minimum": 308.8, "maximum": 308.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 308.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND ON/MAC DRAW", "code_information": [{"code": "92202", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPSCPY EXTND RTA DRAW UNI/BI", "code_information": [{"code": "92201", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTH SURGERY 1ST 30", "code_information": [{"code": "3480103117", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3951.0, "discounted_cash": 5926.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OPTH SURGERY EA ADDL", "code_information": [{"code": "3480103118", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7906.0, "discounted_cash": 11859.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OPTICAL ENDOMICROSCPY INTERP", "code_information": [{"code": "88375", "type": "CPT"}], "standard_charges": [{"minimum": 50.87, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92534", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTOKINETIC NYSTAGMUS TEST", "code_information": [{"code": "92544", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX ACUTE SHOULDER DISLC", "code_information": [{"code": "23660", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX OF RIB FX W/FIXJ SCOPE", "code_information": [{"code": "21811", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC FX", "code_information": [{"code": "23670", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX SHO DISLC NECK FX FIXJ", "code_information": [{"code": "23680", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX STRCLV DSLC AQ/CHRN GRF", "code_information": [{"code": "23532", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX STRNCLAV DISLC AQT/CHRN", "code_information": [{"code": "23530", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPTX THIGH FX", "code_information": [{"code": "27269", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OR CABLE/EXTENSION*S", "code_information": [{"code": "3100209880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORAL ANTRAL FISTULA CLOSURE", "code_information": [{"code": "D7260", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL APREPITANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8501", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.5, "maximum": 3.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL BUSULFAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8510", "type": "HCPCS"}], "standard_charges": [{"minimum": 64.87, "maximum": 64.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 64.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL DEXAMETHASONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8540", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL EVALUATION, PT < 3YRS", "code_information": [{"code": "D0145", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL EVEROLIMUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7527", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.68, "maximum": 2.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL FLUDARABINE PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8562", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL FUNCTION THERAPY", "code_information": [{"code": "92526", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL HIV 1 & HIV SCR", "code_information": [{"code": "G0435", "type": "HCPCS"}, {"code": "3440101260", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.83, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL HIV 1 &/HIV 2 S", "code_information": [{"code": "G0435", "type": "HCPCS"}, {"code": "3440101261", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.83, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 19.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL HYGIENE INSTRUCTION", "code_information": [{"code": "D1330", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL MED ADM DIRECT OBSERVE", "code_information": [{"code": "H0033", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL MR CONTRAST, 100 ML", "code_information": [{"code": "Q9954", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.1, "maximum": 13.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL NETUPITANT, PALONOSETRO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8655", "type": "HCPCS"}], "standard_charges": [{"minimum": 409.05, "maximum": 409.05, "discounted_cash": 658.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 409.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORAL PRESCRIPTION DRUG CHEMO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8999", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORAL SPEECH DEVICE EVAL", "code_information": [{"code": "92597", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL SURGERY 1ST 30", "code_information": [{"code": "3480103119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORAL SURGERY EA ADDL", "code_information": [{"code": "3480103120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORAL SURGERY PROCEDURE", "code_information": [{"code": "D7999", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORAL/FACIAL PHOTO IMAGES", "code_information": [{"code": "D0350", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORB FLR RT 0.6MM*52-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2315.04, "maximum": 3207.98, "gross_charge": 3307.2, "discounted_cash": 4960.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2811.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2480.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2315.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3207.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2315.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2480.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2811.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2645.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL FLOOR PLATE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 701.4, "maximum": 971.94, "gross_charge": 1002.0, "discounted_cash": 1503.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 851.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 751.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 701.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 971.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 701.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 751.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 851.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 801.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "113", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13479.62, "maximum": 13479.62, "discounted_cash": 27992.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13479.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "114", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7200.94, "maximum": 7200.94, "discounted_cash": 13752.51, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7200.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITAL PROSTHESIS", "code_information": [{"code": "D5915", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITAL REPLACEMENT", "code_information": [{"code": "D5928", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61584", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61585", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": [{"code": "61592", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORBITOTOMY W/O BONE", "code_information": [{"code": "67400", "type": "CPT"}, {"code": "3480102206", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4695.04, "gross_charge": 4788.0, "discounted_cash": 5918.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4079.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4024.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4063.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3945.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4695.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3945.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3945.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4024.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY, PARTIAL", "code_information": [{"code": "54522", "type": "CPT"}, {"code": "3480102065", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6913.19, "gross_charge": 7127.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6057.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5345.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4988.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6913.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4988.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5345.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6057.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5701.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY, SIMPLE", "code_information": [{"code": "54520", "type": "CPT"}, {"code": "3480102064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIECTOMY, SIMPLE", "code_information": [{"code": "54520", "type": "CPT"}, {"code": "3480103263", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY (FOWLER-STEPHENS)", "code_information": [{"code": "54650", "type": "CPT"}], "standard_charges": [{"minimum": 2109.3, "maximum": 2109.3, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORCHIOPEXY, INGUINAL", "code_information": [{"code": "54640", "type": "CPT"}, {"code": "3480102067", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACID 1 QUANT", "code_information": [{"code": "83921", "type": "CPT"}, {"code": "3440100960", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.21, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 34.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS QUAL EACH", "code_information": [{"code": "83919", "type": "CPT"}], "standard_charges": [{"minimum": 16.45, "maximum": 40.05, "discounted_cash": 26.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORGANIC ACIDS TOTAL QUANT", "code_information": [{"code": "83918", "type": "CPT"}], "standard_charges": [{"minimum": 20.03, "maximum": 23.6, "discounted_cash": 37.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [{"code": "884", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4161.2, "maximum": 4161.2, "discounted_cash": 19615.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4161.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORIGO IRRGATION LINE", "code_information": [{"code": "3100209304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORION, PER SQ CM", "code_information": [{"code": "Q4276", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORIOS BONE MATRIX 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORIOS BONE MATRIX 2.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2839.2, "maximum": 3934.32, "gross_charge": 4056.0, "discounted_cash": 6084.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3447.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3042.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2839.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3934.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2839.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3042.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3447.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3244.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORIOS BONE MATRIX 5C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5678.4, "maximum": 7868.64, "gross_charge": 8112.0, "discounted_cash": 12168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6895.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6084.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5678.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7868.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5678.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6084.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6895.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6489.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORISE GEL*M00519201", "code_information": [{"code": "3100204772", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORPHENADRINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2360", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.12, "maximum": 9.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHC/PROSTC MGMT SBSQ ENC", "code_information": [{"code": "97763", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORTHO SURGERY 1ST 30", "code_information": [{"code": "3480103121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHO SURGERY EA ADD", "code_information": [{"code": "3480103122", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1957.0, "discounted_cash": 2935.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHO WEDGE", "code_information": [{"code": "3100104435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHO WEDGE", "code_information": [{"code": "L3420", "type": "HCPCS"}, {"code": "3100101158", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 67.2, "maximum": 93.12, "gross_charge": 96.0, "discounted_cash": 144.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHO WEDGE", "code_information": [{"code": "L3420", "type": "HCPCS"}, {"code": "3100102936", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 64.4, "maximum": 89.24, "gross_charge": 92.0, "discounted_cash": 138.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 78.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 69.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 64.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 89.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 64.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 69.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 78.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 73.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHOBLEND SM 10CC*T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2315.15, "maximum": 3208.13, "gross_charge": 3307.36, "discounted_cash": 4961.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2811.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2480.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2315.15, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3208.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2315.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2480.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2811.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2645.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHODONTIC PROCEDURE", "code_information": [{"code": "D8999", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORTHODONTIC REM APPLIANCE TX", "code_information": [{"code": "D8210", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORTHODONTIC RETENTION", "code_information": [{"code": "D8680", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORTHOLOCK EX-PIN STR", "code_information": [{"code": "3100101159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 311.0, "discounted_cash": 466.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ORTHOP TRAING PFRMD PHYS/QHP", "code_information": [{"code": "92065", "type": "CPT"}], "standard_charges": [{"minimum": 142.4, "maximum": 142.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORTHOPOXVIRUS AMP PRB EACH", "code_information": [{"code": "87593", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ORTHOTIC MGMT&TRAING 1ST ENC", "code_information": [{"code": "97760", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ORTHOVISC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7324", "type": "HCPCS"}, {"code": "3100102207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 131.56, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 209.87, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 131.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORTHROSPACE INSPACE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSCILLATING TRACKING TEST", "code_information": [{"code": "92545", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSIA 2 PROCESSOR KIT", "code_information": [{"code": "3100205774", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10751.0, "discounted_cash": 16126.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSMOLALITY BLOOD", "code_information": [{"code": "83930", "type": "CPT"}, {"code": "3440100961", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.61, "maximum": 52.38, "gross_charge": 54.0, "discounted_cash": 10.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSMOLALITY URINE", "code_information": [{"code": "83935", "type": "CPT"}, {"code": "3440100962", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.82, "maximum": 52.38, "gross_charge": 54.0, "discounted_cash": 10.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY, CALCANEUS", "code_information": [{"code": "28118", "type": "CPT"}, {"code": "3480101753", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY, COMPLETE", "code_information": [{"code": "28112", "type": "CPT"}, {"code": "3480101751", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY, COMPLETE", "code_information": [{"code": "28113", "type": "CPT"}, {"code": "3480101752", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTECTOMY, PARTIAL E", "code_information": [{"code": "28110", "type": "CPT"}, {"code": "3480101750", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "gross_charge": 6653.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEO LAMBOTTE", "code_information": [{"code": "3100104089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.0, "discounted_cash": 307.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEO LAMBOTTE", "code_information": [{"code": "3100104090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOAMP FIBERS 10CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4406.22, "maximum": 6105.76, "gross_charge": 6294.6, "discounted_cash": 9441.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5350.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4720.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4406.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6105.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4406.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4720.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5350.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5035.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOAMP FIBERS 15CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5436.34, "maximum": 7533.21, "gross_charge": 7766.2, "discounted_cash": 11649.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6601.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5824.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5436.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7533.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5436.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5824.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6601.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6212.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOAMP FIBERS 1CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 802.2, "maximum": 1111.62, "gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 974.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 859.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 802.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1111.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 802.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 859.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 974.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 916.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOAMP FIBERS 2.5C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1803.2, "maximum": 2498.72, "gross_charge": 2576.0, "discounted_cash": 3864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1803.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2498.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1803.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2189.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2060.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOAMP FIBERS 5CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2642.64, "maximum": 3661.94, "gross_charge": 3775.2, "discounted_cash": 5662.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3208.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2831.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2642.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3661.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2642.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2831.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3208.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3020.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOART ALGRFT W/SURF & B1", "code_information": [{"code": "20932", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCELL MATRIX 2CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL CORE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL CORE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL CORE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL CORE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6552.0, "maximum": 9079.2, "gross_charge": 9360.0, "discounted_cash": 14040.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9079.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7956.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL FLAP R", "code_information": [{"code": "3100101160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL KNEE AUTOGRAFT", "code_information": [{"code": "27416", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOCHONDRAL TALUS AUTOGRFT", "code_information": [{"code": "28446", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH CC", "code_information": [{"code": "540", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6420.1, "maximum": 6420.1, "discounted_cash": 14493.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6420.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITH MCC", "code_information": [{"code": "539", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9081.1, "maximum": 9081.1, "discounted_cash": 22154.96, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9081.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOMYELITIS WITHOUT CC/MCC", "code_information": [{"code": "541", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3806.44, "maximum": 3806.44, "discounted_cash": 9578.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3806.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 1-2 REGIONS", "code_information": [{"code": "98925", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 3-4 REGIONS", "code_information": [{"code": "98926", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 5-6 REGIONS", "code_information": [{"code": "98927", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 7-8 REGIONS", "code_information": [{"code": "98928", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOPATH MANJ 9-10 REGIONS", "code_information": [{"code": "98929", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 39.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1 VRT SGM CRV", "code_information": [{"code": "22220", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM EA", "code_information": [{"code": "22226", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM LMBR", "code_information": [{"code": "22224", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT DSC ANT 1VRT SGM THRC", "code_information": [{"code": "22222", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOT HUM XTRNL LNGTH DEV", "code_information": [{"code": "594T", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOTOME", "code_information": [{"code": "3100104543", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.75, "discounted_cash": 248.63, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME ACET", "code_information": [{"code": "3100104071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2043.0, "discounted_cash": 3064.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME BLADE 8M*0", "code_information": [{"code": "3100207454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME DISTRACTIN", "code_information": [{"code": "3100101161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1467.0, "discounted_cash": 2200.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME FLEXIBLE", "code_information": [{"code": "3100104066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 2358.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOME SPLIT", "code_information": [{"code": "3100101162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1165.0, "discounted_cash": 1747.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OSTEOTOMY SPINE EA A", "code_information": [{"code": "22208", "type": "CPT"}, {"code": "3340102319", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1355.9, "maximum": 5178.02, "gross_charge": 1937.0, "discounted_cash": 2905.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1646.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1452.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1355.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1878.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1355.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1452.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1646.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1549.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY SPINE POST", "code_information": [{"code": "22207", "type": "CPT"}, {"code": "3480101486", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4929.4, "maximum": 6830.74, "gross_charge": 7042.0, "discounted_cash": 10563.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5985.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5281.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4929.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6830.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4929.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5281.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5985.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5633.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY SPINE THOR", "code_information": [{"code": "22206", "type": "CPT"}, {"code": "3340102318", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 7719.26, "gross_charge": 7958.0, "discounted_cash": 11937.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6764.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5968.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5570.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7719.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5570.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5968.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6764.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6366.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY, FEMORAL N", "code_information": [{"code": "27161", "type": "CPT"}, {"code": "3480101673", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2130.8, "maximum": 4985.78, "gross_charge": 3044.0, "discounted_cash": 4566.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2587.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2283.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2130.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2952.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2130.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2283.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2587.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2435.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY, SHORTENIN", "code_information": [{"code": "28310", "type": "CPT"}, {"code": "3480101770", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 5544.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTEOTOMY, WITH OR W", "code_information": [{"code": "28306", "type": "CPT"}, {"code": "3480101769", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8687.35, "gross_charge": 5544.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OSTETOME CURVED ZIMM", "code_information": [{"code": "3100103886", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 523.0, "discounted_cash": 784.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OT EVAL HIGH COMPLEX", "code_information": [{"code": "97167", "type": "CPT"}, {"code": "3320103022", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 513.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL HIGH COMPLEX 60 MIN", "code_information": [{"code": "97167", "type": "CPT"}], "standard_charges": [{"minimum": 122.38, "maximum": 122.38, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OT EVAL LOW COMPLEX", "code_information": [{"code": "97165", "type": "CPT"}, {"code": "3320103020", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 513.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL LOW COMPLEX 30 MIN", "code_information": [{"code": "97165", "type": "CPT"}], "standard_charges": [{"minimum": 122.38, "maximum": 122.38, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OT EVAL MOD COMPLEX", "code_information": [{"code": "97166", "type": "CPT"}, {"code": "3320103021", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 513.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT EVAL MOD COMPLEX 45 MIN", "code_information": [{"code": "97166", "type": "CPT"}], "standard_charges": [{"minimum": 122.38, "maximum": 122.38, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OT EVALUATION", "code_information": [{"code": "97003", "type": "CPT"}, {"code": "3320100291", "type": "CDM"}, {"code": "434", "type": "RC"}], "standard_charges": [{"minimum": 122.38, "maximum": 278.39, "gross_charge": 287.0, "discounted_cash": 430.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 243.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 215.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 200.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 278.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 200.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 215.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 243.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OT MANUAL THERAPY TE", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "3320103016", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 183.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97168", "type": "CPT"}], "standard_charges": [{"minimum": 122.38, "maximum": 122.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 122.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OT SELF CARE/HOME EA", "code_information": [{"code": "97535", "type": "CPT"}, {"code": "3320100295", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT THERAPEUTC ACTIVT", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "3320100294", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT THERAPEUTC EXERCS", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "3320100293", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 165.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "3320103017", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OT WHIRLPOOL 1 OR >", "code_information": [{"code": "97022", "type": "CPT"}, {"code": "3320100292", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GO"}, {"description": "OTH RESP PROC, GROUP", "code_information": [{"code": "G0239", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTH RESP PROC, INDIV", "code_information": [{"code": "G0238", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "818", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4926.05, "maximum": 4926.05, "discounted_cash": 13097.15, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4926.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "817", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6811.75, "maximum": 6811.75, "discounted_cash": 25176.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6811.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "819", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4382.54, "maximum": 4382.54, "discounted_cash": 10128.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4382.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [{"code": "832", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3198.98, "maximum": 3198.98, "discounted_cash": 8236.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3198.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [{"code": "831", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4359.79, "maximum": 4359.79, "discounted_cash": 11273.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4359.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "833", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2451.96, "maximum": 2451.96, "discounted_cash": 5714.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2451.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [{"code": "228", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32497.67, "maximum": 32497.67, "discounted_cash": 56254.89, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32497.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [{"code": "229", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18952.26, "maximum": 18952.26, "discounted_cash": 35498.85, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18952.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "315", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5708.73, "maximum": 5708.73, "discounted_cash": 10799.49, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5708.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "314", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10784.19, "maximum": 10784.19, "discounted_cash": 23373.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10784.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "316", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3449.22, "maximum": 3449.22, "discounted_cash": 7733.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3449.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [{"code": "264", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14997.03, "maximum": 14997.03, "discounted_cash": 36463.47, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14997.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [{"code": "394", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4669.66, "maximum": 4669.66, "discounted_cash": 10460.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4669.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "393", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8961.82, "maximum": 8961.82, "discounted_cash": 18082.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8961.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "395", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4324.74, "maximum": 4324.74, "discounted_cash": 7229.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4324.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "357", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12811.3, "maximum": 12811.3, "discounted_cash": 24526.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12811.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "356", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19646.41, "maximum": 19646.41, "discounted_cash": 47769.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19646.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "358", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6994.35, "maximum": 6994.35, "discounted_cash": 14302.92, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6994.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [{"code": "92", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4740.98, "maximum": 4740.98, "discounted_cash": 11455.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4740.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [{"code": "91", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9103.23, "maximum": 9103.23, "discounted_cash": 19975.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9103.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC", "code_information": [{"code": "93", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3527.92, "maximum": 3527.92, "discounted_cash": 8645.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3527.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [{"code": "124", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5642.33, "maximum": 5642.33, "discounted_cash": 14758.44, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5642.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [{"code": "125", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2582.3, "maximum": 2582.3, "discounted_cash": 8903.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2582.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [{"code": "155", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4591.58, "maximum": 4591.58, "discounted_cash": 10568.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4591.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [{"code": "154", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6320.49, "maximum": 6320.49, "discounted_cash": 17173.34, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6320.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "156", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3835.95, "maximum": 3835.95, "discounted_cash": 7318.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3835.95, "methodology": "fee schedule"}], "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": 6228.27, "maximum": 6228.27, "discounted_cash": 19320.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6228.27, "methodology": "fee schedule"}], "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": 15237.43, "maximum": 15237.43, "discounted_cash": 37128.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15237.43, "methodology": "fee schedule"}], "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": 5199.04, "maximum": 5199.04, "discounted_cash": 13633.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5199.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [{"code": "629", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10211.16, "maximum": 10211.16, "discounted_cash": 25263.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10211.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [{"code": "628", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12883.23, "maximum": 12883.23, "discounted_cash": 44820.15, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12883.23, "methodology": "fee schedule"}], "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": 8652.56, "maximum": 8652.56, "discounted_cash": 15589.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8652.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [{"code": "319", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26541.77, "maximum": 26541.77, "discounted_cash": 48698.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26541.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [{"code": "320", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15028.39, "maximum": 15028.39, "discounted_cash": 24852.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15028.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [{"code": "951", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2705.27, "maximum": 2705.27, "discounted_cash": 6587.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2705.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC", "code_information": [{"code": "749", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13421.83, "maximum": 13421.83, "discounted_cash": 28103.45, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13421.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "750", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9015.31, "maximum": 9015.31, "discounted_cash": 15183.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9015.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [{"code": "215", "type": "MS-DRG"}], "standard_charges": [{"minimum": 50601.45, "maximum": 50601.45, "discounted_cash": 114043.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50601.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [{"code": "424", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14031.74, "maximum": 14031.74, "discounted_cash": 23303.79, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14031.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [{"code": "423", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21686.42, "maximum": 21686.42, "discounted_cash": 43663.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21686.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "425", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8600.3, "maximum": 8600.3, "discounted_cash": 17884.52, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8600.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER IMMUNOELECTROPHORESIS", "code_information": [{"code": "86325", "type": "CPT"}], "standard_charges": [{"minimum": 23.13, "maximum": 30.26, "discounted_cash": 37.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [{"code": "868", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5607.9, "maximum": 5607.9, "discounted_cash": 12119.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5607.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [{"code": "867", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9597.56, "maximum": 9597.56, "discounted_cash": 23359.62, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9597.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "869", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3390.81, "maximum": 3390.81, "discounted_cash": 7711.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3390.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [{"code": "922", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7810.24, "maximum": 7810.24, "discounted_cash": 19481.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7810.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [{"code": "923", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4278.01, "maximum": 4278.01, "discounted_cash": 11291.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4278.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [{"code": "699", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5705.04, "maximum": 5705.04, "discounted_cash": 11396.79, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5705.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [{"code": "698", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7498.52, "maximum": 7498.52, "discounted_cash": 18470.66, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7498.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "700", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2814.71, "maximum": 2814.71, "discounted_cash": 7907.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2814.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [{"code": "674", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13562.62, "maximum": 13562.62, "discounted_cash": 26596.23, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13562.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [{"code": "673", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15673.35, "maximum": 15673.35, "discounted_cash": 41286.56, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15673.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "675", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10774.97, "maximum": 10774.97, "discounted_cash": 17712.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10774.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [{"code": "271", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20930.18, "maximum": 20930.18, "discounted_cash": 38586.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20930.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "270", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29189.24, "maximum": 29189.24, "discounted_cash": 56458.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29189.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "272", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13745.84, "maximum": 13745.84, "discounted_cash": 27235.95, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13745.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC", "code_information": [{"code": "729", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6179.7, "maximum": 6179.7, "discounted_cash": 11208.11, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6179.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "730", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3478.73, "maximum": 3478.73, "discounted_cash": 6939.9, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3478.73, "methodology": "fee schedule"}], "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": 8417.08, "maximum": 8417.08, "discounted_cash": 20249.18, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8417.08, "methodology": "fee schedule"}], "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": 4142.75, "maximum": 4142.75, "discounted_cash": 13127.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4142.75, "methodology": "fee schedule"}], "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": 12415.96, "maximum": 12415.96, "discounted_cash": 24645.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12415.96, "methodology": "fee schedule"}], "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": 7335.58, "maximum": 7335.58, "discounted_cash": 15878.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7335.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [{"code": "887", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7998.38, "maximum": 7998.38, "discounted_cash": 14464.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7998.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "964", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8268.29, "maximum": 8268.29, "discounted_cash": 16758.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8268.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "963", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11946.22, "maximum": 11946.22, "discounted_cash": 30527.27, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11946.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "965", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5871.66, "maximum": 5871.66, "discounted_cash": 10672.2, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5871.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [{"code": "565", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5546.42, "maximum": 5546.42, "discounted_cash": 11157.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5546.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [{"code": "564", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6169.86, "maximum": 6169.86, "discounted_cash": 17437.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6169.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "566", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3227.26, "maximum": 3227.26, "discounted_cash": 8379.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3227.26, "methodology": "fee schedule"}], "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": 11223.79, "maximum": 11223.79, "discounted_cash": 22784.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11223.79, "methodology": "fee schedule"}], "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": 16243.3, "maximum": 16243.3, "discounted_cash": 35296.77, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16243.3, "methodology": "fee schedule"}], "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": 8978.42, "maximum": 8978.42, "discounted_cash": 16684.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8978.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [{"code": "844", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5442.51, "maximum": 5442.51, "discounted_cash": 12919.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5442.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [{"code": "843", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8118.27, "maximum": 8118.27, "discounted_cash": 20772.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8118.27, "methodology": "fee schedule"}], "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": 5211.33, "maximum": 5211.33, "discounted_cash": 9656.24, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5211.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [{"code": "908", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9572.35, "maximum": 9572.35, "discounted_cash": 22374.9, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9572.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [{"code": "907", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17815.43, "maximum": 17815.43, "discounted_cash": 41526.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17815.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "909", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5708.12, "maximum": 5708.12, "discounted_cash": 15142.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5708.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "958", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20048.51, "maximum": 20048.51, "discounted_cash": 45158.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20048.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "957", "type": "MS-DRG"}], "standard_charges": [{"minimum": 36393.87, "maximum": 36393.87, "discounted_cash": 80747.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36393.87, "methodology": "fee schedule"}], "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": 13624.72, "maximum": 13624.72, "discounted_cash": 28273.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13624.72, "methodology": "fee schedule"}], "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": 10291.71, "maximum": 10291.71, "discounted_cash": 20745.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10291.71, "methodology": "fee schedule"}], "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": 22808.5, "maximum": 22808.5, "discounted_cash": 37851.23, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22808.5, "methodology": "fee schedule"}], "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": 7266.72, "maximum": 7266.72, "discounted_cash": 13513.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7266.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER ORAL PATHOLOGY PROCEDU", "code_information": [{"code": "D0502", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [{"code": "205", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7150.52, "maximum": 7150.52, "discounted_cash": 20211.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7150.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [{"code": "206", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4212.84, "maximum": 4212.84, "discounted_cash": 10198.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4212.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [{"code": "167", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10337.82, "maximum": 10337.82, "discounted_cash": 20317.28, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10337.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [{"code": "166", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19113.96, "maximum": 19113.96, "discounted_cash": 45303.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19113.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "168", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7561.23, "maximum": 7561.23, "discounted_cash": 15135.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7561.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [{"code": "580", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7236.6, "maximum": 7236.6, "discounted_cash": 19500.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7236.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [{"code": "579", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10849.36, "maximum": 10849.36, "discounted_cash": 37314.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10849.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "581", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5397.63, "maximum": 5397.63, "discounted_cash": 15035.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5397.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER SPECIFIED CASE MGMT", "code_information": [{"code": "G9012", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER TMJ IMAGES BY REPORT", "code_information": [{"code": "D0321", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [{"code": "253", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15103.4, "maximum": 15103.4, "discounted_cash": 28481.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15103.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "252", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20404.5, "maximum": 20404.5, "discounted_cash": 37443.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20404.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER VASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "254", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9353.47, "maximum": 9353.47, "discounted_cash": 19371.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9353.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHR OT CUR STAT 0%", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100374", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "OTHR OT CUR STAT 100", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100381", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "OTHR OT CUR STAT 20-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100335", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "OTHR OT CUR STAT 40-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100382", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "OTHR OT CUR STAT 60-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100383", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "OTHR OT CUR STAT 80-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100384", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "OTHR OT CUR STAT1-19", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3320100378", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "OTHR OT D/C STAT 0%", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100380", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "OTHR OT D/C STAT 100", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100395", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "OTHR OT D/C STAT 20-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100385", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "OTHR OT D/C STAT 40-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100396", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "OTHR OT D/C STAT 60-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100397", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "OTHR OT D/C STAT 80-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100398", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "OTHR OT D/C STAT1-19", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3320100392", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "OTHR OT PR STAT 0% I", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100387", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "OTHR OT PR STAT 100%", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100388", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "OTHR OT PR STAT 20-3", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100386", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "OTHR OT PR STAT 40-5", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100389", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "OTHR OT PR STAT 60-7", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100390", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "OTHR OT PR STAT 80-9", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100391", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "OTHR OT PR STAT1-19%", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3320100379", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "OTHR PT CUR STAT 0%", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100506", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "OTHR PT CUR STAT 100", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100513", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "OTHR PT CUR STAT 20-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100468", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "OTHR PT CUR STAT 40-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100514", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "OTHR PT CUR STAT 60-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100515", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "OTHR PT CUR STAT 80-", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100516", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "OTHR PT CUR STAT1-19", "code_information": [{"code": "G8990", "type": "HCPCS"}, {"code": "3330100510", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "OTHR PT D/C STAT 0%", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100512", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "OTHR PT D/C STAT 100", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100527", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "OTHR PT D/C STAT 20-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100517", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "OTHR PT D/C STAT 40-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100528", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "OTHR PT D/C STAT 60-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100529", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "OTHR PT D/C STAT 80-", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100530", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "OTHR PT D/C STAT1-19", "code_information": [{"code": "G8992", "type": "HCPCS"}, {"code": "3330100524", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "OTHR PT PR STAT 0% I", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100519", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "OTHR PT PR STAT 100%", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100520", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "OTHR PT PR STAT 20-3", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100518", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "OTHR PT PR STAT 40-5", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100521", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "OTHR PT PR STAT 60-7", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100522", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "OTHR PT PR STAT 80-9", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100523", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "OTHR PT PR STAT1-19%", "code_information": [{"code": "G8991", "type": "HCPCS"}, {"code": "3330100511", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [{"code": "152", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3364.37, "maximum": 3364.37, "discounted_cash": 13265.73, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3364.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [{"code": "153", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2731.09, "maximum": 2731.09, "discounted_cash": 8203.73, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2731.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTO PORE FIRM*5400-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 277.48, "maximum": 384.5, "gross_charge": 396.4, "discounted_cash": 594.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 336.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 384.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 336.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 317.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTO PORE STAND", "code_information": [{"code": "3100101163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.4, "discounted_cash": 594.6, "setting": "both", "billing_class": "facility"}]}, {"description": "OTOLARYNGOLOGIC EXAM", "code_information": [{"code": "92502", "type": "CPT"}, {"code": "3390100677", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 936.05, "gross_charge": 965.0, "discounted_cash": 842.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 820.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 580.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 723.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 675.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 936.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 675.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 578.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 723.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 668.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 820.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 772.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 561.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTOSCOPE DIAG W/SPEC", "code_information": [{"code": "3100101164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OUT OF OFFICE EMERG MED SERV", "code_information": [{"code": "99060", "type": "CPT"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OUTER EAR SURGERY PR", "code_information": [{"code": "69399", "type": "CPT"}, {"code": "3340102400", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.7, "maximum": 296.61, "gross_charge": 294.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 285.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OUTPT IV INSULIN TX ANY MEA", "code_information": [{"code": "G9147", "type": "HCPCS"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVA&PARA DIR SMRS CO", "code_information": [{"code": "87177", "type": "CPT"}, {"code": "3440101178", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.9, "maximum": 93.12, "gross_charge": 96.0, "discounted_cash": 14.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE COMPLETE MANDIB", "code_information": [{"code": "D5865", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE COMPLETE MAX", "code_information": [{"code": "D5863", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE PARTIAL MANDIB", "code_information": [{"code": "D5866", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVERDENTURE PARTIAL MAX", "code_information": [{"code": "D5864", "type": "HCPCS"}], "standard_charges": [{"minimum": 604.31, "maximum": 604.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVINE, 1000 USP UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3472", "type": "HCPCS"}], "standard_charges": [{"minimum": 144.46, "maximum": 144.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 144.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OVINE, UP TO 999 USP UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3471", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OVULATION MGMT PER CYCLE", "code_information": [{"code": "S4042", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OVULATION TESTS", "code_information": [{"code": "84830", "type": "CPT"}], "standard_charges": [{"minimum": 12.7, "maximum": 34.27, "discounted_cash": 20.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OXACILLIN SODIUM INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2700", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.13, "maximum": 1.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXALATE", "code_information": [{"code": "83945", "type": "CPT"}, {"code": "3440100963", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.45, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 23.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.48, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OXALIPLATIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9263", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXCARBAZEPINE", "code_information": [{"code": "80183", "type": "CPT"}, {"code": "3440100822", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OXYGEN PER HOUR", "code_information": [{"code": "3310100264", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "OXYGEN PER SHIFT (12", "code_information": [{"code": "3310100292", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 178.0, "discounted_cash": 267.0, "setting": "both", "billing_class": "facility"}]}, {"description": "OXYMORPHONE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2410", "type": "HCPCS"}, {"code": "3400300298", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.82, "maximum": 5.82, "gross_charge": 6.0, "discounted_cash": 9.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OXYTETRACYCLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2460", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "OXYTOCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2590", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.79, "maximum": 0.79, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy, Evaluation Or Reevaluation", "code_information": [{"code": "434", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Occupational Therapy, General", "code_information": [{"code": "430", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Oct Scan Of Skin Lesion With Interpretation And Report, Each Additional Lesion", "code_information": [{"code": "471T", "type": "CPT"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Oct Scan Of Skin Lesion With Interpretation And Report, First Lesion", "code_information": [{"code": "470T", "type": "CPT"}], "standard_charges": [{"minimum": 439.22, "maximum": 439.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 439.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy Except Trauma, Major", "code_information": [{"code": "21.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51030.61, "maximum": 51030.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51030.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy Except Trauma, Minor", "code_information": [{"code": "21.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23952.52, "maximum": 23952.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23952.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy Except Trauma, Moderate", "code_information": [{"code": "21.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29170.78, "maximum": 29170.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29170.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy Except Trauma, Severe", "code_information": [{"code": "21.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 99097.11, "maximum": 99097.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 99097.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy For Trauma, Major", "code_information": [{"code": "20.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37828.6, "maximum": 37828.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37828.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy For Trauma, Minor", "code_information": [{"code": "20.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24254.95, "maximum": 24254.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24254.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy For Trauma, Moderate", "code_information": [{"code": "20.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33363.85, "maximum": 33363.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33363.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Craniotomy For Trauma, Severe", "code_information": [{"code": "20.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 94370.94, "maximum": 94370.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 94370.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Extracranial Vascular Procedures, Major", "code_information": [{"code": "24.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26519.36, "maximum": 26519.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26519.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Extracranial Vascular Procedures, Minor", "code_information": [{"code": "24.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10528.8, "maximum": 10528.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10528.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Extracranial Vascular Procedures, Moderate", "code_information": [{"code": "24.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15612.51, "maximum": 15612.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15612.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Open Extracranial Vascular Procedures, Severe", "code_information": [{"code": "24.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 59141.23, "maximum": 59141.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59141.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Operating Room Services, General", "code_information": [{"code": "360", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Operating Room Services, Minor Surgery", "code_information": [{"code": "361", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Opioid Abuse And Dependence, Major", "code_information": [{"code": "773.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11192.62, "maximum": 11192.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11192.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Opioid Abuse And Dependence, Minor", "code_information": [{"code": "773.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5688.58, "maximum": 5688.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5688.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Opioid Abuse And Dependence, Moderate", "code_information": [{"code": "773.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8123.43, "maximum": 8123.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8123.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Opioid Abuse And Dependence, Severe", "code_information": [{"code": "773.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25390.36, "maximum": 25390.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25390.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Orbit And Eye Procedures, Major", "code_information": [{"code": "73.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26247.68, "maximum": 26247.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26247.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Orbit And Eye Procedures, Minor", "code_information": [{"code": "73.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19318.61, "maximum": 19318.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19318.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Orbit And Eye Procedures, Moderate", "code_information": [{"code": "73.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24522.78, "maximum": 24522.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24522.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Orbit And Eye Procedures, Severe", "code_information": [{"code": "73.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 60089.54, "maximum": 60089.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60089.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Organic Mental Health Disturbances, Major", "code_information": [{"code": "757.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31756.85, "maximum": 31756.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31756.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Organic Mental Health Disturbances, Minor", "code_information": [{"code": "757.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9014.07, "maximum": 9014.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9014.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Organic Mental Health Disturbances, Moderate", "code_information": [{"code": "757.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20796.18, "maximum": 20796.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20796.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Organic Mental Health Disturbances, Severe", "code_information": [{"code": "757.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36530.44, "maximum": 36530.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36530.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections, Major", "code_information": [{"code": "344.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22585.16, "maximum": 22585.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22585.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections, Minor", "code_information": [{"code": "344.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9162.73, "maximum": 9162.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9162.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections, Moderate", "code_information": [{"code": "344.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10708.21, "maximum": 10708.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10708.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Osteomyelitis, Septic Arthritis And Other Musculoskeletal Infections, Severe", "code_information": [{"code": "344.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37164.78, "maximum": 37164.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37164.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other  O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Major", "code_information": [{"code": "681.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39335.64, "maximum": 39335.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39335.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other  O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Minor", "code_information": [{"code": "681.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15093.51, "maximum": 15093.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15093.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other  O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Moderate", "code_information": [{"code": "681.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21121.68, "maximum": 21121.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21121.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other  O.R. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms, Severe", "code_information": [{"code": "681.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 98419.2, "maximum": 98419.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 98419.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Aftercare And Convalescence, Major", "code_information": [{"code": "862.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5997.42, "maximum": 5997.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5997.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Aftercare And Convalescence, Minor", "code_information": [{"code": "862.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3683.03, "maximum": 3683.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3683.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Aftercare And Convalescence, Moderate", "code_information": [{"code": "862.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5368.2, "maximum": 5368.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5368.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Aftercare And Convalescence, Severe", "code_information": [{"code": "862.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12670.19, "maximum": 12670.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12670.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other And Unspecified Gastrointestinal Hemorrhage, Major", "code_information": [{"code": "253.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14407.9, "maximum": 14407.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14407.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other And Unspecified Gastrointestinal Hemorrhage, Minor", "code_information": [{"code": "253.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7360.94, "maximum": 7360.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7360.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other And Unspecified Gastrointestinal Hemorrhage, Moderate", "code_information": [{"code": "253.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9352.39, "maximum": 9352.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9352.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other And Unspecified Gastrointestinal Hemorrhage, Severe", "code_information": [{"code": "253.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33843.13, "maximum": 33843.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33843.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Anemia And Disorders Of Blood And Blood-Forming Organs, Major", "code_information": [{"code": "663.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13296.84, "maximum": 13296.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13296.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Anemia And Disorders Of Blood And Blood-Forming Organs, Minor", "code_information": [{"code": "663.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6326.77, "maximum": 6326.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6326.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Anemia And Disorders Of Blood And Blood-Forming Organs, Moderate", "code_information": [{"code": "663.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9565.12, "maximum": 9565.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9565.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Anemia And Disorders Of Blood And Blood-Forming Organs, Severe", "code_information": [{"code": "663.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34501.82, "maximum": 34501.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34501.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Back And Neck Disorders, Fractures And Injuries, Major", "code_information": [{"code": "347.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11035.0, "maximum": 11035.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11035.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Back And Neck Disorders, Fractures And Injuries, Minor", "code_information": [{"code": "347.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7425.01, "maximum": 7425.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7425.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Back And Neck Disorders, Fractures And Injuries, Moderate", "code_information": [{"code": "347.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10000.83, "maximum": 10000.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10000.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Back And Neck Disorders, Fractures And Injuries, Severe", "code_information": [{"code": "347.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21790.63, "maximum": 21790.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21790.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Bladder Procedures, Major", "code_information": [{"code": "445.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26588.56, "maximum": 26588.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26588.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Bladder Procedures, Minor", "code_information": [{"code": "445.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12211.41, "maximum": 12211.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12211.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Bladder Procedures, Moderate", "code_information": [{"code": "445.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18292.13, "maximum": 18292.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18292.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Bladder Procedures, Severe", "code_information": [{"code": "445.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48489.4, "maximum": 48489.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48489.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Cardiothoracic And Thoracic Vascular Procedures, Major", "code_information": [{"code": "167.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 61596.58, "maximum": 61596.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61596.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Cardiothoracic And Thoracic Vascular Procedures, Minor", "code_information": [{"code": "167.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37519.76, "maximum": 37519.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37519.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Cardiothoracic And Thoracic Vascular Procedures, Moderate", "code_information": [{"code": "167.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38998.61, "maximum": 38998.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38998.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Cardiothoracic And Thoracic Vascular Procedures, Severe", "code_information": [{"code": "167.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 93394.44, "maximum": 93394.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93394.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Chemotherapy, Major", "code_information": [{"code": "696.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17770.56, "maximum": 17770.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17770.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Chemotherapy, Minor", "code_information": [{"code": "696.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11343.84, "maximum": 11343.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11343.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Chemotherapy, Moderate", "code_information": [{"code": "696.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12944.43, "maximum": 12944.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12944.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Chemotherapy, Severe", "code_information": [{"code": "696.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 45896.92, "maximum": 45896.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45896.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Diagnoses, Major", "code_information": [{"code": "207.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15499.74, "maximum": 15499.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15499.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Diagnoses, Minor", "code_information": [{"code": "207.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6889.34, "maximum": 6889.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6889.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Diagnoses, Moderate", "code_information": [{"code": "207.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8908.99, "maximum": 8908.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8908.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Diagnoses, Severe", "code_information": [{"code": "207.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21657.35, "maximum": 21657.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21657.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Procedures, Major", "code_information": [{"code": "180.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31232.72, "maximum": 31232.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31232.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Procedures, Minor", "code_information": [{"code": "180.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22004.64, "maximum": 22004.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22004.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Procedures, Moderate", "code_information": [{"code": "180.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25908.09, "maximum": 25908.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25908.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Circulatory System Procedures, Severe", "code_information": [{"code": "180.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 45839.26, "maximum": 45839.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45839.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Complications Of Treatment, Major", "code_information": [{"code": "813.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14100.34, "maximum": 14100.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14100.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Complications Of Treatment, Minor", "code_information": [{"code": "813.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8779.56, "maximum": 8779.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8779.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Complications Of Treatment, Moderate", "code_information": [{"code": "813.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9199.89, "maximum": 9199.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9199.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Complications Of Treatment, Severe", "code_information": [{"code": "813.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22859.4, "maximum": 22859.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22859.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Diagnostic Services Electromyelogram", "code_information": [{"code": "922", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Other Diagnostic Services, General", "code_information": [{"code": "920", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Other Diagnostic Services, Peripheral Vascular Laboratory", "code_information": [{"code": "921", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Other Digestive System And Abdominal Procedures, Major", "code_information": [{"code": "229.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42175.45, "maximum": 42175.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42175.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System And Abdominal Procedures, Minor", "code_information": [{"code": "229.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15442.08, "maximum": 15442.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15442.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System And Abdominal Procedures, Moderate", "code_information": [{"code": "229.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19635.14, "maximum": 19635.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19635.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System And Abdominal Procedures, Severe", "code_information": [{"code": "229.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 57201.03, "maximum": 57201.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 57201.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System Diagnoses, Major", "code_information": [{"code": "254.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13700.52, "maximum": 13700.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13700.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System Diagnoses, Minor", "code_information": [{"code": "254.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6650.99, "maximum": 6650.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6650.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System Diagnoses, Moderate", "code_information": [{"code": "254.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9422.87, "maximum": 9422.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9422.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Digestive System Diagnoses, Severe", "code_information": [{"code": "254.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24125.52, "maximum": 24125.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24125.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of Nervous System, Major", "code_information": [{"code": "58.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13733.84, "maximum": 13733.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13733.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of Nervous System, Minor", "code_information": [{"code": "58.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8043.98, "maximum": 8043.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8043.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of Nervous System, Moderate", "code_information": [{"code": "58.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9973.91, "maximum": 9973.91, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9973.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of Nervous System, Severe", "code_information": [{"code": "58.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25369.86, "maximum": 25369.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25369.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of The Liver, Major", "code_information": [{"code": "283.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12752.21, "maximum": 12752.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12752.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of The Liver, Minor", "code_information": [{"code": "283.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7996.56, "maximum": 7996.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7996.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of The Liver, Moderate", "code_information": [{"code": "283.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8181.1, "maximum": 8181.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8181.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Disorders Of The Liver, Severe", "code_information": [{"code": "283.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26470.66, "maximum": 26470.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26470.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Drug Abuse And Dependence, Major", "code_information": [{"code": "776.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10933.76, "maximum": 10933.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10933.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Drug Abuse And Dependence, Minor", "code_information": [{"code": "776.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6510.02, "maximum": 6510.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6510.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Drug Abuse And Dependence, Moderate", "code_information": [{"code": "776.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7760.76, "maximum": 7760.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7760.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Drug Abuse And Dependence, Severe", "code_information": [{"code": "776.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19714.6, "maximum": 19714.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19714.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth And Throat Procedures, Major", "code_information": [{"code": "98.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27361.31, "maximum": 27361.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27361.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth And Throat Procedures, Minor", "code_information": [{"code": "98.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12065.32, "maximum": 12065.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12065.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth And Throat Procedures, Moderate", "code_information": [{"code": "98.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17124.68, "maximum": 17124.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17124.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth And Throat Procedures, Severe", "code_information": [{"code": "98.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42932.81, "maximum": 42932.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42932.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth, Throat And Cranial Or Facial Diagnoses, Major", "code_information": [{"code": "115.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12979.03, "maximum": 12979.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12979.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth, Throat And Cranial Or Facial Diagnoses, Minor", "code_information": [{"code": "115.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6442.1, "maximum": 6442.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6442.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth, Throat And Cranial Or Facial Diagnoses, Moderate", "code_information": [{"code": "115.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8281.05, "maximum": 8281.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8281.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Ear, Nose, Mouth, Throat And Cranial Or Facial Diagnoses, Severe", "code_information": [{"code": "115.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26334.83, "maximum": 26334.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26334.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Endocrine Disorders, Major", "code_information": [{"code": "424.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18886.75, "maximum": 18886.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18886.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Endocrine Disorders, Minor", "code_information": [{"code": "424.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7581.35, "maximum": 7581.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7581.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Endocrine Disorders, Moderate", "code_information": [{"code": "424.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10555.72, "maximum": 10555.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10555.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Endocrine Disorders, Severe", "code_information": [{"code": "424.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26402.74, "maximum": 26402.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26402.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Esophageal Disorders, Major", "code_information": [{"code": "243.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15854.72, "maximum": 15854.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15854.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Esophageal Disorders, Minor", "code_information": [{"code": "243.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7161.02, "maximum": 7161.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7161.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Esophageal Disorders, Moderate", "code_information": [{"code": "243.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8058.07, "maximum": 8058.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8058.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Esophageal Disorders, Severe", "code_information": [{"code": "243.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20839.75, "maximum": 20839.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20839.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Female Reproductive System And Related Procedures, Major", "code_information": [{"code": "518.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28089.2, "maximum": 28089.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28089.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Female Reproductive System And Related Procedures, Minor", "code_information": [{"code": "518.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9447.22, "maximum": 9447.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9447.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Female Reproductive System And Related Procedures, Moderate", "code_information": [{"code": "518.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15744.51, "maximum": 15744.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15744.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Female Reproductive System And Related Procedures, Severe", "code_information": [{"code": "518.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55418.47, "maximum": 55418.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55418.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Gastroenteritis, Nausea And Vomiting, Major", "code_information": [{"code": "249.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12189.63, "maximum": 12189.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12189.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Gastroenteritis, Nausea And Vomiting, Minor", "code_information": [{"code": "249.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6371.62, "maximum": 6371.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6371.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Gastroenteritis, Nausea And Vomiting, Moderate", "code_information": [{"code": "249.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6976.49, "maximum": 6976.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6976.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Gastroenteritis, Nausea And Vomiting, Severe", "code_information": [{"code": "249.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18324.17, "maximum": 18324.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18324.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Hepatobiliary, Pancreas And Abdominal Procedures, Major", "code_information": [{"code": "264.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28048.19, "maximum": 28048.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28048.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Hepatobiliary, Pancreas And Abdominal Procedures, Minor", "code_information": [{"code": "264.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18324.17, "maximum": 18324.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18324.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Hepatobiliary, Pancreas And Abdominal Procedures, Moderate", "code_information": [{"code": "264.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24098.61, "maximum": 24098.61, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24098.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Hepatobiliary, Pancreas And Abdominal Procedures, Severe", "code_information": [{"code": "264.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62578.21, "maximum": 62578.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62578.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Imaging Services Ultrasound", "code_information": [{"code": "402", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Other Infectious And Parasitic Diseases, Major", "code_information": [{"code": "724.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21007.63, "maximum": 21007.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21007.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Infectious And Parasitic Diseases, Minor", "code_information": [{"code": "724.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9403.65, "maximum": 9403.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9403.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Infectious And Parasitic Diseases, Moderate", "code_information": [{"code": "724.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10721.03, "maximum": 10721.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10721.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Infectious And Parasitic Diseases, Severe", "code_information": [{"code": "724.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46846.51, "maximum": 46846.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46846.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Injury, Poisoning And Toxic Effect Diagnoses, Major", "code_information": [{"code": "815.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14047.8, "maximum": 14047.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14047.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Injury, Poisoning And Toxic Effect Diagnoses, Minor", "code_information": [{"code": "815.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5225.96, "maximum": 5225.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5225.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Injury, Poisoning And Toxic Effect Diagnoses, Moderate", "code_information": [{"code": "815.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7440.39, "maximum": 7440.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7440.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Injury, Poisoning And Toxic Effect Diagnoses, Severe", "code_information": [{"code": "815.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35441.16, "maximum": 35441.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35441.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney And Urinary Tract Diagnoses, Signs And Symptoms, Major", "code_information": [{"code": "468.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13950.41, "maximum": 13950.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13950.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney And Urinary Tract Diagnoses, Signs And Symptoms, Minor", "code_information": [{"code": "468.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6930.35, "maximum": 6930.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6930.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney And Urinary Tract Diagnoses, Signs And Symptoms, Moderate", "code_information": [{"code": "468.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8378.45, "maximum": 8378.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8378.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney And Urinary Tract Diagnoses, Signs And Symptoms, Severe", "code_information": [{"code": "468.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21706.05, "maximum": 21706.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21706.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney, Urinary Tract And Related Procedures, Major", "code_information": [{"code": "447.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 37410.83, "maximum": 37410.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 37410.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney, Urinary Tract And Related Procedures, Minor", "code_information": [{"code": "447.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22080.25, "maximum": 22080.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22080.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney, Urinary Tract And Related Procedures, Moderate", "code_information": [{"code": "447.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25860.67, "maximum": 25860.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25860.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Kidney, Urinary Tract And Related Procedures, Severe", "code_information": [{"code": "447.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 65307.8, "maximum": 65307.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65307.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Major Head And Neck Procedures, Major", "code_information": [{"code": "91.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 58855.45, "maximum": 58855.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 58855.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Major Head And Neck Procedures, Minor", "code_information": [{"code": "91.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26838.45, "maximum": 26838.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26838.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Major Head And Neck Procedures, Moderate", "code_information": [{"code": "91.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34679.95, "maximum": 34679.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34679.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Major Head And Neck Procedures, Severe", "code_information": [{"code": "91.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 94328.65, "maximum": 94328.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 94328.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Male Reproductive System And Related Procedures, Major", "code_information": [{"code": "484.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21302.37, "maximum": 21302.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21302.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Male Reproductive System And Related Procedures, Minor", "code_information": [{"code": "484.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13940.16, "maximum": 13940.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13940.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Male Reproductive System And Related Procedures, Moderate", "code_information": [{"code": "484.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11348.96, "maximum": 11348.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11348.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Male Reproductive System And Related Procedures, Severe", "code_information": [{"code": "484.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 52358.25, "maximum": 52358.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 52358.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Mental Health Disorders, Major", "code_information": [{"code": "760.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18612.51, "maximum": 18612.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18612.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Mental Health Disorders, Minor", "code_information": [{"code": "760.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9880.37, "maximum": 9880.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9880.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Mental Health Disorders, Moderate", "code_information": [{"code": "760.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16304.52, "maximum": 16304.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16304.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Mental Health Disorders, Severe", "code_information": [{"code": "760.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20634.71, "maximum": 20634.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20634.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Diagnoses, Major", "code_information": [{"code": "351.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15595.86, "maximum": 15595.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15595.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Diagnoses, Minor", "code_information": [{"code": "351.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8443.8, "maximum": 8443.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8443.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Diagnoses, Moderate", "code_information": [{"code": "351.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8630.9, "maximum": 8630.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8630.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Diagnoses, Severe", "code_information": [{"code": "351.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26605.22, "maximum": 26605.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26605.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Procedures, Major", "code_information": [{"code": "320.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28686.38, "maximum": 28686.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28686.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Procedures, Minor", "code_information": [{"code": "320.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14857.71, "maximum": 14857.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14857.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Procedures, Moderate", "code_information": [{"code": "320.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19827.37, "maximum": 19827.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19827.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Musculoskeletal System And Connective Tissue Procedures, Severe", "code_information": [{"code": "320.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 51572.69, "maximum": 51572.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51572.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Nervous System And Related Procedures, Major", "code_information": [{"code": "26.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33723.95, "maximum": 33723.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33723.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Nervous System And Related Procedures, Minor", "code_information": [{"code": "26.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13788.94, "maximum": 13788.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13788.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Nervous System And Related Procedures, Moderate", "code_information": [{"code": "26.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16549.29, "maximum": 16549.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16549.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Nervous System And Related Procedures, Severe", "code_information": [{"code": "26.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 67172.39, "maximum": 67172.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 67172.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Non-Hypovolemic Electrolyte Disorders, Major", "code_information": [{"code": "425.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14086.25, "maximum": 14086.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14086.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Non-Hypovolemic Electrolyte Disorders, Minor", "code_information": [{"code": "425.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6174.27, "maximum": 6174.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6174.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Non-Hypovolemic Electrolyte Disorders, Moderate", "code_information": [{"code": "425.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9247.3, "maximum": 9247.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9247.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Non-Hypovolemic Electrolyte Disorders, Severe", "code_information": [{"code": "425.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35794.86, "maximum": 35794.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35794.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Open Craniotomy, Major", "code_information": [{"code": "27.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40653.02, "maximum": 40653.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40653.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Open Craniotomy, Minor", "code_information": [{"code": "27.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20200.28, "maximum": 20200.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20200.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Open Craniotomy, Moderate", "code_information": [{"code": "27.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25779.94, "maximum": 25779.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25779.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Open Craniotomy, Severe", "code_information": [{"code": "27.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 77517.94, "maximum": 77517.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 77517.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Percutaneous Intracranial Procedures, Major", "code_information": [{"code": "29.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35685.93, "maximum": 35685.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35685.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Percutaneous Intracranial Procedures, Minor", "code_information": [{"code": "29.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29785.9, "maximum": 29785.9, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29785.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Percutaneous Intracranial Procedures, Moderate", "code_information": [{"code": "29.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32834.59, "maximum": 32834.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32834.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Percutaneous Intracranial Procedures, Severe", "code_information": [{"code": "29.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 65125.83, "maximum": 65125.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65125.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Peripheral Vascular And Related Procedures, Major", "code_information": [{"code": "182.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48366.37, "maximum": 48366.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48366.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Peripheral Vascular And Related Procedures, Minor", "code_information": [{"code": "182.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31030.24, "maximum": 31030.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31030.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Peripheral Vascular And Related Procedures, Moderate", "code_information": [{"code": "182.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36267.73, "maximum": 36267.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36267.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Peripheral Vascular And Related Procedures, Severe", "code_information": [{"code": "182.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 79882.3, "maximum": 79882.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79882.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Pneumonia, Major", "code_information": [{"code": "139.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12430.55, "maximum": 12430.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12430.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Pneumonia, Minor", "code_information": [{"code": "139.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7252.01, "maximum": 7252.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7252.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Pneumonia, Moderate", "code_information": [{"code": "139.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8969.22, "maximum": 8969.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8969.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Pneumonia, Severe", "code_information": [{"code": "139.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18748.35, "maximum": 18748.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18748.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures For Endocrine, Nutritional And Metabolic Disorders, Major", "code_information": [{"code": "405.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31695.34, "maximum": 31695.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31695.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures For Endocrine, Nutritional And Metabolic Disorders, Minor", "code_information": [{"code": "405.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18643.26, "maximum": 18643.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18643.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures For Endocrine, Nutritional And Metabolic Disorders, Moderate", "code_information": [{"code": "405.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20363.04, "maximum": 20363.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20363.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures For Endocrine, Nutritional And Metabolic Disorders, Severe", "code_information": [{"code": "405.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 64542.75, "maximum": 64542.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 64542.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures Of Blood And Blood-Forming Organs, Major", "code_information": [{"code": "651.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30201.11, "maximum": 30201.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30201.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures Of Blood And Blood-Forming Organs, Minor", "code_information": [{"code": "651.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13217.39, "maximum": 13217.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13217.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures Of Blood And Blood-Forming Organs, Moderate", "code_information": [{"code": "651.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18531.77, "maximum": 18531.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18531.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Procedures Of Blood And Blood-Forming Organs, Severe", "code_information": [{"code": "651.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 68470.55, "maximum": 68470.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68470.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory And Chest Procedures, Major", "code_information": [{"code": "121.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38489.85, "maximum": 38489.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38489.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory And Chest Procedures, Minor", "code_information": [{"code": "121.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19544.16, "maximum": 19544.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19544.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory And Chest Procedures, Moderate", "code_information": [{"code": "121.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26396.34, "maximum": 26396.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26396.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory And Chest Procedures, Severe", "code_information": [{"code": "121.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 72240.72, "maximum": 72240.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 72240.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory Diagnoses Except Signs, Symptoms And Miscellaneous Diagnoses, Major", "code_information": [{"code": "143.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15525.37, "maximum": 15525.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15525.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory Diagnoses Except Signs, Symptoms And Miscellaneous Diagnoses, Minor", "code_information": [{"code": "143.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7446.8, "maximum": 7446.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7446.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory Diagnoses Except Signs, Symptoms And Miscellaneous Diagnoses, Moderate", "code_information": [{"code": "143.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9516.42, "maximum": 9516.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9516.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Respiratory Diagnoses Except Signs, Symptoms And Miscellaneous Diagnoses, Severe", "code_information": [{"code": "143.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 30673.98, "maximum": 30673.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30673.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Significant Hip And Femur Surgery, Major", "code_information": [{"code": "309.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34676.11, "maximum": 34676.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34676.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Significant Hip And Femur Surgery, Minor", "code_information": [{"code": "309.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20161.84, "maximum": 20161.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20161.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Significant Hip And Femur Surgery, Moderate", "code_information": [{"code": "309.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20766.71, "maximum": 20766.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20766.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Significant Hip And Femur Surgery, Severe", "code_information": [{"code": "309.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62097.65, "maximum": 62097.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62097.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Breast Disorders, Major", "code_information": [{"code": "385.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14101.63, "maximum": 14101.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14101.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Breast Disorders, Minor", "code_information": [{"code": "385.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7341.71, "maximum": 7341.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7341.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Breast Disorders, Moderate", "code_information": [{"code": "385.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12215.26, "maximum": 12215.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12215.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Breast Disorders, Severe", "code_information": [{"code": "385.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26507.83, "maximum": 26507.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26507.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Related Procedures, Major", "code_information": [{"code": "364.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22709.46, "maximum": 22709.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22709.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Related Procedures, Minor", "code_information": [{"code": "364.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10273.79, "maximum": 10273.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10273.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Related Procedures, Moderate", "code_information": [{"code": "364.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16401.92, "maximum": 16401.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16401.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Skin, Subcutaneous Tissue And Related Procedures, Severe", "code_information": [{"code": "364.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 44829.43, "maximum": 44829.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44829.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Small And Large Bowel Procedures, Major", "code_information": [{"code": "223.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27538.15, "maximum": 27538.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27538.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Small And Large Bowel Procedures, Minor", "code_information": [{"code": "223.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13158.44, "maximum": 13158.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13158.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Small And Large Bowel Procedures, Moderate", "code_information": [{"code": "223.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18298.54, "maximum": 18298.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18298.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Small And Large Bowel Procedures, Severe", "code_information": [{"code": "223.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53145.09, "maximum": 53145.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53145.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Stomach, Esophageal And Duodenal Procedures, Major", "code_information": [{"code": "222.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25512.1, "maximum": 25512.1, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25512.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Stomach, Esophageal And Duodenal Procedures, Minor", "code_information": [{"code": "222.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10236.62, "maximum": 10236.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10236.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Stomach, Esophageal And Duodenal Procedures, Moderate", "code_information": [{"code": "222.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21156.28, "maximum": 21156.28, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21156.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other Stomach, Esophageal And Duodenal Procedures, Severe", "code_information": [{"code": "222.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 64237.75, "maximum": 64237.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 64237.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Other pt/ot  d/c status", "code_information": [{"code": "G8992", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Other pt/ot current status", "code_information": [{"code": "G8990", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Other pt/ot goal status", "code_information": [{"code": "G8991", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "P32 CHROMIC PHOSPHATE", "code_information": [{"code": "A9564", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "P32 NA PHOSPHATE", "code_information": [{"code": "A9563", "type": "HCPCS"}], "standard_charges": [{"minimum": 362.86, "maximum": 362.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 362.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PABPN1 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81312", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAC CUSTOM SPINE", "code_information": [{"code": "3100101165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAC CUSTOM SPINE", "code_information": [{"code": "3100104323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ANT HIP*SOP1RAH", "code_information": [{"code": "3100208511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.2, "discounted_cash": 841.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ACL", "code_information": [{"code": "3100101166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.2, "discounted_cash": 544.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSC", "code_information": [{"code": "3100101167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 186.04, "discounted_cash": 279.06, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM BASIC DE", "code_information": [{"code": "3100101168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.92, "discounted_cash": 188.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM CYSTO (C", "code_information": [{"code": "3100101169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.52, "discounted_cash": 141.78, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMIT", "code_information": [{"code": "3100101170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.64, "discounted_cash": 306.96, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM FRACTURE", "code_information": [{"code": "3100101171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7046.0, "discounted_cash": 10569.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAVH", "code_information": [{"code": "3100101172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAVH", "code_information": [{"code": "3100102937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM NASAL", "code_information": [{"code": "3100101173", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.2, "discounted_cash": 213.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM NEURO BA", "code_information": [{"code": "3100101174", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 327.32, "discounted_cash": 490.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM OB/GYN", "code_information": [{"code": "3100101175", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.64, "discounted_cash": 155.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER", "code_information": [{"code": "3100101176", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.88, "discounted_cash": 322.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL KN", "code_information": [{"code": "3100101177", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.44, "discounted_cash": 623.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL KN", "code_information": [{"code": "3100102938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.76, "discounted_cash": 701.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CYSTO FEMALE*AM", "code_information": [{"code": "3100203203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.52, "discounted_cash": 65.28, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CYSTO MALE*AMS5", "code_information": [{"code": "3100203204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.76, "discounted_cash": 43.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HIP*DYNJS3011", "code_information": [{"code": "3100208883", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 362.0, "discounted_cash": 543.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK KNEE*DYNJS3013", "code_information": [{"code": "3100208882", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.36, "discounted_cash": 474.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MALE CYSTO*1008", "code_information": [{"code": "3100203233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.4, "discounted_cash": 48.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK NEURO*DYNJS3069", "code_information": [{"code": "3100208959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 538.6, "discounted_cash": 807.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK NOSE*DYNJS3068", "code_information": [{"code": "3100208964", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.72, "discounted_cash": 221.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ORTHO*29181", "code_information": [{"code": "3100206970", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.52, "discounted_cash": 93.78, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE TX1*5", "code_information": [{"code": "3100202485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE TX2*5", "code_information": [{"code": "3100202551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2366.0, "discounted_cash": 3549.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER*29160", "code_information": [{"code": "3100209765", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.6, "discounted_cash": 159.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK TOTAL SHOULDER*", "code_information": [{"code": "3100209154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 470.68, "discounted_cash": 706.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PACKING VAG", "code_information": [{"code": "3100101178", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "discounted_cash": 28.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACLITAXEL (AMERICAN REGENT)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9259", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.14, "maximum": 15.14, "discounted_cash": 24.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACLITAXEL (TEVA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9258", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PACLITAXEL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9267", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.11, "maximum": 0.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACLITAXEL PROTEIN BOUND", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9264", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.71, "maximum": 13.71, "discounted_cash": 22.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAD COVER W VELCRO*1", "code_information": [{"code": "3100207581", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD DISPOSABLE", "code_information": [{"code": "3100104588", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD DRI-SAFE ABSORB", "code_information": [{"code": "3100102208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD DRI-SAFE ABSORB", "code_information": [{"code": "3100102209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD FOOT", "code_information": [{"code": "3100102210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING", "code_information": [{"code": "3100102923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING", "code_information": [{"code": "3100102925", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 463.0, "discounted_cash": 694.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD GROUNDING", "code_information": [{"code": "3100104450", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD INTELLI-FLO", "code_information": [{"code": "3100101179", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAD TOTAL KNEE STABI", "code_information": [{"code": "3100101180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PADDLE DISTRACTOR", "code_information": [{"code": "3100102211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 740.0, "discounted_cash": 1110.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PADS UNIV", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100104694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAIN BUSTER ON Q 2 1", "code_information": [{"code": "3100205114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 550.76, "discounted_cash": 826.14, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN BUSTER ON Q 4\"*", "code_information": [{"code": "3100205115", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.76, "discounted_cash": 887.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN MGMT 11 ENDOGENOUS ANAL", "code_information": [{"code": "117U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1350.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAIN MGMT MRNA GEN XPRSN 36", "code_information": [{"code": "290U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAIN MGT OPI USE GNOTYP PNL", "code_information": [{"code": "78U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 724.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAIN PUMP DISPOSABLE", "code_information": [{"code": "3100101181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN PUMP DISPOSABLE", "code_information": [{"code": "3100102939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN PUMP DISPOSABLE", "code_information": [{"code": "3100102940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN PUMP SYSTEM*PM0", "code_information": [{"code": "3100202625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.8, "discounted_cash": 691.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PAIN PUMP SYSTEM*PM0", "code_information": [{"code": "3100202626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.8, "discounted_cash": 799.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PALATAL LIFT PROSTHESIS", "code_information": [{"code": "D5955", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALATOPHARYNGOPLASTY", "code_information": [{"code": "42145", "type": "CPT"}, {"code": "3480101919", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE FULL GENE SEQ", "code_information": [{"code": "81307", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 676.5, "discounted_cash": 1086.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALB2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81308", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 301.35, "discounted_cash": 484.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALB2 MRNA SEQ ALYS", "code_information": [{"code": "137U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALIFERMIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2425", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.12, "maximum": 25.12, "discounted_cash": 42.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PALINGEN OR PALINGEN XPLUS", "code_information": [{"code": "Q4173", "type": "HCPCS"}], "standard_charges": [{"minimum": 394.06, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 394.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALINGEN OR PROMATRX", "code_information": [{"code": "Q4174", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALLIATIVE TX DENTAL PAIN", "code_information": [{"code": "D9110", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PALONOSETRON HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2469", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.19, "maximum": 1.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAMIDRONATE DISODIUM /30 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2430", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.1, "maximum": 14.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS REMOVAL/TRANSPLANT", "code_information": [{"code": "48160", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREAS TRANSPLANT", "code_information": [{"code": "10", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22248.38, "maximum": 22248.38, "discounted_cash": 53741.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22248.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [{"code": "406", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15269.4, "maximum": 15269.4, "discounted_cash": 32236.56, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15269.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "405", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25160.24, "maximum": 25160.24, "discounted_cash": 61463.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25160.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "407", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10789.72, "maximum": 10789.72, "discounted_cash": 24014.99, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10789.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48146", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48152", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48153", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANCREATIC DELIVE 10", "code_information": [{"code": "3100203586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCREATIC DELIVE 7", "code_information": [{"code": "3100203585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PANCREATIC STENT 5X3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.7, "maximum": 485.97, "gross_charge": 501.0, "discounted_cash": 751.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATIC STENT 5X5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.7, "maximum": 485.97, "gross_charge": 501.0, "discounted_cash": 751.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATIC STENT 5X7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.7, "maximum": 485.97, "gross_charge": 501.0, "discounted_cash": 751.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATIC STENT 7X5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATIC STENT 7X7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATIC STENT 7X9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANEL HORIZON EXT*10", "code_information": [{"code": "L0456", "type": "HCPCS"}, {"code": "3100104242", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANEL VISTA LS EXT", "code_information": [{"code": "L0631", "type": "HCPCS"}, {"code": "3100104149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 53.2, "maximum": 73.72, "gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 73.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 64.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANITUMUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9303", "type": "HCPCS"}], "standard_charges": [{"minimum": 151.24, "maximum": 151.24, "discounted_cash": 242.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 151.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANO RADIO IMAGE", "code_information": [{"code": "D0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.17, "maximum": 47.17, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANORAMIC IMAGE", "code_information": [{"code": "D0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.78, "maximum": 179.78, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PANORAMIC X-RAY OF JAWS", "code_information": [{"code": "70355", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAP SMEAR SCREENING", "code_information": [{"code": "G0123", "type": "HCPCS"}, {"code": "3440103101", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 21.7, "maximum": 74.69, "gross_charge": 77.0, "discounted_cash": 32.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 25.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAPAVERINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2440", "type": "HCPCS"}, {"code": "3400300157", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.25, "maximum": 13.93, "gross_charge": 7.5, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAPILLECTOMY OR EXCI", "code_information": [{"code": "46220", "type": "CPT"}, {"code": "3480101973", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5209.87, "gross_charge": 5371.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4565.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4028.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3759.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5209.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3759.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4028.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4565.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4296.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAPPA SERUM", "code_information": [{"code": "84163", "type": "CPT"}], "standard_charges": [{"minimum": 15.05, "maximum": 40.05, "discounted_cash": 24.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARAFFIN BATH THERAPY", "code_information": [{"code": "97018", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARAINFLUENZA AG IF", "code_information": [{"code": "87279", "type": "CPT"}], "standard_charges": [{"minimum": 16.43, "maximum": 24.03, "discounted_cash": 26.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARALLEL SIDE 8MM*99", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3385.2, "maximum": 4690.92, "gross_charge": 4836.0, "discounted_cash": 7254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4110.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3627.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4690.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3627.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4110.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARANASAL SINUS ULTRASOUND", "code_information": [{"code": "S9024", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/SPECT&CT", "code_information": [{"code": "78072", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARATHYRD PLANAR W/WO SUBTRJ", "code_information": [{"code": "78071", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARATHYROID HORMONE", "code_information": [{"code": "83970", "type": "CPT"}, {"code": "3440100964", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 41.28, "maximum": 360.84, "gross_charge": 372.0, "discounted_cash": 66.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 52.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 44.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 297.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 44.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 45.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARATHYROID PLANAR IMAGING", "code_information": [{"code": "78070", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARATHYROIDECTOMY OR", "code_information": [{"code": "60500", "type": "CPT"}, {"code": "3480102132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5635.04, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL AMINO ACID 5.", "code_information": [{"code": "B4172", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SOL HEPATIC FREAM", "code_information": [{"code": "B5200", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARENTERAL SUPP NOT OTHRWS C", "code_information": [{"code": "B9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.29, "maximum": 50.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARENTING CLASS", "code_information": [{"code": "S9444", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARICALCITOL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2501", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.75, "maximum": 0.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARING/CUTG B9 HYPRKER LES 1", "code_information": [{"code": "11055", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES 2-4", "code_information": [{"code": "11056", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARNG/CUTG B9 HYPRKR LES >4", "code_information": [{"code": "11057", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42507", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42509", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION", "code_information": [{"code": "42510", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART EXC BN DIST PHA", "code_information": [{"code": "26236", "type": "CPT"}, {"code": "3480101631", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4829.63, "gross_charge": 4979.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4829.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3983.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART PULP FOR APEXOGENESIS", "code_information": [{"code": "D3222", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF ANKLE/HEEL", "code_information": [{"code": "28120", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28111", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVE HIP BONE SUPER", "code_information": [{"code": "27070", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTCLE AGGLUTINTN S", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "3440101087", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 11.54, "maximum": 87.3, "gross_charge": 90.0, "discounted_cash": 18.54, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL AMPUTATION OF TOE", "code_information": [{"code": "28825", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3930.57, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC BONE HUMERUS", "code_information": [{"code": "24140", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION", "code_information": [{"code": "28124", "type": "CPT"}, {"code": "3480101755", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION (CR", "code_information": [{"code": "28122", "type": "CPT"}, {"code": "3480101754", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION CRA", "code_information": [{"code": "26235", "type": "CPT"}, {"code": "3480101630", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION CRA", "code_information": [{"code": "27360", "type": "CPT"}, {"code": "3480101692", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF", "code_information": [{"code": "40510", "type": "CPT"}, {"code": "3340102358", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6311.79, "gross_charge": 6507.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40500", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXCISION OF LIP", "code_information": [{"code": "40520", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HIP REPLACEMENT", "code_information": [{"code": "27125", "type": "CPT"}], "standard_charges": [{"minimum": 5311.52, "maximum": 5311.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HOSPITALIZATION SERV", "code_information": [{"code": "S0201", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYMENECTOMY", "code_information": [{"code": "56700", "type": "CPT"}, {"code": "3480102085", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL HYSTERECTOMY", "code_information": [{"code": "58180", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45113", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL PROCTECTOMY", "code_information": [{"code": "45123", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL RELEASE OF LUNG", "code_information": [{"code": "32225", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL COLL", "code_information": [{"code": "23120", "type": "CPT"}, {"code": "3480101535", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47140", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47141", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL DONOR LIVER", "code_information": [{"code": "47142", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL FOOT FASCIA", "code_information": [{"code": "28060", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51550", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF BLADDER", "code_information": [{"code": "51555", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44141", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44143", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44144", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44145", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44146", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF COLON", "code_information": [{"code": "44147", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43116", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43117", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43118", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43121", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43122", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43123", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF EYE FLUID", "code_information": [{"code": "67005", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FIBULA", "code_information": [{"code": "27641", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF FOOT BONE", "code_information": [{"code": "28288", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF H", "code_information": [{"code": "26230", "type": "CPT"}, {"code": "3480101629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33031", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF KIDNEY", "code_information": [{"code": "50240", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31367", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31368", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31375", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31380", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31382", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIP", "code_information": [{"code": "40530", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47120", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47125", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LIVER", "code_information": [{"code": "47130", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LUNG", "code_information": [{"code": "32480", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF NOSE", "code_information": [{"code": "30150", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF OVARY(S)", "code_information": [{"code": "58920", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48140", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48145", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PANCREAS", "code_information": [{"code": "48150", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PENIS", "code_information": [{"code": "54120", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF PHARYNX", "code_information": [{"code": "42890", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF R", "code_information": [{"code": "25151", "type": "CPT"}, {"code": "3480101591", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF R", "code_information": [{"code": "25230", "type": "CPT"}, {"code": "3480101593", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45116", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21600", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2470.2, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5178.02, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF SCAPULA", "code_information": [{"code": "23190", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF STERNUM", "code_information": [{"code": "21620", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF THYROID", "code_information": [{"code": "60225", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5635.04, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TIBIA", "code_information": [{"code": "27640", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28126", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28153", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TOE", "code_information": [{"code": "28160", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41120", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7111.29, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF TONGUE", "code_information": [{"code": "41130", "type": "CPT"}], "standard_charges": [{"minimum": 4566.59, "maximum": 4566.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF U", "code_information": [{"code": "25240", "type": "CPT"}, {"code": "3480101594", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25119", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF ULNA", "code_information": [{"code": "25150", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF VULVA", "code_information": [{"code": "56620", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3796.41, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL TEAR GLAND", "code_information": [{"code": "68505", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL THROMBOPLAST", "code_information": [{"code": "85730", "type": "CPT"}, {"code": "3440101056", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 6.01, "maximum": 50.44, "gross_charge": 52.0, "discounted_cash": 9.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL THYROID EXCISION", "code_information": [{"code": "60212", "type": "CPT"}], "standard_charges": [{"minimum": 5635.04, "maximum": 5635.04, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTICLE AGGLUT ANTBDY TITR", "code_information": [{"code": "86406", "type": "CPT"}], "standard_charges": [{"minimum": 10.64, "maximum": 30.26, "discounted_cash": 17.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARVOVIRUS AB", "code_information": [{"code": "86747", "type": "CPT"}, {"code": "3440101116", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.03, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 24.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PASSING ELEVATOR", "code_information": [{"code": "3100104596", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSPORT CAN", "code_information": [{"code": "3100104613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSPORT CANN 12X5*A", "code_information": [{"code": "3100204171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASSPORT CANN12X4*AR", "code_information": [{"code": "3100204170", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PASTE HYDROSET 10CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4867.8, "maximum": 6745.38, "gross_charge": 6954.0, "discounted_cash": 10431.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5910.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5215.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4867.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6745.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4867.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5215.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5910.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5563.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PASTE HYDROSET 15CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6984.6, "maximum": 9678.66, "gross_charge": 9978.0, "discounted_cash": 14967.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8481.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7483.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6984.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9678.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6984.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7483.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8481.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PASTE HYDROSET 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2580.9, "maximum": 3576.39, "gross_charge": 3687.0, "discounted_cash": 5530.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3133.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2765.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2580.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3576.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2580.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2765.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3133.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2949.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATCH DECELLULAR DER", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "3100101185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1123.2, "maximum": 1725.27, "gross_charge": 2808.0, "discounted_cash": 4212.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1123.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATCH DECELLULAR DER", "code_information": [{"code": "Q4125", "type": "HCPCS"}, {"code": "3100102941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2028.0, "gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATELLA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 25X6.2MM SER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 911.4, "maximum": 1262.94, "gross_charge": 1302.0, "discounted_cash": 1953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1262.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1041.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 29MM*1518-20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 32 X 8*AR-52", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 872.78, "maximum": 1209.42, "gross_charge": 1246.83, "discounted_cash": 1870.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1059.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 935.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 872.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1209.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 872.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 935.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1059.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 997.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 32MM*1518-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 32MM*1518-20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 32X10*5552-L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 34X7.8MM SER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 911.4, "maximum": 1262.94, "gross_charge": 1302.0, "discounted_cash": 1953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1262.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1041.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 35MM*1518-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 35MM*1518-20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 38MM*1518-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 38MM*1518-20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 41MM*1518-20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA 8MM*00-5420-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1131.9, "maximum": 1568.49, "gross_charge": 1617.0, "discounted_cash": 2425.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1374.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1212.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1131.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1131.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1212.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1374.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1293.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA ALLOGRAFT RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17150.0, "maximum": 23765.0, "gross_charge": 24500.0, "discounted_cash": 36750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20825.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17150.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23765.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17150.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20825.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA ALLOGRAFT*33", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17150.0, "maximum": 23765.0, "gross_charge": 24500.0, "discounted_cash": 36750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20825.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17150.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23765.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17150.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20825.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA ASYM 32X10*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA BIOMET", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 911.4, "maximum": 1262.94, "gross_charge": 1302.0, "discounted_cash": 1953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1262.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 911.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 976.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1106.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1041.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA CUTTER 33MM*", "code_information": [{"code": "3100207522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA CUTTER 36MM*", "code_information": [{"code": "3100207523", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA CUTTER 38MM*", "code_information": [{"code": "3100207524", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA CUTTER 42MM*", "code_information": [{"code": "3100207525", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA CUTTER 46MM*", "code_information": [{"code": "3100207526", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATELLA DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1285.2, "maximum": 1780.92, "gross_charge": 1836.0, "discounted_cash": 2754.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1780.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1468.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1213.1, "maximum": 1681.01, "gross_charge": 1733.0, "discounted_cash": 2599.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1473.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1299.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1213.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1681.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1213.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1299.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1473.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA DJO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1528.8, "maximum": 2118.48, "gross_charge": 2184.0, "discounted_cash": 3276.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1638.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1528.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2118.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1528.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1638.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1856.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1747.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA DOME 30X8*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2160.34, "maximum": 2993.61, "gross_charge": 3086.2, "discounted_cash": 4629.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2623.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2314.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2160.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2993.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2160.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2314.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2623.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2468.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA DOME 37X10*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 872.78, "maximum": 1209.42, "gross_charge": 1246.83, "discounted_cash": 1870.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1059.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 935.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 872.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1209.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 872.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 935.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1059.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 997.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA DOMED SZ 29M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3416.14, "maximum": 4733.79, "gross_charge": 4880.2, "discounted_cash": 7320.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4148.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3660.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3416.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4733.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3416.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3660.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4148.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3904.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA GENESIS 29MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1864.17, "maximum": 2583.2, "gross_charge": 2663.1, "discounted_cash": 3994.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2263.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1997.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1864.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2583.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1864.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1997.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2263.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2130.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA GENESIS 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1876.23, "maximum": 2599.92, "gross_charge": 2680.33, "discounted_cash": 4020.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2278.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2010.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1876.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2599.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1876.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2010.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2278.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2144.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA IMP 34X9*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 872.78, "maximum": 1209.42, "gross_charge": 1246.83, "discounted_cash": 1870.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1059.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 935.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 872.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1209.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 872.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 935.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1059.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 997.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA OVAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1513.4, "maximum": 2097.14, "gross_charge": 2162.0, "discounted_cash": 3243.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1837.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1621.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1513.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2097.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1513.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1621.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1837.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1729.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA OVAL 3PEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1540.7, "maximum": 2134.97, "gross_charge": 2201.0, "discounted_cash": 3301.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1870.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1650.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1540.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2134.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1540.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1650.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1870.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1760.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA OVAL 3PEG 38", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA PLONG 32MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA PLONG 35MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA POLY*1294-09", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.1, "maximum": 1690.71, "gross_charge": 1743.0, "discounted_cash": 2614.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1481.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1307.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1690.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1307.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1481.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1394.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA ROUND 3PEG 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1513.05, "maximum": 2096.65, "gross_charge": 2161.5, "discounted_cash": 3242.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1837.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1621.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1513.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2096.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1513.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1621.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1837.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1729.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER ASYM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1526.7, "maximum": 2115.57, "gross_charge": 2181.0, "discounted_cash": 3271.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1853.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1635.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1526.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2115.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1526.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1635.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1853.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1744.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER ASYM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER SYME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER SYME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1526.7, "maximum": 2115.57, "gross_charge": 2181.0, "discounted_cash": 3271.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1853.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1635.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1526.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2115.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1526.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1635.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1853.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1744.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER SYME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1362.9, "maximum": 1888.59, "gross_charge": 1947.0, "discounted_cash": 2920.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1654.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1460.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1362.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1888.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1362.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1460.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1654.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1557.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER X3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA STRYKER X3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA SYM 27X8MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA SYM 36X10MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1452.36, "maximum": 2012.55, "gross_charge": 2074.8, "discounted_cash": 3112.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1763.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1556.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1452.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2012.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1452.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1556.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1763.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1659.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA SYM 39X11MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA SYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1452.5, "maximum": 2012.75, "gross_charge": 2075.0, "discounted_cash": 3112.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1763.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1556.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1452.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2012.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1452.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1556.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1763.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA SZ 32MM*1803", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA X3 29X8MM*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA X3 31X9MM*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA X3 38X11*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA X3 39X11M*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.75, "maximum": 545.62, "gross_charge": 562.5, "discounted_cash": 843.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLA ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL LG*6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7351.34, "maximum": 10186.86, "gross_charge": 10501.92, "discounted_cash": 15752.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8926.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7876.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7351.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10186.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7351.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7876.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8926.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8401.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL SM*6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3337.02, "maximum": 4624.16, "gross_charge": 4767.18, "discounted_cash": 7150.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4052.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3575.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3337.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4624.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3337.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3575.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4052.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3813.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL SZ1*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8663.2, "maximum": 12004.72, "gross_charge": 12376.0, "discounted_cash": 18564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12004.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9900.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL SZ1*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8663.2, "maximum": 12004.72, "gross_charge": 12376.0, "discounted_cash": 18564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12004.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9900.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL SZ3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8663.2, "maximum": 12004.72, "gross_charge": 12376.0, "discounted_cash": 18564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12004.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9900.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8663.2, "maximum": 12004.72, "gross_charge": 12376.0, "discounted_cash": 18564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12004.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9900.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLO FEMORAL*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8663.2, "maximum": 12004.72, "gross_charge": 12376.0, "discounted_cash": 18564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12004.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8663.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10519.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9900.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ 5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ2*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3300.85, "maximum": 4574.03, "gross_charge": 4715.5, "discounted_cash": 7073.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4008.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3536.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3300.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4574.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3300.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3536.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4008.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3772.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ3*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ3*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ4*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ4*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATELLOFEMORAL SZ6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3298.75, "maximum": 4571.12, "gross_charge": 4712.5, "discounted_cash": 7068.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4571.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3298.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3534.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4005.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3770.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ HIGH 41-60", "code_information": [{"code": "80505", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 84.67, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 84.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ MOD 21-40", "code_information": [{"code": "80504", "type": "CPT"}], "standard_charges": [{"minimum": 47.11, "maximum": 60.52, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ PROLNG SVC", "code_information": [{"code": "80506", "type": "CPT"}], "standard_charges": [{"minimum": 37.95, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CLIN CONSLTJ SF 5-20", "code_information": [{"code": "80503", "type": "CPT"}], "standard_charges": [{"minimum": 24.01, "maximum": 60.52, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CNSLT SURG W FR", "code_information": [{"code": "88331", "type": "CPT"}, {"code": "3440101241", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 60.52, "maximum": 207.41, "gross_charge": 155.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 88.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CNSLT SURG W FR", "code_information": [{"code": "88332", "type": "CPT"}, {"code": "3440101242", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 44.18, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG CYTO XM 1", "code_information": [{"code": "88333", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 101.28, "discounted_cash": 1316.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 101.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CONSLTJ SURG CYTO XM EA", "code_information": [{"code": "88334", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 61.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 61.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH CONSULT DURING", "code_information": [{"code": "88329", "type": "CPT"}, {"code": "3440101240", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 40.33, "maximum": 79.54, "gross_charge": 82.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 79.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 61.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 69.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 65.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATH SURGERY 1ST 30", "code_information": [{"code": "3480103123", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.0, "discounted_cash": 1974.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATHOGEN REDUCED PLASMA POOL", "code_information": [{"code": "P9070", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 50.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATHOGEN REDUCED PLASMA SING", "code_information": [{"code": "P9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 372.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATHOGEN TEST FOR PLATELETS", "code_information": [{"code": "P9100", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.61, "maximum": 43.61, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [{"code": "543", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8243.08, "maximum": 8243.08, "discounted_cash": 12177.2, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8243.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [{"code": "542", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9430.94, "maximum": 9430.94, "discounted_cash": 20360.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9430.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "544", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2931.53, "maximum": 2931.53, "discounted_cash": 8568.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2931.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATIENT CONTROLLER D", "code_information": [{"code": "3100205741", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2517.48, "discounted_cash": 3776.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT CONTROLLER*6", "code_information": [{"code": "3100208950", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT MAGNET*6884", "code_information": [{"code": "3100205740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PATIENT PROGRAMMER *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PATIENT RECORDED SPIROMETRY", "code_information": [{"code": "94014", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATIENT RECORDED SPIROMETRY", "code_information": [{"code": "94015", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PATTERN ERG W/I&R", "code_information": [{"code": "509T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PCA SET Y-TYPE", "code_information": [{"code": "3100101194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PCA3/KLK3 ANTIGEN", "code_information": [{"code": "81313", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 255.05, "discounted_cash": 409.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PCV13 VACCINE IM", "code_information": [{"code": "90670", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 257.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 257.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PCV15 VACCINE IM", "code_information": [{"code": "90671", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 253.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 253.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PCV20 VACCINE IM", "code_information": [{"code": "90677", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 298.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 298.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PDGFRA GENE", "code_information": [{"code": "81314", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 329.51, "discounted_cash": 529.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PE LINER 22,2/45*DS1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PE LINER 28/47*DS100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEAK EXPIRATORY FLOW RATE (P", "code_information": [{"code": "S8110", "type": "HCPCS"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI", "code_information": [{"code": "165U", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 68.53, "discounted_cash": 745.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEANUT ALLG ASMT EPI CLIN RX", "code_information": [{"code": "178U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 738.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PED FBRL KD IFI27&MCEMP1 RNA", "code_information": [{"code": "389U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC COMPL", "code_information": [{"code": "94774", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC DOWNLD", "code_information": [{"code": "94776", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC HK-UP", "code_information": [{"code": "94775", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PED HOME APNEA REC REPORT", "code_information": [{"code": "94777", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDCLE FH/CH/CH/M/N/AX/G/H/F", "code_information": [{"code": "15574", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC PARTIAL DENTURE FX", "code_information": [{"code": "D6985", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDIATRIC SPEECH AID", "code_information": [{"code": "D5952", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDICLE E/N/E/L/NTRORAL", "code_information": [{"code": "15576", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PEDICLE IPAS III DIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 817.6, "maximum": 1132.96, "gross_charge": 1168.0, "discounted_cash": 1752.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 992.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 876.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 817.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 817.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 876.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 992.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 934.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 10X10X25*HA1010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 10X11X25*HA1011", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 10X12X25*HA1012", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 16X19X06*CH1619", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 16X19X07*CH1619", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 16X19X08*CH1619", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 8X10X25*HA08102", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK 8X8X25*HA080825", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK ANCHOR 6.5*3910", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 526.55, "maximum": 729.65, "gross_charge": 752.22, "discounted_cash": 1128.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 639.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 564.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 526.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 729.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 526.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 564.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 639.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 601.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK AVS TL 8X25X4*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 12X14X6*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 12X14X7*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 14X16X6*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 14X16X7*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 14X16X8*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 14X16X9*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK CAGE 16X19X9*CH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK LDR SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK SPACER*140-PRO-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6879.6, "maximum": 9533.16, "gross_charge": 9828.0, "discounted_cash": 14742.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8353.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7371.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6879.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9533.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6879.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7371.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8353.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7862.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK SPACER*144-PRO-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7243.6, "maximum": 10037.56, "gross_charge": 10348.0, "discounted_cash": 15522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8795.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7761.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10037.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7761.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8795.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK SPACER*144-PRO-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7243.6, "maximum": 10037.56, "gross_charge": 10348.0, "discounted_cash": 15522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8795.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7761.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10037.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7761.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8795.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK SPACER*144-PRO-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7243.6, "maximum": 10037.56, "gross_charge": 10348.0, "discounted_cash": 15522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8795.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7761.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10037.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7761.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8795.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEEK TRIBECCA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.2, "maximum": 422.92, "gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 422.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 10MM THREADED LO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 12MM THREADED LO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 14MM THREADED LO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 362.6, "maximum": 502.46, "gross_charge": 518.0, "discounted_cash": 777.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 440.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 362.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 502.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 362.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 440.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 414.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 08*FP08", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 10*FP10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 11*FP11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 12*FP12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 13*FP13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 14*FP14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 15*FP15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 16*FP16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 18*FP18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 20*FP20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 2.5 X 22*FP22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 22MM THREADED LO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG 24MM THREADED LO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG FEMORAL DISTAL F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG KIT STANDARD*M00", "code_information": [{"code": "3100204050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG KIT STANDARD*M00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 200.2, "maximum": 277.42, "gross_charge": 286.0, "discounted_cash": 429.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 243.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 200.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 277.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 200.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 243.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCK 2.3X17MM*TP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCK 2.3X23MM*TP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCK 2.7X23MM*HC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.7, "maximum": 563.57, "gross_charge": 581.0, "discounted_cash": 871.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 493.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 406.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 563.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 406.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 493.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG NLOCK 2.7X18MM*T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG NLOCK SKELETAL D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 291.2, "maximum": 403.52, "gross_charge": 416.0, "discounted_cash": 624.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 403.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG NLOCK SKELETAL D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG RADIOLUCENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 565.6, "maximum": 783.76, "gross_charge": 808.0, "discounted_cash": 1212.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 686.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 606.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 565.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 783.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 565.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 606.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 686.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 646.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5 X18*SP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X11MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X12MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X13MM*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X14MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X14MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208689", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X15MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208690", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X16MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X20*SP2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X22*SP2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG SCREW 2.5X26MM*S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X12*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X13*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.2, "maximum": 471.42, "gross_charge": 486.0, "discounted_cash": 729.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X14*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.2, "maximum": 471.42, "gross_charge": 486.0, "discounted_cash": 729.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X16*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X18*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X22*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREAD 2.5X24*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 473.2, "maximum": 655.72, "gross_charge": 676.0, "discounted_cash": 1014.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 574.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 473.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 655.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 473.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 574.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEG THREADED LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGADEMASE BOVINE, 25 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2504", "type": "HCPCS"}], "standard_charges": [{"minimum": 356.23, "maximum": 356.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 356.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGAPTANIB SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2503", "type": "HCPCS"}], "standard_charges": [{"minimum": 778.72, "maximum": 778.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 778.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGASPARGASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9266", "type": "HCPCS"}], "standard_charges": [{"minimum": 25781.46, "maximum": 25781.46, "discounted_cash": 41417.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25781.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGINESATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0890", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PEGLOTICASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2507", "type": "HCPCS"}], "standard_charges": [{"minimum": 3391.91, "maximum": 3391.91, "discounted_cash": 5415.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3391.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGS AFFINITI PERIPH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 218.4, "maximum": 302.64, "gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 302.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 249.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEGUNIGALSIDASE ALFA-IWXJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2508", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 342.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC", "code_information": [{"code": "734", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10516.12, "maximum": 10516.12, "discounted_cash": 24267.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10516.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC", "code_information": [{"code": "735", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10178.58, "maximum": 10178.58, "discounted_cash": 14069.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10178.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "57410", "type": "CPT"}, {"code": "3480103133", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 167.32, "maximum": 4668.61, "gross_charge": 4813.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4091.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3609.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3369.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4668.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3369.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3609.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4091.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3850.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC EXENTERATION", "code_information": [{"code": "45126", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FRACTURE UNI/BIL", "code_information": [{"code": "G0413", "type": "HCPCS"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PELVIC RING FX TREAT INT FIX", "code_information": [{"code": "G0414", "type": "HCPCS"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENCIL HAND CONTROL", "code_information": [{"code": "3100101203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PENETRATOR", "code_information": [{"code": "3100101204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2759.0, "discounted_cash": 4138.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PENG BENZATHINE/PROCAINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0558", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.37, "maximum": 17.37, "discounted_cash": 28.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN G BENZATHINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0561", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.0, "maximum": 22.0, "discounted_cash": 34.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN G POTASSI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "3400300019", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.83, "maximum": 13.77, "gross_charge": 14.2, "discounted_cash": 21.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN G POTASSI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2540", "type": "HCPCS"}, {"code": "3400300020", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.83, "maximum": 40.35, "gross_charge": 41.6, "discounted_cash": 62.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENICILLIN G PROCAINE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2510", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.38, "maximum": 43.38, "discounted_cash": 65.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 43.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE IMPLANT SYSTE", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100101205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 905.1, "maximum": 1254.21, "gross_charge": 1293.0, "discounted_cash": 1939.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1099.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 905.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1254.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 905.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1099.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1034.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93980", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENILE VASCULAR STUDY", "code_information": [{"code": "93981", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PLASTIC SURGER", "code_information": [{"code": "54620", "type": "CPT"}, {"code": "3480103195", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PLASTIC SURGER", "code_information": [{"code": "54620", "type": "CPT"}, {"code": "3480103265", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITH CC/MCC", "code_information": [{"code": "709", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14218.04, "maximum": 14218.04, "discounted_cash": 23668.88, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14218.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "710", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6775.47, "maximum": 6775.47, "discounted_cash": 13780.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6775.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE COMP UNIT DOSE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7676", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTAMIDINE NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2545", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.1, "maximum": 87.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 87.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTASTARCH 10% SOLUTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2513", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PENTAZOCINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3070", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.88, "maximum": 31.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOBARBITAL SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2515", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.6, "maximum": 22.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENTOSTATIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9268", "type": "HCPCS"}], "standard_charges": [{"minimum": 2335.72, "maximum": 2335.72, "discounted_cash": 3651.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2335.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEP THERAPY", "code_information": [{"code": "94660", "type": "CPT"}, {"code": "3310100281", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 217.61, "maximum": 645.05, "gross_charge": 665.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 645.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC ASPIR OF SPINAL", "code_information": [{"code": "62268", "type": "CPT"}, {"code": "3430100730", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC CRYO ABLATE RENAL TUM", "code_information": [{"code": "50593", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO SIN", "code_information": [{"code": "C9607", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG B", "code_information": [{"code": "C9605", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC T CABG S", "code_information": [{"code": "C9604", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC W AMI S", "code_information": [{"code": "C9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER BR", "code_information": [{"code": "C9603", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR STENT ATHER S", "code_information": [{"code": "C9602", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT SING", "code_information": [{"code": "C9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC ENDOSCOPIC GAST", "code_information": [{"code": "3100206127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERC EXT KIT*3560022", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC LYSIS OF ADHESI", "code_information": [{"code": "62263", "type": "CPT"}, {"code": "3430100728", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2908.06, "gross_charge": 2998.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2908.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2398.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC LYSIS OF ADHESI", "code_information": [{"code": "62264", "type": "CPT"}, {"code": "3430100729", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2908.06, "gross_charge": 2998.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2908.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2398.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC RF ABLATE RENAL TUMOR", "code_information": [{"code": "50592", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERC VERTEBROPLASTY", "code_information": [{"code": "22520", "type": "CPT"}, {"code": "3480101492", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5651.8, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 12111.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCLOSE PROGLIDE*12", "code_information": [{"code": "3100205169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERCUT ABLATE LIVER RF", "code_information": [{"code": "47382", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUT ALLERGY SKIN TESTS", "code_information": [{"code": "95004", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUT VERTEBRAL AUG", "code_information": [{"code": "22523", "type": "CPT"}, {"code": "3480101493", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 14363.3, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 30778.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUT VERTEBROPLAST", "code_information": [{"code": "22521", "type": "CPT"}, {"code": "3340102384", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6311.2, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 13524.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [{"code": "273", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15652.44, "maximum": 15652.44, "discounted_cash": 43508.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15652.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [{"code": "274", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15652.44, "maximum": 15652.44, "discounted_cash": 36182.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15652.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [{"code": "250", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11092.22, "maximum": 11092.22, "discounted_cash": 26245.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11092.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [{"code": "251", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8442.29, "maximum": 8442.29, "discounted_cash": 17717.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8442.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS ISLET CELLTRANS", "code_information": [{"code": "G0341", "type": "HCPCS"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS KYPHOPL", "code_information": [{"code": "22524", "type": "CPT"}, {"code": "3480101494", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 14363.3, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 30778.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "26608", "type": "CPT"}, {"code": "3480101644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "26676", "type": "CPT"}, {"code": "3480101647", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "26727", "type": "CPT"}, {"code": "3480101649", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7776.49, "gross_charge": 8017.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7776.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6413.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "26756", "type": "CPT"}, {"code": "3480101652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "26776", "type": "CPT"}, {"code": "3480101654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7776.49, "gross_charge": 8017.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7776.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6413.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "27756", "type": "CPT"}, {"code": "3480101730", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 6681.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKELETA", "code_information": [{"code": "28636", "type": "CPT"}, {"code": "3480101776", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERCUTANEOUS SKETAL", "code_information": [{"code": "26650", "type": "CPT"}, {"code": "3480101646", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7776.49, "gross_charge": 8017.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7776.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5611.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6012.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6814.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6413.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERFORMA CATH*7602-2", "code_information": [{"code": "3100205197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.0, "discounted_cash": 501.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAND", "code_information": [{"code": "D5996", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI MEDICAMENT W/SEAL, MAX", "code_information": [{"code": "D5995", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEV EVAL ISDSS IP", "code_information": [{"code": "684T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI-PX DEVICE EVAL & PRGR", "code_information": [{"code": "93287", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERI-PX EVAL PM/LDLS PM IP", "code_information": [{"code": "93286", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIACETABULAR OSTEOTOMY", "code_information": [{"code": "S2115", "type": "HCPCS"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERICARDIOCENTESIS W/IMAGING", "code_information": [{"code": "33016", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODIC ASSESSMENT", "code_information": [{"code": "G2077", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORAL EVALUATION", "code_information": [{"code": "D0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODIC ORTHODONTC TX VISIT", "code_information": [{"code": "D8670", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL MAINT PROCEDURES", "code_information": [{"code": "D4910", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING & ROOT", "code_information": [{"code": "D4341", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIODONTAL SCALING 1-3TEETH", "code_information": [{"code": "D4342", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [{"code": "300", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6137.89, "maximum": 6137.89, "discounted_cash": 11912.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6137.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [{"code": "299", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6140.35, "maximum": 6140.35, "discounted_cash": 17597.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6140.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "301", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3351.46, "maximum": 3351.46, "discounted_cash": 7924.61, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3351.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL VASCULAR REHAB", "code_information": [{"code": "93668", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "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": 12130.06, "maximum": 12130.06, "discounted_cash": 24904.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12130.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [{"code": "40", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16744.39, "maximum": 16744.39, "discounted_cash": 42989.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16744.39, "methodology": "fee schedule"}], "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": 6207.98, "maximum": 6207.98, "discounted_cash": 19424.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6207.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERIPROSTHETIC CAPUL", "code_information": [{"code": "19371", "type": "CPT"}, {"code": "3480101415", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [{"code": "336", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11755.01, "maximum": 11755.01, "discounted_cash": 23504.76, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11755.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [{"code": "335", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17388.12, "maximum": 17388.12, "discounted_cash": 39913.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17388.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC", "code_information": [{"code": "337", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9497.34, "maximum": 9497.34, "discounted_cash": 16706.66, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9497.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERITONEAL LAVAGE", "code_information": [{"code": "49084", "type": "CPT"}], "standard_charges": [{"minimum": 1083.58, "maximum": 1083.58, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERM FLP TUBE OCCLS W/IMPLT", "code_information": [{"code": "567T", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [{"code": "243", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14352.68, "maximum": 14352.68, "discounted_cash": 25428.41, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14352.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [{"code": "242", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18032.47, "maximum": 18032.47, "discounted_cash": 38574.69, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18032.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC", "code_information": [{"code": "244", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11023.36, "maximum": 11023.36, "discounted_cash": 20425.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11023.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE 4MG ORAL", "code_information": [{"code": "Q0175", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.61, "maximum": 0.61, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERPHENAZINE INJECITON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3310", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.66, "maximum": 4.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ & ICUT ALLG TEST VENOMS", "code_information": [{"code": "95017", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ABLTJ LVR CRYOABLATION", "code_information": [{"code": "47383", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ACCESS & CLSR FEM ART", "code_information": [{"code": "34713", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ CERVICOTHORACIC INJECT", "code_information": [{"code": "22510", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ CLSR TCAT L ATR APNDGE", "code_information": [{"code": "33340", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST STRTCTC", "code_information": [{"code": "19283", "type": "CPT"}], "standard_charges": [{"minimum": 717.96, "maximum": 1551.72, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD STRTCTC", "code_information": [{"code": "19284", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST 1ST IMAG", "code_information": [{"code": "19281", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ DEVICE BREAST EA IMAG", "code_information": [{"code": "19282", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ FIX DIST RAD W/", "code_information": [{"code": "25606", "type": "CPT"}, {"code": "3480101608", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ FIX ULNAR STYLO", "code_information": [{"code": "25651", "type": "CPT"}, {"code": "3480101614", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3303.0, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ IMPLTJ/RPLCMT ISDNS PTN", "code_information": [{"code": "587T", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 10468.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ ISLET CELL TRANSPLANT", "code_information": [{"code": "584T", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM CRV/THRC", "code_information": [{"code": "274T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ LAMOT/LAM LUMBAR", "code_information": [{"code": "275T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR 1ST", "code_information": [{"code": "629T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC CT LMBR EA", "code_information": [{"code": "630T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR 1ST", "code_information": [{"code": "627T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NJX ALGC FLUOR LMBR EA", "code_information": [{"code": "628T", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP CPLX>2CM", "code_information": [{"code": "50081", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ NL/PL LITHOTRP SMPL<2CM", "code_information": [{"code": "50080", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47539", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ PRCRD DRG INSJ CATH CT", "code_information": [{"code": "33019", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT BILAT INJ", "code_information": [{"code": "201T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ SACRAL AUGMT UNILAT INJ", "code_information": [{"code": "200T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ STENT/CHEST VERT ART", "code_information": [{"code": "75T", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT ILIAC ANAST IMPLT", "code_information": [{"code": "553T", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT INTRATRL SEPTL SHT", "code_information": [{"code": "613T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TCAT US ABLTJ NRV P-ART", "code_information": [{"code": "632T", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML ANGP NT/RECR COA", "code_information": [{"code": "33897", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TX MALAR FRACTURE", "code_information": [{"code": "21355", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGME", "code_information": [{"code": "22525", "type": "CPT"}, {"code": "3480101495", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 14363.3, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 30778.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22513", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22514", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ VERTEBRAL AUGMENTATION", "code_information": [{"code": "22515", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERSONA ALL POLY*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA ALL POLY*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA ALL POLY*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA ALL POLY*425", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA BEAR SZ10*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA CR BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1920.8, "maximum": 2661.68, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2661.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA CR BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1920.8, "maximum": 2661.68, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2661.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA CR BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1920.8, "maximum": 2661.68, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2661.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA CR BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1920.8, "maximum": 2661.68, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2661.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA FEMUR CEM*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA FEMUR CEM*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3166.8, "maximum": 4388.28, "gross_charge": 4524.0, "discounted_cash": 6786.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4388.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3393.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3845.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA FEMUR CEM*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5261.62, "maximum": 7291.1, "gross_charge": 7516.6, "discounted_cash": 11274.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6389.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5261.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7291.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5261.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6389.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6013.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA FEMUR CEM*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5261.62, "maximum": 7291.1, "gross_charge": 7516.6, "discounted_cash": 11274.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6389.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5261.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7291.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5261.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6389.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6013.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA FEMUR SZ7*42", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5261.62, "maximum": 7291.1, "gross_charge": 7516.6, "discounted_cash": 11274.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6389.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5261.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7291.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5261.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5637.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6389.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6013.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA PS BEARING*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "411591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2497.04, "maximum": 3460.18, "gross_charge": 3567.2, "discounted_cash": 5350.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3032.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2675.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2497.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3460.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2497.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2675.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3032.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2853.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA TIBIA CEM *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PERTUZU, TRASTUZU, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9316", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.32, "maximum": 65.32, "discounted_cash": 107.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET DX FOR NON-TUMOR ID, NOC", "code_information": [{"code": "A9598", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PET IMAGE FULL BODY", "code_information": [{"code": "78813", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMAGE SKULL-THIGH", "code_information": [{"code": "78812", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT FULL BODY", "code_information": [{"code": "78816", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT LMTD", "code_information": [{"code": "78814", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT SKULL-THIGH", "code_information": [{"code": "78815", "type": "CPT"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMAGING INITIAL DX", "code_information": [{"code": "G0252", "type": "HCPCS"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET IMG WHOLBOD MELANO NONCO", "code_information": [{"code": "G0219", "type": "HCPCS"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET NOT OTHERWISE SPECIFIED", "code_information": [{"code": "G0235", "type": "HCPCS"}], "standard_charges": [{"minimum": 2365.18, "maximum": 2365.18, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2365.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PET, DX, FOR TUMOR ID, NOC", "code_information": [{"code": "A9597", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFAS 16 PFAS COMPND LC MS/MS", "code_information": [{"code": "398U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFAS 16 PFAS COMPND LC MS/MS", "code_information": [{"code": "399U", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADMIN 1ST DOSE", "code_information": [{"code": "D1701", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PFIZER VACC ADMIN 2ND DOSE", "code_information": [{"code": "D1702", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PFT PRE/POST BRONCHO", "code_information": [{"code": "94060", "type": "CPT"}, {"code": "3310100271", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 278.57, "maximum": 645.05, "gross_charge": 665.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 645.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 565.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 532.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PFT SCREEN W-VC FLO", "code_information": [{"code": "94010", "type": "CPT"}, {"code": "3310100270", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 401.58, "gross_charge": 414.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 351.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 310.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 401.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 310.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 351.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 331.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PH BODY FLUID NOS", "code_information": [{"code": "83986", "type": "CPT"}, {"code": "3440100965", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.58, "maximum": 32.01, "gross_charge": 33.0, "discounted_cash": 5.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHALANGECTOMY, TOE,", "code_information": [{"code": "28150", "type": "CPT"}, {"code": "3480101756", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHARMACOLOGIC MGMT W/PSYTX", "code_information": [{"code": "90863", "type": "CPT"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENOBARBITAL", "code_information": [{"code": "80184", "type": "CPT"}, {"code": "3440100823", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.3, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 24.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENOBARBITAL SODIUM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2560", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.8, "maximum": 32.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CLT ADD", "code_information": [{"code": "87904", "type": "CPT"}], "standard_charges": [{"minimum": 26.07, "maximum": 79.66, "discounted_cash": 41.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CULTURE", "code_information": [{"code": "87903", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 488.66, "discounted_cash": 785.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 488.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENOTYPE INFECT AGENT DRUG", "code_information": [{"code": "87900", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 130.35, "discounted_cash": 209.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENTOLAINE MESYLATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2760", "type": "HCPCS"}], "standard_charges": [{"minimum": 444.32, "maximum": 444.32, "discounted_cash": 717.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 444.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYLEP KETOROLAC OPTH SOLN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1097", "type": "HCPCS"}], "standard_charges": [{"minimum": 119.92, "maximum": 119.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 119.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE HCL", "code_information": [{"code": "3400300221", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 13.7, "discounted_cash": 20.55, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENYLEPHRINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2370", "type": "HCPCS"}, {"code": "3400300176", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 7.17, "gross_charge": 7.4, "discounted_cash": 11.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN / DILANTIN", "code_information": [{"code": "80185", "type": "CPT"}, {"code": "3440100824", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.25, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN / DILANTIN", "code_information": [{"code": "80186", "type": "CPT"}, {"code": "3440100825", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.76, "maximum": 115.43, "gross_charge": 119.0, "discounted_cash": 22.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 115.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 83.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHENYTOIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1165", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.64, "maximum": 0.64, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHLEBOTOMY", "code_information": [{"code": "99195", "type": "CPT"}], "standard_charges": [{"minimum": 300.38, "maximum": 300.38, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ALKAL SO", "code_information": [{"code": "84080", "type": "CPT"}, {"code": "3440100967", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.78, "maximum": 129.01, "gross_charge": 133.0, "discounted_cash": 23.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 129.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.83, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.83, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOSPHATASE ALKALINE", "code_information": [{"code": "84075", "type": "CPT"}, {"code": "3440100966", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOSPHOLIPID PLTLT NEUTRALIZ", "code_information": [{"code": "85597", "type": "CPT"}], "standard_charges": [{"minimum": 17.98, "maximum": 20.47, "discounted_cash": 28.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOSPHORUS", "code_information": [{"code": "84100", "type": "CPT"}, {"code": "3440100968", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.74, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 7.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTO PATCH TEST", "code_information": [{"code": "95052", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-A", "code_information": [{"code": "96912", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOCHEMOTHERAPY WITH UV-B", "code_information": [{"code": "96910", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTODYNAMIC TX ADDL 15 MIN", "code_information": [{"code": "96571", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS", "code_information": [{"code": "36522", "type": "CPT"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "discounted_cash": 7083.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOREFRACTIVE KERATECTOMY", "code_information": [{"code": "S0810", "type": "HCPCS"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOTHERAP KERATECT", "code_information": [{"code": "S0812", "type": "HCPCS"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHP/IOP OT SERVICE", "code_information": [{"code": "G0129", "type": "HCPCS"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/MNTR", "code_information": [{"code": "94626", "type": "CPT"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHY/QHP OP PULM RHB W/O MNTR", "code_information": [{"code": "94625", "type": "CPT"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 26.59, "maximum": 60.52, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV REACTJ", "code_information": [{"code": "86078", "type": "CPT"}], "standard_charges": [{"minimum": 49.54, "maximum": 60.52, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 47.11, "maximum": 60.52, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PERFORMANCE TEST", "code_information": [{"code": "97750", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHYSOSTIGMINE SALICY", "code_information": [{"code": "3400300216", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 12.6, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PICC CAP*306597", "code_information": [{"code": "3100209593", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.04, "discounted_cash": 31.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PICC KIT*3884446", "code_information": [{"code": "3100207456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.48, "discounted_cash": 185.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PICC LINE 3F SNG LUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 242.56, "maximum": 336.12, "gross_charge": 346.52, "discounted_cash": 519.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 294.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 242.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 336.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 242.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 294.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 277.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PICC LINE 4F SNG LUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 301.98, "maximum": 418.45, "gross_charge": 431.4, "discounted_cash": 647.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 366.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 323.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 301.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 418.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 301.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 323.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 366.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 345.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PICC LINE 5F DBL LUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 302.87, "maximum": 419.69, "gross_charge": 432.68, "discounted_cash": 649.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 367.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 324.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 302.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 419.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 302.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 324.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 367.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 346.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PICC LINE 6F TPL LUM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 371.28, "maximum": 514.48, "gross_charge": 530.4, "discounted_cash": 795.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 450.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 371.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 514.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 371.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 450.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 424.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PICC LINE INTRODUCER", "code_information": [{"code": "3100209662", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.36, "discounted_cash": 209.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PICC SHERLOCK 4F*119", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 421.07, "maximum": 583.48, "gross_charge": 601.53, "discounted_cash": 902.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 511.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 451.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 421.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 583.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 421.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 451.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 511.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 481.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61250", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR BIOPSY", "code_information": [{"code": "61140", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61150", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61151", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL FOR DRAINAGE", "code_information": [{"code": "61156", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL IMPLANT DEVICE", "code_information": [{"code": "61210", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIFLU F-18, DIA 1 MILLICURIE", "code_information": [{"code": "A9595", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 932.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PIGTAIL STENT 10X10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIGTAIL STENT 10X5*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIGTAIL STENT 10X7*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203647", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIGTAIL STENT 7X10*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIGTAIL STENT 7X5*M0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIGTAIL STENT 7X7*M0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIK3CA GENE TRGT SEQ ALYS", "code_information": [{"code": "81309", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 274.83, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PILD/PLACEBO CONTROL CLIN TR", "code_information": [{"code": "G0276", "type": "HCPCS"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PILLCAM GENIIUS*FGS-", "code_information": [{"code": "3100210186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1855.8, "discounted_cash": 2783.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PILLOW ZIMFOAM ABDUC", "code_information": [{"code": "3100101206", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 186.0, "discounted_cash": 279.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PILOCARPINE HCL", "code_information": [{"code": "3400300212", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 93.4, "discounted_cash": 140.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.2 X 250*CES-31", "code_information": [{"code": "3100206291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.2 X 350*CES-31", "code_information": [{"code": "3100206290", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 3.2 X 350*CES-34", "code_information": [{"code": "3100207060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 6.0 X 300*AR-896", "code_information": [{"code": "3100208454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 378.0, "discounted_cash": 567.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 6X30X200*7107603", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 813.64, "maximum": 1127.47, "gross_charge": 1162.35, "discounted_cash": 1743.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 987.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 813.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1127.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 813.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 987.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 929.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN 6X35X200*7107603", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 813.64, "maximum": 1127.47, "gross_charge": 1162.35, "discounted_cash": 1743.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 987.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 813.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1127.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 813.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 987.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 929.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN ACCESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.57, "maximum": 531.52, "gross_charge": 547.96, "discounted_cash": 821.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 410.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 410.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN ARTHREX BB TAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 147.0, "maximum": 203.7, "gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 178.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 203.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 178.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN ARTHREX BB TAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.9, "maximum": 346.29, "gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 346.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN ARTHREX BB TAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102947", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN ARTHREX GUIDE", "code_information": [{"code": "3100101208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 3.5*800-01-", "code_information": [{"code": "3100209190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE*800-01-338", "code_information": [{"code": "3100204887", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CONN ANG 85MM*71", "code_information": [{"code": "3100209133", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1458.6, "discounted_cash": 2187.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 51.8, "maximum": 71.78, "gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 71.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 51.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 62.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN DISTRACTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN DISTRACTION12MM*", "code_information": [{"code": "3100203550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTOR SYNTH", "code_information": [{"code": "3100101209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTOR SYNTH", "code_information": [{"code": "3100102948", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 395.0, "discounted_cash": 592.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTOR SYNTH", "code_information": [{"code": "3100102949", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL", "code_information": [{"code": "3100104648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN EXCHANGE 3.2*500", "code_information": [{"code": "3100208044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN EXTRACTOR 2.4*AR", "code_information": [{"code": "3100208579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1968.75, "discounted_cash": 2953.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN FIXATION 120MM*2", "code_information": [{"code": "3100202302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 445.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION SYNTHES", "code_information": [{"code": "3100101210", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION SYNTHES", "code_information": [{"code": "3100102950", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION SYNTHES", "code_information": [{"code": "3100102951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 459.0, "discounted_cash": 688.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION SYNTHES", "code_information": [{"code": "3100102952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION TEMP", "code_information": [{"code": "3100104197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN FIXATION TEMP*23", "code_information": [{"code": "3100208407", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN GDE 3.0X100*7000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.0, "maximum": 562.6, "gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 493.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 562.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 493.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN HEADED THREAD*AR", "code_information": [{"code": "3100202790", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HEADED THREAD*AR", "code_information": [{"code": "3100203189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN HEADLESS HOWMEDI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN HOLD COLP", "code_information": [{"code": "3100101212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN KIT", "code_information": [{"code": "3100101213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN KNUCKLE DISLOCATION", "code_information": [{"code": "26706", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN MEDTRONIC PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 372.4, "maximum": 516.04, "gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 516.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN MEDTRONIC PREFIX", "code_information": [{"code": "3100101215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 508.0, "discounted_cash": 762.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PERCUTANEOUS ST*", "code_information": [{"code": "3100203057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 908.43, "discounted_cash": 1362.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN PERCUTANEOUS ST*", "code_information": [{"code": "3100203058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 908.43, "discounted_cash": 1362.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN RADIOULNAR DISLOCATION", "code_information": [{"code": "25671", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIN RETAINER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN RETRACTOR", "code_information": [{"code": "3100103976", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SCHANZ", "code_information": [{"code": "3100104195", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SCHANZ 4.0X125MM", "code_information": [{"code": "3100208748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.26, "discounted_cash": 681.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SCHANZ 5.0X150MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 481.95, "maximum": 667.84, "gross_charge": 688.5, "discounted_cash": 1032.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 585.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 516.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 481.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 667.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 481.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 516.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 585.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.5, "maximum": 557.75, "gross_charge": 575.0, "discounted_cash": 862.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 488.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 431.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 402.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 557.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 402.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 431.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 488.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 460.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SELF-DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SET GLENOID*AR-9", "code_information": [{"code": "3100204629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 936.0, "discounted_cash": 1404.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SET REV UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SHARP STEIN", "code_information": [{"code": "3100104145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SKULL TI", "code_information": [{"code": "3100101218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SMOOTH TKA*AR-61", "code_information": [{"code": "3100202791", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 2520.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN SNAP 1.9X 22*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 1.9X10*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 1.9X18*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 1.9X42*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 2.4X28*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 2.4X34*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 2.4X36*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 2.4X42*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN SNAP 2.4X50*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN STABILITY 17MM*5", "code_information": [{"code": "3100205607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STABILITY 9CM*51", "code_information": [{"code": "3100205072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.4, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STACKABLE 250MM*", "code_information": [{"code": "3100205877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STACKABLE 350MM*", "code_information": [{"code": "3100205876", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN STEINMAN 2.4X300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN STEINMANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN STEINMANN 2.8*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN STEINMANN 7\"*110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 637.01, "maximum": 882.71, "gross_charge": 910.02, "discounted_cash": 1365.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 773.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 682.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 637.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 882.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 637.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 682.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 773.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 728.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TEMP FIXATION*AT", "code_information": [{"code": "3100203020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN TEMPORARY FIX*A0", "code_information": [{"code": "3100202818", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN THREADED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 730.8, "maximum": 1012.68, "gross_charge": 1044.0, "discounted_cash": 1566.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 887.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 783.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 730.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1012.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 730.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 783.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 887.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 835.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TRANSFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 348.6, "maximum": 483.06, "gross_charge": 498.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 483.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 398.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN TRIA HEADLESS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 942.9, "maximum": 1306.59, "gross_charge": 1347.0, "discounted_cash": 2020.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1144.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1010.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 942.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1306.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 942.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1010.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1144.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1077.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIN UNIV ECLIPSE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINCH GRAFT UP TO 2 CM DIAM", "code_information": [{"code": "15050", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PINK SAFETY PAD*4059", "code_information": [{"code": "3100202906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS APEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 152.6, "maximum": 211.46, "gross_charge": 218.0, "discounted_cash": 327.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 185.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 163.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 152.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 211.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 152.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 163.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 185.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 174.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS ARTHREX ACL COL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 430.5, "maximum": 596.55, "gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 461.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 430.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 596.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 430.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 461.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 492.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS ARTHREX ACL GUI", "code_information": [{"code": "3100101220", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS BIOMET ORTHO SO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 476.7, "maximum": 660.57, "gross_charge": 681.0, "discounted_cash": 1021.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 578.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 510.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 476.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 660.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 476.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 510.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 578.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS CASPAR DISTRACT", "code_information": [{"code": "3100101222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS MAYFIELD SKULL", "code_information": [{"code": "3100101223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.0, "discounted_cash": 190.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS SONIC RX", "code_information": [{"code": "3100101224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN", "code_information": [{"code": "3100101225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN", "code_information": [{"code": "3100102953", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN", "code_information": [{"code": "3100102954", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN", "code_information": [{"code": "3100102955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN", "code_information": [{"code": "3100102956", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN BIOMET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.57, "maximum": 531.52, "gross_charge": 547.96, "discounted_cash": 821.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 410.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 410.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS STEIN SYNTHES T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 403.2, "maximum": 558.72, "gross_charge": 576.0, "discounted_cash": 864.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 489.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 558.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 489.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 460.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS STEIN THRD DBL", "code_information": [{"code": "3100101228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.0, "discounted_cash": 148.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN THREAD", "code_information": [{"code": "3100101229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS STEIN TROCAR", "code_information": [{"code": "3100101230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PINS SYNTHES BEND TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 444.5, "maximum": 615.95, "gross_charge": 635.0, "discounted_cash": 952.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 539.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 476.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 444.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 615.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 444.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 476.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 539.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 508.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS SYNTHES BEND TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.5, "maximum": 460.75, "gross_charge": 475.0, "discounted_cash": 712.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 403.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 356.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 460.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 356.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 403.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS THREADED ZIMMER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINS ZIMMER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAM", "code_information": [{"code": "87172", "type": "CPT"}], "standard_charges": [{"minimum": 4.27, "maximum": 24.03, "discounted_cash": 6.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PINWORM EXAMINATIONS", "code_information": [{"code": "Q0113", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.27, "maximum": 24.03, "discounted_cash": 6.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIP DART 2.5X30*AR-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1249.5, "maximum": 1731.45, "gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1731.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP DART 2.5X30*AR-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1249.5, "maximum": 1731.45, "gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1731.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP IMPLANT SZ 10*PI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2871.96, "maximum": 3979.71, "gross_charge": 4102.8, "discounted_cash": 6154.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3487.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3077.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2871.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3979.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2871.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3077.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3487.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3282.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP IMPLANT SZ 12*PI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.64, "maximum": 2197.24, "gross_charge": 2265.2, "discounted_cash": 3397.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP IMPLANT SZ 30*PI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2735.46, "maximum": 3790.56, "gross_charge": 3907.8, "discounted_cash": 5861.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3790.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3126.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP IMPLANT SZ 40*PI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2735.46, "maximum": 3790.56, "gross_charge": 3907.8, "discounted_cash": 5861.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3790.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2735.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2930.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3321.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3126.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIP POST 4.0 X 16*12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2216.76, "maximum": 3071.79, "gross_charge": 3166.8, "discounted_cash": 4750.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2691.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3071.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2691.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2533.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIPERACILLIN/TAZOBAC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2543", "type": "HCPCS"}, {"code": "3400300227", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.05, "maximum": 31.91, "gross_charge": 32.9, "discounted_cash": 49.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 27.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 24.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 27.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PIPFIX*PFX-426", "code_information": [{"code": "3100207983", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIRANHA CONTAINER*22", "code_information": [{"code": "3100207584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.8, "discounted_cash": 148.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIRANHA FILTER*2228.", "code_information": [{"code": "3100207583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.16, "discounted_cash": 111.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PIRANHA MORCELLATOR*", "code_information": [{"code": "3100207582", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1052.34, "discounted_cash": 1578.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PIRANHA O-RING*15364", "code_information": [{"code": "3100207586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIRANHA TUBING*41702", "code_information": [{"code": "3100207585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.6, "discounted_cash": 146.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PITUITARY EVALUATION PANEL", "code_information": [{"code": "80418", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 579.48, "discounted_cash": 930.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 579.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PITUITARY FORCEPS UP", "code_information": [{"code": "3100101234", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2738.0, "discounted_cash": 4107.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIVOT NAV BALLOON*PV", "code_information": [{"code": "3100206570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5655.0, "discounted_cash": 8482.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PIVOT PRO*610-1553", "code_information": [{"code": "3100209861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLACE BREAST CATH FOR RAD", "code_information": [{"code": "19297", "type": "CPT"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE BREAST RAD TUBE/CATHS", "code_information": [{"code": "19298", "type": "CPT"}], "standard_charges": [{"minimum": 4656.04, "maximum": 4656.04, "discounted_cash": 9981.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTD ART", "code_information": [{"code": "36224", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36222", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH CAROTID/INOM ART", "code_information": [{"code": "36223", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH INTRACRANIAL ART", "code_information": [{"code": "36228", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH SUBCLAVIAN ART", "code_information": [{"code": "36225", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": "36221", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", "code_information": [{"code": "36227", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN AORTA", "code_information": [{"code": "36200", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36013", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36014", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36015", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36218", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36011", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 1029.73, "maximum": 1029.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1029.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE CECOSTOMY TUBE PERC", "code_information": [{"code": "49442", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE IMPACTED TOOTH", "code_information": [{"code": "D7283", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE DEVICE/MARKER, NON PRO", "code_information": [{"code": "C9728", "type": "HCPCS"}], "standard_charges": [{"minimum": 2192.96, "maximum": 2192.96, "discounted_cash": 2120.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"minimum": 2670.89, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TU", "code_information": [{"code": "49440", "type": "CPT"}, {"code": "3480103324", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4306.8, "gross_charge": 4440.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3774.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3108.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4306.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3108.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3330.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3774.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3552.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE INTRA-SOCKET BIO DRESS", "code_information": [{"code": "D7922", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES H&N FOR RT", "code_information": [{"code": "41019", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLES PELVIC FOR RT", "code_information": [{"code": "55920", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE OF INFUS PUMP", "code_information": [{"code": "62362", "type": "CPT"}, {"code": "3430100740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 47907.33, "gross_charge": 49389.0, "discounted_cash": 27298.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 41980.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18817.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 37041.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 34572.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 47907.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18562.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 34572.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18744.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 37041.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18198.84, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21656.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 41980.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18198.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 39511.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18198.84, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18562.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19559.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE PERM PACING CARDIOVERT", "code_information": [{"code": "G0448", "type": "HCPCS"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE PO BREAST CATH FOR RAD", "code_information": [{"code": "19296", "type": "CPT"}], "standard_charges": [{"minimum": 4656.04, "maximum": 4656.04, "discounted_cash": 14428.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARK", "code_information": [{"code": "55876", "type": "CPT"}, {"code": "3480103198", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3620.04, "gross_charge": 3732.0, "discounted_cash": 2120.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3172.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1462.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2799.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2612.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3620.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1442.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2612.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1456.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2799.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1413.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1682.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3172.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1413.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2985.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1413.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1442.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACE RT DEVICE/MARK", "code_information": [{"code": "55876", "type": "CPT"}, {"code": "3480103272", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4452.3, "gross_charge": 4590.0, "discounted_cash": 2120.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3901.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1462.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3442.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3213.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4452.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1442.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3213.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1456.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3442.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1413.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1682.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3901.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1413.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3672.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1413.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1442.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT BILE DUCT SUPPORT", "code_information": [{"code": "47801", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF DRAIN PANCREAS", "code_information": [{"code": "48001", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACEMENT OF SETON", "code_information": [{"code": "46020", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLACENTAL LACTOGEN", "code_information": [{"code": "83632", "type": "CPT"}], "standard_charges": [{"minimum": 20.22, "maximum": 40.05, "discounted_cash": 32.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLAELET RICH PLASMA UNIT", "code_information": [{"code": "P9020", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 881.64, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLANTAR FAS ENDOBLAD", "code_information": [{"code": "3100202748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2631.3, "discounted_cash": 3946.95, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMA CRYO REDU PATH EACH", "code_information": [{"code": "P9025", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 497.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLASMA PROTEIN FRACT,5%,50ML", "code_information": [{"code": "P9043", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 12.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME MULTIPLE", "code_information": [{"code": "78111", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLASMA VOLUME SINGLE", "code_information": [{"code": "78110", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLASMALOOP MEDIUM*WA", "code_information": [{"code": "3100209298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1244.88, "discounted_cash": 1867.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASMAPROTEIN FRACT,5%,250ML", "code_information": [{"code": "P9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 163.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLASTIC OPERATION ON", "code_information": [{"code": "54360", "type": "CPT"}, {"code": "3480102055", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9422.58, "gross_charge": 9714.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8256.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7285.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6799.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9422.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6799.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7285.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8256.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7771.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY 1ST", "code_information": [{"code": "3480103125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5269.0, "discounted_cash": 7903.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY EA A", "code_information": [{"code": "3480103126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 2963.0, "discounted_cash": 4444.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLASTIC SURGERY NECK", "code_information": [{"code": "15819", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3196.88, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1356.07, "maximum": 1879.13, "gross_charge": 1937.25, "discounted_cash": 2905.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1646.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1452.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1356.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1879.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1356.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1452.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1646.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1549.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104159", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1959.3, "maximum": 2715.03, "gross_charge": 2799.0, "discounted_cash": 4198.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2379.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2099.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2715.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2099.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2379.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2239.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1820.0, "maximum": 2522.0, "gross_charge": 2600.0, "discounted_cash": 3900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2210.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2522.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2210.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1606.5, "maximum": 2226.15, "gross_charge": 2295.0, "discounted_cash": 3442.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1950.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2226.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1950.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1307.6, "maximum": 1811.96, "gross_charge": 1868.0, "discounted_cash": 2802.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1587.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1401.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1307.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1811.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1307.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1401.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1587.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1154.3, "maximum": 1599.53, "gross_charge": 1649.0, "discounted_cash": 2473.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1401.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1154.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1599.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1154.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1401.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1319.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 636.3, "maximum": 881.73, "gross_charge": 909.0, "discounted_cash": 1363.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 772.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 681.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 636.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 881.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 636.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 681.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 772.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 727.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 515.2, "maximum": 713.92, "gross_charge": 736.0, "discounted_cash": 1104.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 625.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 515.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 713.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 515.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1360.8, "maximum": 1885.68, "gross_charge": 1944.0, "discounted_cash": 2916.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1652.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1458.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1360.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1885.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1360.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1458.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1652.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1555.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1719.9, "maximum": 2383.29, "gross_charge": 2457.0, "discounted_cash": 3685.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1842.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1719.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2383.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1719.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1842.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2088.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1585.5, "maximum": 2197.05, "gross_charge": 2265.0, "discounted_cash": 3397.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1925.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1698.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1585.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2197.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1585.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1698.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1925.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3311.7, "maximum": 4589.07, "gross_charge": 4731.0, "discounted_cash": 7096.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4021.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3548.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3311.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4589.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3311.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3548.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4021.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3784.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 637.87, "maximum": 883.91, "gross_charge": 911.25, "discounted_cash": 1366.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 774.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 683.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 637.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 883.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 637.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 683.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 774.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2106.3, "maximum": 2918.73, "gross_charge": 3009.0, "discounted_cash": 4513.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2557.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2256.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2918.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2256.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2557.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2407.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1542.12, "maximum": 2136.94, "gross_charge": 2203.04, "discounted_cash": 3304.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1872.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1652.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1542.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2136.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1542.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1652.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1872.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1762.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8451.8, "maximum": 11711.78, "gross_charge": 12074.0, "discounted_cash": 18111.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10262.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8451.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11711.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8451.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9055.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10262.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9659.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1886.5, "maximum": 2614.15, "gross_charge": 2695.0, "discounted_cash": 4042.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2290.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2021.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1886.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2614.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1886.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2021.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2290.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2156.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL 10MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL 12MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL 20*711", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL 24*711", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1 LEVEL*0220-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.3 LCKNG*02.1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 989.89, "maximum": 1371.71, "gross_charge": 1414.14, "discounted_cash": 2121.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1202.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1060.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 989.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1371.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 989.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1060.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1202.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1131.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.3 LCKNG*02.1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1128.3, "maximum": 1563.51, "gross_charge": 1611.87, "discounted_cash": 2417.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1370.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1208.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1128.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1563.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1128.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1208.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1370.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1289.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.4 8H*AR-1871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.4/ 6 HOLE*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.5 12 HOLE*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1208.9, "maximum": 1675.19, "gross_charge": 1727.01, "discounted_cash": 2590.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1467.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1295.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1208.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1675.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1208.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1295.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1467.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1381.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.5 6H*01-7050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 179.2, "maximum": 248.32, "gross_charge": 256.0, "discounted_cash": 384.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 179.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 248.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 179.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 204.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.5M 6-HOLE*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 911.92, "maximum": 1263.66, "gross_charge": 1302.75, "discounted_cash": 1954.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1107.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 977.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 911.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1263.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 911.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 977.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1107.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1042.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.5M 7-HOLE*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 990.67, "maximum": 1372.79, "gross_charge": 1415.25, "discounted_cash": 2122.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1202.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1061.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 990.67, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1372.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 990.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1061.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1202.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1132.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.6 X 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.6 X2X5H*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 1.6 X8H*AR-187", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 476.7, "maximum": 660.57, "gross_charge": 681.0, "discounted_cash": 1021.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 578.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 510.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 476.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 660.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 476.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 510.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 578.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 10H LT*AR-8963", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3592.68, "maximum": 4978.42, "gross_charge": 5132.4, "discounted_cash": 7698.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4362.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3849.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3592.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4978.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3592.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3849.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4362.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4105.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 10H RT*PL-LEL1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3518.06, "maximum": 4875.02, "gross_charge": 5025.8, "discounted_cash": 7538.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4271.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3769.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3518.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4875.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3518.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3769.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4271.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4020.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 10MM*API-11001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 11H 2.7*02.118", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1896.98, "maximum": 2628.68, "gross_charge": 2709.98, "discounted_cash": 4064.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2303.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2032.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1896.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2628.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1896.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2032.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2303.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2167.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 11H LT*3024-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5341.24, "maximum": 7401.43, "gross_charge": 7630.35, "discounted_cash": 11445.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6485.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5722.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5341.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7401.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5341.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5722.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6485.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6104.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 12H 1.0*50-723", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1124.92, "maximum": 1558.82, "gross_charge": 1607.04, "discounted_cash": 2410.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1365.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1205.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1124.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1558.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1124.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1205.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1365.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1285.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 12H 2.7*247.37", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 863.7, "maximum": 1196.85, "gross_charge": 1233.87, "discounted_cash": 1850.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1048.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 925.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 863.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1196.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 863.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 925.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1048.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 987.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 12H LADDER*50-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1587.6, "maximum": 2199.96, "gross_charge": 2268.0, "discounted_cash": 3402.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1927.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1701.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1587.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2199.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1587.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1701.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1927.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1814.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 12H RT*AR-8963", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 12MM 1LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 130 DEG 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1343.3, "maximum": 1861.43, "gross_charge": 1919.0, "discounted_cash": 2878.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1631.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1439.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1343.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1861.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1343.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1439.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1631.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1535.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 130 DEG 9H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1466.5, "maximum": 2032.15, "gross_charge": 2095.0, "discounted_cash": 3142.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1780.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1571.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1466.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2032.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1466.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1571.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1780.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1676.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 14MM 1LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 16MM 1LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 16MM*00-1015-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1480.5, "maximum": 2051.55, "gross_charge": 2115.0, "discounted_cash": 3172.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2051.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 17H RT*3032-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2851.57, "maximum": 3951.46, "gross_charge": 4073.68, "discounted_cash": 6110.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3462.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3055.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2851.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3951.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2851.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3055.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3462.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3258.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 17MM 1 LEV*31-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204689", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 18MM 1 LEV*31-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 18MM*436-0118", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE OSTEOME", "code_information": [{"code": "3100103830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 262.0, "discounted_cash": 393.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 HOLE OSTEOME", "code_information": [{"code": "3100103839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 336.0, "discounted_cash": 504.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 28MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2593.5, "maximum": 3593.85, "gross_charge": 3705.0, "discounted_cash": 5557.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 30MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2593.5, "maximum": 3593.85, "gross_charge": 3705.0, "discounted_cash": 5557.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 32MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 34MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2593.5, "maximum": 3593.85, "gross_charge": 3705.0, "discounted_cash": 5557.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 36*711", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 40*711", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2 LEVEL 44*711", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.0 6H*AR-1872", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.0 6H*AR-1872", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209563", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.0 X 5H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.0MM 6H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1616.51, "maximum": 2240.02, "gross_charge": 2309.3, "discounted_cash": 3463.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1962.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1731.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1616.51, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1616.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1731.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1962.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1847.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 *AR-8952MS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 5H LT*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 5H RT*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 6H*AR-1872", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 6H*AR8952M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 7H*AR-8952", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 8H*AR-1872", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 8H*AR-8952", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4 LCP WRIST*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3647.28, "maximum": 5054.08, "gross_charge": 5210.4, "discounted_cash": 7815.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4428.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3907.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3647.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5054.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3647.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3907.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4428.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4168.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/ 10H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/ 6H*AR-187", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/2.7 *02.21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2418.78, "maximum": 3351.73, "gross_charge": 3455.4, "discounted_cash": 5183.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3351.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2591.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/2.7 12H*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3905.17, "maximum": 5411.45, "gross_charge": 5578.82, "discounted_cash": 8368.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5411.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4463.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/2.7 SM*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2031.12, "maximum": 2814.55, "gross_charge": 2901.6, "discounted_cash": 4352.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2466.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2176.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2031.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2814.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2031.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2176.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2466.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2321.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/2X4 H*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/6H*AR-187", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4/8H*AR-187", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4MM 6H/10H *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4860.43, "maximum": 6735.17, "gross_charge": 6943.48, "discounted_cash": 10415.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5901.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5207.61, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4860.43, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6735.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4860.43, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5207.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5901.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5554.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.4VOLT*02.424", "code_information": [{"code": "C1176", "type": "HCPCS"}, {"code": "3100210254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2026.59, "discounted_cash": 3039.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 2.7 3H*AR-1882", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 4H*04.118.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1994.13, "maximum": 2763.3, "gross_charge": 2848.77, "discounted_cash": 4273.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2421.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2136.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1994.13, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2763.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1994.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2136.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2421.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2279.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 4H*04.118.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1994.13, "maximum": 2763.3, "gross_charge": 2848.77, "discounted_cash": 4273.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2421.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2136.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1994.13, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2763.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1994.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2136.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2421.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2279.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 5H*04.118.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2098.97, "maximum": 2908.57, "gross_charge": 2998.53, "discounted_cash": 4497.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2548.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2248.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2098.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2908.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2098.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2248.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2548.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2398.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 5H*04.118.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1912.6, "maximum": 2650.32, "gross_charge": 2732.29, "discounted_cash": 4098.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2322.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2049.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1912.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2650.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1912.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2049.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2322.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2185.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 6H*04.118.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1832.52, "maximum": 2539.35, "gross_charge": 2617.89, "discounted_cash": 3926.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2225.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1963.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1832.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2539.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1832.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1963.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2225.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2094.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 ANGLE RT*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4941.3, "maximum": 6847.23, "gross_charge": 7059.0, "discounted_cash": 10588.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6000.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5294.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4941.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6847.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4941.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5294.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6000.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5647.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 T 10H*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 10H*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2174.9, "maximum": 3013.79, "gross_charge": 3107.0, "discounted_cash": 4660.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2640.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2330.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2174.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3013.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2174.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2330.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2640.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2485.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 10H*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 20H*02.2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1112.83, "maximum": 1542.06, "gross_charge": 1589.76, "discounted_cash": 2384.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1351.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1192.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1112.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1542.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1112.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1192.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1351.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1271.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 2H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 40*02.21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206947", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2288.26, "maximum": 3170.88, "gross_charge": 3268.95, "discounted_cash": 4903.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2778.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2451.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2288.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3170.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2288.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2451.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2778.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2615.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 56*02.21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2373.3, "maximum": 3288.71, "gross_charge": 3390.43, "discounted_cash": 5085.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2881.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2542.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2373.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3288.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2373.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2542.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2881.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2712.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X64 LT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2205.2, "maximum": 3055.78, "gross_charge": 3150.29, "discounted_cash": 4725.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2677.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2362.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2205.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3055.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2205.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2362.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2677.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2520.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X64 LT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1888.67, "maximum": 2617.15, "gross_charge": 2698.1, "discounted_cash": 4047.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2293.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2023.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1888.67, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2617.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1888.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2023.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2293.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2158.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X64 RT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2369.42, "maximum": 3283.34, "gross_charge": 3384.89, "discounted_cash": 5077.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2877.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2538.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2369.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3283.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2369.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2538.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2877.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2707.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X70 LT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2385.07, "maximum": 3305.03, "gross_charge": 3407.25, "discounted_cash": 5110.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2896.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2555.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2385.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3305.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2385.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2555.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2896.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2725.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X70 RT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2220.85, "maximum": 3077.47, "gross_charge": 3172.65, "discounted_cash": 4758.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2696.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2379.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2220.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3077.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2220.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2379.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2696.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2538.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7 X70 RT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1901.1, "maximum": 2634.38, "gross_charge": 2715.86, "discounted_cash": 4073.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2308.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2036.89, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1901.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2634.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1901.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2036.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2308.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2172.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7MM 8H OSTEO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2106.3, "maximum": 2918.73, "gross_charge": 3009.0, "discounted_cash": 4513.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2557.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2256.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2918.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2256.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2557.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2407.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7MM FIB 3H R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1329.3, "maximum": 1842.03, "gross_charge": 1899.0, "discounted_cash": 2848.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1614.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1424.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1842.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1424.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1614.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1519.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7MM FIB 4H *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1309.28, "maximum": 1814.29, "gross_charge": 1870.41, "discounted_cash": 2805.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1589.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1402.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1309.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1814.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1309.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1402.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1589.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1496.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7MM FIB 4H R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1219.93, "maximum": 1690.47, "gross_charge": 1742.76, "discounted_cash": 2614.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1481.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1307.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1219.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1690.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1219.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1307.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1481.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1394.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7MM FIB 5H*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1324.78, "maximum": 1835.77, "gross_charge": 1892.55, "discounted_cash": 2838.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1608.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1419.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1324.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1835.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1324.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1419.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1608.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1514.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7MM TI LCP T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1513.57, "maximum": 2097.38, "gross_charge": 2162.25, "discounted_cash": 3243.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1837.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1621.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1513.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2097.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1513.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1621.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1837.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1729.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7X 56MM*02.2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2373.3, "maximum": 3288.71, "gross_charge": 3390.43, "discounted_cash": 5085.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2881.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2542.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2373.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3288.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2373.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2542.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2881.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2712.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7X 58 RT*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2585.7, "maximum": 3583.05, "gross_charge": 3693.87, "discounted_cash": 5540.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3139.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2770.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2585.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3583.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2585.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2770.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3139.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2955.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7X3.5MM 6H*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2698.33, "maximum": 3739.11, "gross_charge": 3854.76, "discounted_cash": 5782.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3276.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2891.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2698.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3739.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2698.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2891.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3276.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3083.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2.7X3.5MM 8H*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3346.91, "maximum": 4637.86, "gross_charge": 4781.3, "discounted_cash": 7171.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4064.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3585.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3346.91, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4637.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3346.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3585.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4064.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3825.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 20MM*1681-020", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 22MM*00-1015-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1480.5, "maximum": 2051.55, "gross_charge": 2115.0, "discounted_cash": 3172.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2051.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 22MM*436-0122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 24MM*436-0124", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 24MM*AA01-41F2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 26MM*436-0126", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 28MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 28MM*436-0128", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2H 2.7X82MM*02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2076.16, "maximum": 2876.97, "gross_charge": 2965.95, "discounted_cash": 4448.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2521.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2224.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2076.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2876.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2076.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2224.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2521.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2372.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 2H RT LCP 2.7X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1809.57, "maximum": 2507.54, "gross_charge": 2585.1, "discounted_cash": 3877.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2197.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1938.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1809.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2507.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1809.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1938.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2197.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2068.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3 HOLE*RCP3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206563", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 48MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2593.5, "maximum": 3593.85, "gross_charge": 3705.0, "discounted_cash": 5557.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 54MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2593.5, "maximum": 3593.85, "gross_charge": 3705.0, "discounted_cash": 5557.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3 LEVEL 5MM*AP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2593.5, "maximum": 3593.85, "gross_charge": 3705.0, "discounted_cash": 5557.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3593.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2778.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3149.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2964.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2482.9, "maximum": 3440.59, "gross_charge": 3547.0, "discounted_cash": 5320.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3014.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2660.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2482.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3440.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2482.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2660.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3014.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2837.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 910.7, "maximum": 1261.97, "gross_charge": 1301.0, "discounted_cash": 1951.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1105.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 975.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 910.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1261.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 910.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 975.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1105.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1040.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.7, "maximum": 2037.97, "gross_charge": 2101.0, "discounted_cash": 3151.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102959", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1877.4, "maximum": 2601.54, "gross_charge": 2682.0, "discounted_cash": 4023.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2279.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2011.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1877.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2601.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1877.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2011.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2279.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2145.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1958.6, "maximum": 2714.06, "gross_charge": 2798.0, "discounted_cash": 4197.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2378.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2098.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1958.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2714.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1958.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2098.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2378.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2238.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2355.5, "maximum": 3264.05, "gross_charge": 3365.0, "discounted_cash": 5047.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2860.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2523.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2355.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3264.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2355.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2523.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2860.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 471.8, "maximum": 653.78, "gross_charge": 674.0, "discounted_cash": 1011.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 572.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 505.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 471.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 653.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 471.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 505.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 572.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 539.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 506.1, "maximum": 701.31, "gross_charge": 723.0, "discounted_cash": 1084.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 614.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 506.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 701.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 506.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 614.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 578.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 669.9, "maximum": 928.29, "gross_charge": 957.0, "discounted_cash": 1435.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 928.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 765.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 847.0, "maximum": 1173.7, "gross_charge": 1210.0, "discounted_cash": 1815.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 907.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 847.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1173.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 847.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 907.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1028.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 968.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D 2X2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 924.0, "maximum": 1280.4, "gross_charge": 1320.0, "discounted_cash": 1980.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1280.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D 2X2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D 3X2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D 3X2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 452.9, "maximum": 627.59, "gross_charge": 647.0, "discounted_cash": 970.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 549.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 485.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 452.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 627.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 452.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 485.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 549.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 517.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D 4X2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D 4X2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102968", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 924.0, "maximum": 1280.4, "gross_charge": 1320.0, "discounted_cash": 1980.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1280.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D CRVD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 870.1, "maximum": 1205.71, "gross_charge": 1243.0, "discounted_cash": 1864.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1056.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 932.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 870.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1205.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 870.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 932.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1056.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 994.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 590.8, "maximum": 818.68, "gross_charge": 844.0, "discounted_cash": 1266.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 717.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 633.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 590.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 818.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 590.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 633.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 717.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 675.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1329.3, "maximum": 1842.03, "gross_charge": 1899.0, "discounted_cash": 2848.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1614.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1424.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1842.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1329.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1424.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1614.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1519.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D RCTNGL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 690.2, "maximum": 956.42, "gross_charge": 986.0, "discounted_cash": 1479.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 838.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 690.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 956.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 690.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 838.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 788.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D REPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 924.0, "maximum": 1280.4, "gross_charge": 1320.0, "discounted_cash": 1980.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1280.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3-D SQR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 774.9, "maximum": 1073.79, "gross_charge": 1107.0, "discounted_cash": 1660.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 940.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 830.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 774.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1073.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 774.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 830.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 940.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 885.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3.5 10H*241.92", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3809.84, "maximum": 5279.35, "gross_charge": 5442.63, "discounted_cash": 8163.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4626.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4081.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3809.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5279.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3809.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4081.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4626.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4354.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3.5 12H*AR-765", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3234.01, "maximum": 4481.41, "gross_charge": 4620.02, "discounted_cash": 6930.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3927.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3465.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3234.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4481.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3234.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3465.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3927.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3696.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3.5 HOOK*02-11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1112.13, "maximum": 1541.1, "gross_charge": 1588.77, "discounted_cash": 2383.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1350.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1191.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1112.13, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1541.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1112.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1191.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1350.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1271.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3.5MM HUMR 12H", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3938.09, "maximum": 5457.07, "gross_charge": 5625.85, "discounted_cash": 8438.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4781.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4219.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3938.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5457.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3938.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4219.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4781.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4500.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 30MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 32MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 348MM 2 LEV*31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 34MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 35MM 2 LVL*300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 36MM 2 LEV*31-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 36MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 37MM 1LVL*7100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 37MM 2 LVL*300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 38MM 2 LEV*31-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 38MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 38MM LEVEL 2*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 38MM*436-0238", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 39MM 2 LVL*300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3H RT OLECRANO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1894.29, "maximum": 2624.94, "gross_charge": 2706.13, "discounted_cash": 4059.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2300.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2029.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1894.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2624.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1894.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2029.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2300.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2164.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3H RT*70-0303", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3H RT*VLBPR-3-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2156.7, "maximum": 2988.57, "gross_charge": 3081.0, "discounted_cash": 4621.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2988.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2464.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 3H*DUP3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1302.0, "maximum": 1804.2, "gross_charge": 1860.0, "discounted_cash": 2790.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1395.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1804.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1395.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE DISTIBI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3169.53, "maximum": 4392.06, "gross_charge": 4527.9, "discounted_cash": 6791.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3848.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3395.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3169.53, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4392.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3169.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3395.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3848.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3622.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE OSTEOME", "code_information": [{"code": "3100103831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 502.0, "discounted_cash": 753.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 4 HOLE*25-752-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 729.12, "maximum": 1010.35, "gross_charge": 1041.6, "discounted_cash": 1562.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 885.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 729.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1010.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 729.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 885.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 833.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4 LEVEL 70MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4 STRYKER HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4 STRYKER HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.4, "maximum": 545.14, "gross_charge": 562.0, "discounted_cash": 843.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 477.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 421.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 477.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 449.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 828.1, "maximum": 1147.51, "gross_charge": 1183.0, "discounted_cash": 1774.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1005.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 887.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 828.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1147.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 828.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 887.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1005.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 946.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 883.4, "maximum": 1224.14, "gross_charge": 1262.0, "discounted_cash": 1893.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1072.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 946.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 883.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1224.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 883.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 946.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1072.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1009.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 937.3, "maximum": 1298.83, "gross_charge": 1339.0, "discounted_cash": 2008.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1138.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1004.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 937.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1298.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 937.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1004.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1138.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1071.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1084.3, "maximum": 1502.53, "gross_charge": 1549.0, "discounted_cash": 2323.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1316.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1161.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1084.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1502.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1084.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1161.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1316.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1239.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1146.6, "maximum": 1588.86, "gross_charge": 1638.0, "discounted_cash": 2457.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1392.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1228.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1146.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1588.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1146.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1228.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1392.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1202.6, "maximum": 1666.46, "gross_charge": 1718.0, "discounted_cash": 2577.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1460.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1288.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1202.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1666.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1202.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1288.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1460.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1374.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5 LC-DCP NAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1306.2, "maximum": 1810.02, "gross_charge": 1866.0, "discounted_cash": 2799.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1586.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1399.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1306.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1810.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1306.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1399.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1586.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1492.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4.5M/16H/LT*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3602.23, "maximum": 4991.66, "gross_charge": 5146.05, "discounted_cash": 7719.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4374.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3859.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3602.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4991.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3602.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3859.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4374.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4116.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 40MM 2LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 40MM*436-0240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 40MM*TB-40-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 41MM 2 LVL*300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 42MM*436-02342", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 44MM*436-0244", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 45MM 2 LVL*300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 46MM*436-0246", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 48MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H LT*AR-8916D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2356.9, "maximum": 3265.99, "gross_charge": 3367.0, "discounted_cash": 5050.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3265.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2693.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H RT* AR-8916", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2356.9, "maximum": 3265.99, "gross_charge": 3367.0, "discounted_cash": 5050.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3265.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2693.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H RT*AR-8916D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2356.9, "maximum": 3265.99, "gross_charge": 3367.0, "discounted_cash": 5050.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3265.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2693.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H*42-1004", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 445.2, "maximum": 616.92, "gross_charge": 636.0, "discounted_cash": 954.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 540.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 477.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 445.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 616.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 445.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 477.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 540.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 508.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H*43-1004", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 653.1, "maximum": 905.01, "gross_charge": 933.0, "discounted_cash": 1399.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 793.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 699.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 653.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 905.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 653.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 699.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 793.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 746.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H*43-1005", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 653.1, "maximum": 905.01, "gross_charge": 933.0, "discounted_cash": 1399.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 793.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 699.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 653.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 905.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 653.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 699.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 793.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 746.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H*RSOPR-4-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4H*SP-2375", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 611.1, "maximum": 846.81, "gross_charge": 873.0, "discounted_cash": 1309.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 611.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 846.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 611.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 698.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 4X2 HOLES*5705", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.18, "maximum": 1090.81, "gross_charge": 1124.55, "discounted_cash": 1686.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 955.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.41, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1090.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 955.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 899.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 51MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 52MM*436-0352", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 54MM 3 LEV*31-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 54MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 54MM*436-0354", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 57MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 57MM*186803057", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 57MM*AA01-43F5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 58MM*336-0358", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 5H*58880105", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 844.2, "maximum": 1169.82, "gross_charge": 1206.0, "discounted_cash": 1809.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1025.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 904.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 844.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1169.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 844.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 904.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1025.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 964.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 5H*DUP5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1302.0, "maximum": 1804.2, "gross_charge": 1860.0, "discounted_cash": 2790.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1395.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1804.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1395.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1581.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE LCP*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3205.02, "maximum": 4441.24, "gross_charge": 4578.6, "discounted_cash": 6867.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3891.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3433.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3205.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4441.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3205.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3433.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3891.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3662.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE RT*4330", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 823.2, "maximum": 1140.72, "gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE ST*50-7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1153.57, "maximum": 1598.52, "gross_charge": 1647.96, "discounted_cash": 2471.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1400.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1153.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1598.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1153.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1400.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1318.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 6 HOLE*PC6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1891.4, "maximum": 2620.94, "gross_charge": 2702.0, "discounted_cash": 4053.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2296.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2026.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1891.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2620.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1891.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2026.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2296.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2161.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 60MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 60MM*436-0360", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 60MM*API-31006", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 62MM*436-0362", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 63MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 64MM RT*04.211", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2205.2, "maximum": 3055.78, "gross_charge": 3150.29, "discounted_cash": 4725.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2677.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2362.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2205.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3055.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2205.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2362.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2677.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2520.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 66MM 3LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 6H/ 5H SHAFT R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1880.2, "maximum": 2605.42, "gross_charge": 2686.0, "discounted_cash": 4029.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2283.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2014.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1880.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2605.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1880.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2014.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2283.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2148.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE*25-197-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE*25-197-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 696.15, "maximum": 964.66, "gross_charge": 994.5, "discounted_cash": 1491.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 845.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 745.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 696.15, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 964.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 696.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 745.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 845.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 795.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7 HOLE*MCT-7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 72MM 4LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 74MM*436-0474", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 76MM 4LEV*05-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2310.0, "maximum": 3201.0, "gross_charge": 3300.0, "discounted_cash": 4950.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2805.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2475.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2310.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3201.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2310.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2475.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2805.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 78MM*436-0478", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7H MEDIAL*PL-L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3518.06, "maximum": 4875.02, "gross_charge": 5025.8, "discounted_cash": 7538.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4271.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3769.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3518.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4875.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3518.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3769.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4271.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4020.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7H*43-1007", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 852.6, "maximum": 1181.46, "gross_charge": 1218.0, "discounted_cash": 1827.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1035.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 852.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1181.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 852.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1035.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 974.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7H*VLBPR-7-7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2356.9, "maximum": 3265.99, "gross_charge": 3367.0, "discounted_cash": 5050.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3265.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2693.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 7MM*07.0187300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3367.0, "maximum": 4665.7, "gross_charge": 4810.0, "discounted_cash": 7215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4665.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 80MM*14523228", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 82MM*436-0482", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 8H*PS8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1685.6, "maximum": 2335.76, "gross_charge": 2408.0, "discounted_cash": 3612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1806.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1685.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2335.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1685.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1806.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1926.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 8MM*07.0187300", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4564.56, "maximum": 6325.17, "gross_charge": 6520.8, "discounted_cash": 9781.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6325.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 9 HOLE OSTEOME", "code_information": [{"code": "3100103835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE 90MM*436-0590", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 95MM*436-05950", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE 9H RT*AR-8963A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AC 2 LEV 46MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ACP CUSTOM SPI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ACP CUSTOM SPI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ACP CUSTOM SPI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ACU-LOCK NARRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1898.4, "maximum": 2630.64, "gross_charge": 2712.0, "discounted_cash": 4068.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2305.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2034.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1898.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2630.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1898.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2034.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2305.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ACUMED L SCAPU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3698.1, "maximum": 5124.51, "gross_charge": 5283.0, "discounted_cash": 7924.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4490.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3962.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3698.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5124.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3698.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3962.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4490.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4226.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AFFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7622.3, "maximum": 10562.33, "gross_charge": 10889.0, "discounted_cash": 16333.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9255.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8166.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7622.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10562.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7622.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8166.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9255.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8711.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AFFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9078.3, "maximum": 12579.93, "gross_charge": 12969.0, "discounted_cash": 19453.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11023.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9726.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9078.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12579.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9078.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9726.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11023.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10375.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AFFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7329.0, "maximum": 10155.9, "gross_charge": 10470.0, "discounted_cash": 15705.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8899.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7852.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7329.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10155.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7329.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7852.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8899.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8376.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AFFIX II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7329.0, "maximum": 10155.9, "gross_charge": 10470.0, "discounted_cash": 15705.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8899.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7852.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7329.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10155.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7329.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7852.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8899.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8376.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ALPHA RT 11H*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5341.24, "maximum": 7401.43, "gross_charge": 7630.35, "discounted_cash": 11445.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6485.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5722.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5341.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7401.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5341.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5722.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6485.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6104.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANCHORING ROI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANCHORING ROI-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANKLE 6H*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4251.97, "maximum": 5892.02, "gross_charge": 6074.25, "discounted_cash": 9111.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5163.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4555.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4251.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5892.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4251.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4555.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5163.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4859.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANKLE FUSION*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204497", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3965.32, "maximum": 5494.8, "gross_charge": 5664.75, "discounted_cash": 8497.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4815.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4248.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3965.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5494.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3965.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4248.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4815.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4531.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANKLE FUSION*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3965.32, "maximum": 5494.8, "gross_charge": 5664.75, "discounted_cash": 8497.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4815.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4248.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3965.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5494.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3965.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4248.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4815.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4531.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANKLE FUSION*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3965.32, "maximum": 5494.8, "gross_charge": 5664.75, "discounted_cash": 8497.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4815.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4248.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3965.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5494.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3965.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4248.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4815.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4531.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANKLE LAT*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4156.42, "maximum": 5759.61, "gross_charge": 5937.75, "discounted_cash": 8906.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5047.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4453.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4156.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5759.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4156.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4453.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5047.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4750.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANT PERCUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANT PROCESS LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ANT PROCESS RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARCHON 42MM*87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARCHON 60MM*87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARCHON 62MM*87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1598.62, "maximum": 2215.23, "gross_charge": 2283.75, "discounted_cash": 3425.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1941.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1712.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1598.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2215.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1598.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1712.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1941.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1827.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1492.05, "maximum": 2067.55, "gross_charge": 2131.5, "discounted_cash": 3197.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1811.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1598.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1492.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2067.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1492.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1598.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1811.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1705.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1646.4, "maximum": 2281.44, "gross_charge": 2352.0, "discounted_cash": 3528.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2281.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1646.4, "maximum": 2281.44, "gross_charge": 2352.0, "discounted_cash": 3528.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2281.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1646.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 496.12, "maximum": 687.48, "gross_charge": 708.75, "discounted_cash": 1063.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 602.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 496.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 687.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 496.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 602.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 518.17, "maximum": 718.04, "gross_charge": 740.25, "discounted_cash": 1110.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 629.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 555.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 518.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 718.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 518.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 555.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 629.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 592.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 698.4, "gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 742.05, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 556.5, "maximum": 771.15, "gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 675.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 596.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 771.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 596.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 675.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTH LOCKING T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 617.4, "maximum": 855.54, "gross_charge": 882.0, "discounted_cash": 1323.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 749.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 617.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 855.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 617.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 749.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 705.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX H-PLAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX H-PLAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX H-PLAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1681.4, "maximum": 2329.94, "gross_charge": 2402.0, "discounted_cash": 3603.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2041.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1801.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1681.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2329.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1681.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1801.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2041.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1921.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX H-PLAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1533.0, "maximum": 2124.3, "gross_charge": 2190.0, "discounted_cash": 3285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2124.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LAPIDU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCK D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1617.0, "maximum": 2240.7, "gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2240.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1617.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1732.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCK D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1249.5, "maximum": 1731.45, "gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1731.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX MTP LO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1841.91, "maximum": 2552.36, "gross_charge": 2631.3, "discounted_cash": 3946.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2236.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1973.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1841.91, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2552.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1841.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1973.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2236.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2105.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ARTHREX XSOS T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1890.0, "maximum": 2619.0, "gross_charge": 2700.0, "discounted_cash": 4050.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2295.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2025.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2619.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2025.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2295.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATL ELITE 35MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1711.08, "maximum": 2371.06, "gross_charge": 2444.4, "discounted_cash": 3666.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1833.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1711.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2371.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1711.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1833.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1955.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLAN CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3153.5, "maximum": 4369.85, "gross_charge": 4505.0, "discounted_cash": 6757.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3829.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3378.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3153.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4369.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3153.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3378.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3829.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3604.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLAN CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLAN CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2935.8, "maximum": 4068.18, "gross_charge": 4194.0, "discounted_cash": 6291.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3564.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2935.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4068.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2935.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3145.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3564.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3355.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4176.9, "maximum": 5787.99, "gross_charge": 5967.0, "discounted_cash": 8950.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5071.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4176.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5787.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4176.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5071.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS CERVI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2458.4, "maximum": 3406.64, "gross_charge": 3512.0, "discounted_cash": 5268.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2985.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2634.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2458.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3406.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2458.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2634.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2985.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2809.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS CERVI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS CERVI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2196.6, "maximum": 3043.86, "gross_charge": 3138.0, "discounted_cash": 4707.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2667.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2353.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2196.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3043.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2196.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2353.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2667.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2510.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS ELITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS ELITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3478.3, "maximum": 4819.93, "gross_charge": 4969.0, "discounted_cash": 7453.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4223.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3726.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3478.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4819.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3478.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3726.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4223.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3975.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS ELITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3758.3, "maximum": 5207.93, "gross_charge": 5369.0, "discounted_cash": 8053.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4563.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4026.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3758.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5207.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3758.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4026.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4563.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS ELITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4176.9, "maximum": 5787.99, "gross_charge": 5967.0, "discounted_cash": 8950.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5071.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4176.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5787.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4176.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5071.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLANTIS ELITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4744.6, "maximum": 6574.66, "gross_charge": 6778.0, "discounted_cash": 10167.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5761.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5083.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4744.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6574.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4744.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5083.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5761.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3294.2, "maximum": 4564.82, "gross_charge": 4706.0, "discounted_cash": 7059.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4564.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3529.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2912.0, "maximum": 4035.2, "gross_charge": 4160.0, "discounted_cash": 6240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4035.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3328.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ATLNT CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AVIATOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AVIATOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AVIATOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AVIATOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4808.3, "maximum": 6662.93, "gross_charge": 6869.0, "discounted_cash": 10303.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5838.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5151.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4808.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6662.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4808.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5151.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5838.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5495.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE AVIATOR 4-LEVE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BASE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 3H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2857.4, "maximum": 3959.54, "gross_charge": 4082.0, "discounted_cash": 6123.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3469.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3061.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2857.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3959.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2857.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3061.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3469.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 3H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1965.6, "maximum": 2723.76, "gross_charge": 2808.0, "discounted_cash": 4212.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2106.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2723.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2106.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2246.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 3H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1965.6, "maximum": 2723.76, "gross_charge": 2808.0, "discounted_cash": 4212.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2106.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2723.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2106.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2386.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2246.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 3H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4832.1, "maximum": 6695.91, "gross_charge": 6903.0, "discounted_cash": 10354.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5867.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5177.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4832.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6695.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4832.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5177.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5867.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5522.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 5H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2156.7, "maximum": 2988.57, "gross_charge": 3081.0, "discounted_cash": 4621.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2988.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2464.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 5H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2748.2, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 5889.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 5H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2156.7, "maximum": 2988.57, "gross_charge": 3081.0, "discounted_cash": 4621.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2988.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2464.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 7H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3021.2, "maximum": 4186.52, "gross_charge": 4316.0, "discounted_cash": 6474.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3668.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3237.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3021.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4186.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3021.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3237.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3668.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3452.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BEARING 9H*VL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1983.8, "maximum": 2748.98, "gross_charge": 2834.0, "discounted_cash": 4251.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2748.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2267.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BENDER 1.5 *23", "code_information": [{"code": "3100209744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.6, "discounted_cash": 801.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BENDER 1.5 END", "code_information": [{"code": "3100209743", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BIOMET TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BIOMET TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3059.7, "maximum": 4239.87, "gross_charge": 4371.0, "discounted_cash": 6556.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3715.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3278.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3059.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4239.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3059.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3278.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3715.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3496.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BIOMET TIBIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3126.2, "maximum": 4332.02, "gross_charge": 4466.0, "discounted_cash": 6699.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3796.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3349.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3126.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4332.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3126.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3349.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3796.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3572.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BRIDGE*BRGP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3385.2, "maximum": 4690.92, "gross_charge": 4836.0, "discounted_cash": 7254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4110.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3627.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4690.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3627.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4110.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE BSSO LRG OSTEO", "code_information": [{"code": "3100103997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BSSO MED OSTEO", "code_information": [{"code": "3100103996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 619.0, "discounted_cash": 928.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BURR HOLE OSTE", "code_information": [{"code": "3100103836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BURR HOLE OSTE", "code_information": [{"code": "3100103837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 912.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE BURR HOLE OSTE", "code_information": [{"code": "3100103840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE CALCANEAL*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CALCANEAL*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CALCANEAL*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CARPAL LG*8WC1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1083.6, "maximum": 1501.56, "gross_charge": 1548.0, "discounted_cash": 2322.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1315.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1161.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1083.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1501.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1083.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1161.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1315.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1238.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CARPAL SZ 1*34", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5234.77, "maximum": 7253.9, "gross_charge": 7478.25, "discounted_cash": 11217.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6356.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5608.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5234.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7253.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5234.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5608.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6356.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5982.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CERV 1 LEV*104", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CERVICAL GRADI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2039.1, "maximum": 2825.61, "gross_charge": 2913.0, "discounted_cash": 4369.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2476.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2184.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2039.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2825.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2039.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2184.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2476.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2330.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CHIN 7MM*50-30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 741.3, "maximum": 1027.23, "gross_charge": 1059.0, "discounted_cash": 1588.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 847.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 10H L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 2.7*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2313.22, "maximum": 3205.46, "gross_charge": 3304.6, "discounted_cash": 4956.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2808.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2478.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2313.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3205.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2313.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2478.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2808.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2643.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 2.7*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2172.17, "maximum": 3010.0, "gross_charge": 3103.1, "discounted_cash": 4654.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2637.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2327.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2172.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3010.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2172.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2327.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2637.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2482.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 2.7*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1987.44, "maximum": 2754.02, "gross_charge": 2839.2, "discounted_cash": 4258.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2413.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2129.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1987.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2754.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1987.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2129.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2413.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2271.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 7 HOL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1823.09, "maximum": 2526.28, "gross_charge": 2604.42, "discounted_cash": 3906.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2213.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1953.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1823.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2526.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1823.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1953.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2213.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2083.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 7H LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 7H RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE 8H SS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1882.33, "maximum": 2608.37, "gross_charge": 2689.05, "discounted_cash": 4033.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2285.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2016.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1882.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2608.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1882.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2016.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2285.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2151.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE LT*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE LT*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE LT*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 115.5, "maximum": 160.05, "gross_charge": 165.0, "discounted_cash": 247.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE RT*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1749.3, "maximum": 2424.03, "gross_charge": 2499.0, "discounted_cash": 3748.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2424.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE RT*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE RT*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE RT*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE SH LT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1749.3, "maximum": 2424.03, "gross_charge": 2499.0, "discounted_cash": 3748.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2424.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CLAVICLE SH RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE COMP 4H SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 662.2, "maximum": 917.62, "gross_charge": 946.0, "discounted_cash": 1419.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 917.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE COMP 6H SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CRVD LOW PROFI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 498.4, "maximum": 690.64, "gross_charge": 712.0, "discounted_cash": 1068.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 605.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 534.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 690.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 534.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 605.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 569.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE CUSTOM SPINE R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DEPUY SHORT BA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1213.1, "maximum": 1681.01, "gross_charge": 1733.0, "discounted_cash": 2599.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1473.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1299.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1213.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1681.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1213.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1299.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1473.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIS RADIU 7H*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2835.01, "maximum": 3928.51, "gross_charge": 4050.02, "discounted_cash": 6075.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3442.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3037.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2835.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3928.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2835.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3037.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3442.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3240.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1580.6, "maximum": 2190.26, "gross_charge": 2258.0, "discounted_cash": 3387.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1919.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1693.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1580.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2190.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1580.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1693.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1919.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.4M 7H L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2347.1, "maximum": 3252.41, "gross_charge": 3353.0, "discounted_cash": 5029.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2850.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2514.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2347.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3252.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2347.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2514.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2850.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2682.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.4M 7H R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1959.51, "maximum": 2715.32, "gross_charge": 2799.3, "discounted_cash": 4198.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2379.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2099.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1959.51, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2715.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1959.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2099.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2379.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2239.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7M 9HLT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2227.09, "maximum": 3086.12, "gross_charge": 3181.57, "discounted_cash": 4772.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2704.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2386.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2227.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3086.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2227.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2386.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2704.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2545.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 3HL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1580.25, "maximum": 2189.77, "gross_charge": 2257.5, "discounted_cash": 3386.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1918.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1693.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1580.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2189.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1580.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1693.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1918.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1806.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 4H*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1559.96, "maximum": 2161.66, "gross_charge": 2228.52, "discounted_cash": 3342.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1559.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2161.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1559.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1782.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 5HR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1618.96, "maximum": 2243.41, "gross_charge": 2312.8, "discounted_cash": 3469.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1965.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1618.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2243.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1618.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1965.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1850.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 6H*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2016.1, "maximum": 2793.74, "gross_charge": 2880.15, "discounted_cash": 4320.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2448.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2160.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2016.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2793.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2016.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2160.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2448.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2304.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 6HL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1822.8, "maximum": 2525.88, "gross_charge": 2604.0, "discounted_cash": 3906.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2213.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2525.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1953.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2213.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2083.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 6HR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1701.28, "maximum": 2357.48, "gross_charge": 2430.4, "discounted_cash": 3645.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2065.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1701.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2357.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1701.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2065.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1944.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 7HL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1781.52, "maximum": 2468.68, "gross_charge": 2545.04, "discounted_cash": 3817.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2163.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1908.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1781.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2468.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1781.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1908.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2163.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2036.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 7HR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1782.22, "maximum": 2469.65, "gross_charge": 2546.04, "discounted_cash": 3819.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2164.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1909.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1782.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2469.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1782.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1909.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2164.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2036.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST 2.7MM 9HL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2188.09, "maximum": 3032.07, "gross_charge": 3125.85, "discounted_cash": 4688.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2656.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2344.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2188.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3032.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2188.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2344.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2656.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2500.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST FIBULA*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1542.12, "maximum": 2136.94, "gross_charge": 2203.04, "discounted_cash": 3304.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1872.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1652.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1542.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2136.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1542.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1652.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1872.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1762.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST FIBULA*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1618.96, "maximum": 2243.41, "gross_charge": 2312.8, "discounted_cash": 3469.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1965.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1618.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2243.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1618.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1965.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1850.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DIST TIB*3036-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3583.12, "maximum": 4965.18, "gross_charge": 5118.75, "discounted_cash": 7678.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4350.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3839.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3583.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4965.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3583.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3839.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4350.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DISTAL FIB 4H*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DSL FIB 5H RT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DSL FIB 6H RT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE DSL FIB 8H RT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ELITE 19 MM*72", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1520.96, "maximum": 2107.61, "gross_charge": 2172.8, "discounted_cash": 3259.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1846.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1520.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2107.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1520.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1846.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1738.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ELITE 21 MM*72", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1520.96, "maximum": 2107.61, "gross_charge": 2172.8, "discounted_cash": 3259.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1846.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1520.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2107.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1520.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1846.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1738.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ELITE 60 MM*72", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1901.2, "maximum": 2634.52, "gross_charge": 2716.0, "discounted_cash": 4074.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1901.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2634.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1901.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 12MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 14MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 16MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 18MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 32MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 34MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 36MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 40MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 44MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 48MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 50MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 54MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 58MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 62MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FALCON 76MM*AT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FEM LT/L/XL*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2149.87, "maximum": 2979.11, "gross_charge": 3071.25, "discounted_cash": 4606.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2303.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2149.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2979.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2149.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2303.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FEM LT/SM/MD*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2047.5, "maximum": 2837.25, "gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2837.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FEM RT/L/XL*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2047.5, "maximum": 2837.25, "gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2837.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FEM RT/SM/MD*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2149.87, "maximum": 2979.11, "gross_charge": 3071.25, "discounted_cash": 4606.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2303.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2149.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2979.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2149.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2303.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FEMORAL NECK*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1968.05, "maximum": 2727.16, "gross_charge": 2811.51, "discounted_cash": 4217.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2389.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2108.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1968.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2727.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1968.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2108.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2389.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2249.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FEMUR LT 4 HOL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4829.13, "maximum": 6691.79, "gross_charge": 6898.76, "discounted_cash": 10348.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5863.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5174.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4829.13, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6691.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4829.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5174.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5863.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5519.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 10H*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1913.94, "maximum": 2652.17, "gross_charge": 2734.2, "discounted_cash": 4101.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2324.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2050.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1913.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2652.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1913.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2050.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2324.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2187.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 10H*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1913.94, "maximum": 2652.17, "gross_charge": 2734.2, "discounted_cash": 4101.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2324.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2050.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1913.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2652.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1913.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2050.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2324.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2187.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 4H*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 4H*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1323.0, "maximum": 1833.3, "gross_charge": 1890.0, "discounted_cash": 2835.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1833.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 5H*40-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1599.36, "maximum": 2216.25, "gross_charge": 2284.8, "discounted_cash": 3427.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1942.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1599.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2216.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1599.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1942.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1827.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 5H*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 5H*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 6H*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1519.0, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 3255.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 6H*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1594.95, "maximum": 2210.14, "gross_charge": 2278.5, "discounted_cash": 3417.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1936.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1708.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1594.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2210.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1594.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1708.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1936.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1822.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA 7H*5406", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3357.9, "maximum": 4653.09, "gross_charge": 4797.0, "discounted_cash": 7195.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4077.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3597.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3357.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4653.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3357.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3597.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4077.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3837.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1035.3, "maximum": 1434.63, "gross_charge": 1479.0, "discounted_cash": 2218.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1257.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1035.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1434.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1035.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1257.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1183.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIBULA VARIAX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1117.9, "maximum": 1549.09, "gross_charge": 1597.0, "discounted_cash": 2395.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1357.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1197.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1117.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1549.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1117.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1197.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1357.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FIXED NUVASIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2198.7, "maximum": 3046.77, "gross_charge": 3141.0, "discounted_cash": 4711.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2669.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2355.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2198.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3046.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2198.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2355.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2669.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2512.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE FRACTURE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2309.3, "maximum": 3200.03, "gross_charge": 3299.0, "discounted_cash": 4948.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2804.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2474.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2309.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3200.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2309.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2474.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2804.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2639.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GAP OSTEOMED", "code_information": [{"code": "3100103838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 819.0, "discounted_cash": 1228.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE GEMINUS HOOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3703.7, "maximum": 5132.27, "gross_charge": 5291.0, "discounted_cash": 7936.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4497.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3968.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3703.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5132.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3703.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3968.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4497.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4232.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2582.3, "maximum": 3578.33, "gross_charge": 3689.0, "discounted_cash": 5533.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3135.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2766.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2582.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3578.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2582.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2766.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3135.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2951.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4570.3, "maximum": 6333.13, "gross_charge": 6529.0, "discounted_cash": 9793.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5549.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4896.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4570.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6333.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4570.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4896.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5549.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5814.9, "maximum": 8057.79, "gross_charge": 8307.0, "discounted_cash": 12460.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7060.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6230.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5814.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8057.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5814.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6230.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7060.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6645.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4921.0, "maximum": 6819.1, "gross_charge": 7030.0, "discounted_cash": 10545.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5975.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5272.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4921.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6819.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4921.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5272.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5975.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5624.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GRIP W/2 CABLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2851.1, "maximum": 3950.81, "gross_charge": 4073.0, "discounted_cash": 6109.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3462.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3054.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2851.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3950.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2851.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3054.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3462.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3258.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GRIP W/2 CABLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2006.0, "maximum": 2779.74, "gross_charge": 2865.72, "discounted_cash": 4298.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2435.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2149.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2779.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2149.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2435.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2292.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE GRIP W/2 CABLE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3239.3, "maximum": 4488.75, "gross_charge": 4627.58, "discounted_cash": 6941.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3933.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3470.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3239.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4488.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3239.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3470.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3933.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3702.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HEMI MANDIB CU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4109.7, "maximum": 5694.87, "gross_charge": 5871.0, "discounted_cash": 8806.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4990.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4403.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4109.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5694.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4109.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4403.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4990.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4696.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HIP 3 HOLE*02.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1170.22, "maximum": 1621.59, "gross_charge": 1671.75, "discounted_cash": 2507.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1420.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1253.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1170.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1621.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1170.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1253.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1420.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1337.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HIP 3 HOLE*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1126.12, "maximum": 1560.48, "gross_charge": 1608.75, "discounted_cash": 2413.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1367.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1206.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1126.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1560.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1126.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1206.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1367.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1287.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 0.8MM*700", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 395.07, "maximum": 547.45, "gross_charge": 564.39, "discounted_cash": 846.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 479.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 423.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 395.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 547.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 395.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 423.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 479.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 451.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 3H*04.113", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1107.66, "maximum": 1534.9, "gross_charge": 1582.38, "discounted_cash": 2373.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1345.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1186.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1107.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1534.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1107.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1186.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1345.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1265.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 3H*04.113", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1016.58, "maximum": 1408.7, "gross_charge": 1452.27, "discounted_cash": 2178.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1234.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1089.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1016.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1408.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1016.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1089.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1234.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1161.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 3H*AR-994", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1903.65, "maximum": 2637.91, "gross_charge": 2719.5, "discounted_cash": 4079.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2311.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2039.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1903.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2637.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1903.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2039.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2311.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2175.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 3H*AR-994", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1904.14, "maximum": 2638.59, "gross_charge": 2720.2, "discounted_cash": 4080.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2312.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2040.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1904.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2638.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1904.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2040.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2312.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2176.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 3HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK 3HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.7, "maximum": 1892.47, "gross_charge": 1951.0, "discounted_cash": 2926.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1658.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1463.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1892.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1463.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1658.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK METAT*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2320.5, "maximum": 3215.55, "gross_charge": 3315.0, "discounted_cash": 4972.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3215.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK TI 5H*AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1834.56, "maximum": 2542.17, "gross_charge": 2620.8, "discounted_cash": 3931.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2227.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1834.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2542.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1834.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1965.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2227.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2096.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOOK UNIVER*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1903.65, "maximum": 2637.91, "gross_charge": 2719.5, "discounted_cash": 4079.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2311.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2039.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1903.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2637.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1903.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2039.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2311.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2175.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOWMEDICA PROF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HOWMEDICA PROF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HUMERAL 3H L69", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2076.74, "maximum": 2877.77, "gross_charge": 2966.78, "discounted_cash": 4450.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2521.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2225.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2076.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2877.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2076.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2225.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2521.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2373.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HUMERAL 3H L84", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2076.74, "maximum": 2877.77, "gross_charge": 2966.78, "discounted_cash": 4450.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2521.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2225.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2076.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2877.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2076.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2225.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2521.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2373.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE HUMERAL*3022-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4194.64, "maximum": 5812.57, "gross_charge": 5992.35, "discounted_cash": 8988.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5093.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4494.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4194.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5812.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4194.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4494.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5093.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4793.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE INTERBODY AMEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE INVIZIA 1 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE INVIZIA 1 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE INVIZIA 2 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE INVIZIA 3 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE KLS MARTIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.6, "maximum": 628.56, "gross_charge": 648.0, "discounted_cash": 972.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 486.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 486.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 518.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L HOOK*AR-8956", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2320.5, "maximum": 3215.55, "gross_charge": 3315.0, "discounted_cash": 4972.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3215.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L LEFT*AR-8954", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L RT*AR-8954PR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE LT 2MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.65, "maximum": 484.51, "gross_charge": 499.5, "discounted_cash": 749.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 484.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE LT 2MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 669.9, "maximum": 928.29, "gross_charge": 957.0, "discounted_cash": 1435.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 928.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 765.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE LT 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.65, "maximum": 484.51, "gross_charge": 499.5, "discounted_cash": 749.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 484.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE LT 7MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 527.1, "maximum": 730.41, "gross_charge": 753.0, "discounted_cash": 1129.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 564.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 527.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 730.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 527.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 564.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 602.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE RT 2MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.65, "maximum": 484.51, "gross_charge": 499.5, "discounted_cash": 749.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 484.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE RT 2MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 669.9, "maximum": 928.29, "gross_charge": 957.0, "discounted_cash": 1435.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 928.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 669.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 717.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 813.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 765.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE RT 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.65, "maximum": 484.51, "gross_charge": 499.5, "discounted_cash": 749.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 484.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 424.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE L SHAPE RT 7MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 527.1, "maximum": 730.41, "gross_charge": 753.0, "discounted_cash": 1129.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 564.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 527.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 730.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 527.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 564.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 602.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LATERAL TT*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3776.5, "maximum": 5233.15, "gross_charge": 5395.0, "discounted_cash": 8092.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4585.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4046.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3776.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5233.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3776.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4046.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4585.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4316.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LCP 2.4 7H *24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 524.3, "maximum": 726.53, "gross_charge": 749.01, "discounted_cash": 1123.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 636.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 561.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 524.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 726.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 524.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 561.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 636.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 599.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LCP CONDYLAR 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1214.03, "maximum": 1682.3, "gross_charge": 1734.33, "discounted_cash": 2601.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1474.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1300.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1682.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1300.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1474.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1387.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LCP DIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1633.1, "maximum": 2263.01, "gross_charge": 2333.0, "discounted_cash": 3499.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1983.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1749.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1633.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2263.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1633.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1749.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1983.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1866.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LCP ELBOW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2353.4, "maximum": 3261.14, "gross_charge": 3362.0, "discounted_cash": 5043.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2857.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2521.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2353.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3261.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2353.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2521.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2857.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2689.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LCP RAD 7H*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3431.35, "maximum": 4754.88, "gross_charge": 4901.94, "discounted_cash": 7352.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4166.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3676.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3431.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4754.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3431.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3676.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4166.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3921.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LDR SPINE MC13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LEVEL 1", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "3100104171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LG LEFT*AR-895", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LG PROCESS RT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LG RT*AR-8951L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LOCK 1.5*13122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1064.7, "maximum": 1475.37, "gross_charge": 1521.0, "discounted_cash": 2281.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1292.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1140.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1064.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1475.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1064.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1140.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1292.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1216.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LOCK 1.5*50-73", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1658.16, "maximum": 2297.73, "gross_charge": 2368.8, "discounted_cash": 3553.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2013.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1776.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1658.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2297.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1658.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1776.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2013.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1895.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LOCK 2.5*13122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1119.3, "maximum": 1551.03, "gross_charge": 1599.0, "discounted_cash": 2398.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1359.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1199.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1119.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1551.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1119.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1199.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1359.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1279.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LOCK STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LONG HOOK*AR89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2436.52, "maximum": 3376.32, "gross_charge": 3480.75, "discounted_cash": 5221.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2958.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3376.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2958.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LONG L HOOK*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2320.5, "maximum": 3215.55, "gross_charge": 3315.0, "discounted_cash": 4972.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3215.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LONG L HOOK*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2436.52, "maximum": 3376.32, "gross_charge": 3480.75, "discounted_cash": 5221.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2958.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3376.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2436.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2610.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2958.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2784.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LONG L HOOK*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2320.5, "maximum": 3215.55, "gross_charge": 3315.0, "discounted_cash": 4972.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3215.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2817.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LONG LT*AR-894", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LORDOTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8050.0, "maximum": 11155.0, "gross_charge": 11500.0, "discounted_cash": 17250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9775.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8625.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11155.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8625.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9775.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LT 4H*3024-004", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5150.14, "maximum": 7136.62, "gross_charge": 7357.35, "discounted_cash": 11036.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6253.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5518.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5150.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7136.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5150.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5518.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6253.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5885.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LT 5H*3024-005", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5150.14, "maximum": 7136.62, "gross_charge": 7357.35, "discounted_cash": 11036.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6253.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5518.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5150.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7136.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5150.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5518.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6253.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5885.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE LUMBAR ASPI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4684.4, "maximum": 6491.24, "gross_charge": 6692.0, "discounted_cash": 10038.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5688.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5019.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4684.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6491.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4684.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5019.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5688.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5353.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MANDIB LT*24-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7754.6, "maximum": 10745.66, "gross_charge": 11078.0, "discounted_cash": 16617.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9416.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8308.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7754.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10745.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7754.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8308.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9416.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8862.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MED LEFT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MED LEFT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MED RT *AR8951", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MED RT*AR-8954", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MEDTRONIC ANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.2, "maximum": 3041.92, "gross_charge": 3136.0, "discounted_cash": 4704.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3041.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2508.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MEDTRONIC ANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2935.8, "maximum": 4068.18, "gross_charge": 4194.0, "discounted_cash": 6291.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3564.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2935.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4068.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2935.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3145.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3564.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3355.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MEDTRONIC HOLD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MEDTRONIC ZEPH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3455.9, "maximum": 4788.89, "gross_charge": 4937.0, "discounted_cash": 7405.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4196.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3702.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3455.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4788.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3455.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3702.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4196.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3949.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE METCARP 1.5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1055.25, "maximum": 1462.27, "gross_charge": 1507.5, "discounted_cash": 2261.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1281.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1130.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1462.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1130.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1281.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1206.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE METCARP 1.5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MICRO 4H *25-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MICRO 6H *25-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MINI 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 498.4, "maximum": 690.64, "gross_charge": 712.0, "discounted_cash": 1068.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 605.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 534.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 690.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 534.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 605.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 569.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MINI 3-D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MINI 5H *25-55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 527.1, "maximum": 730.41, "gross_charge": 753.0, "discounted_cash": 1129.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 564.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 527.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 730.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 527.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 564.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 602.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MINI 8H *25-55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE MTP LT*PLP1034", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3069.1, "maximum": 4252.89, "gross_charge": 4384.43, "discounted_cash": 6576.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3726.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3288.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3069.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4252.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3069.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3288.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3726.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3507.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NARROW LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7754.6, "maximum": 10745.66, "gross_charge": 11078.0, "discounted_cash": 16617.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9416.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8308.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7754.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10745.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7754.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8308.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9416.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8862.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NARROW LT SM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8451.8, "maximum": 11711.78, "gross_charge": 12074.0, "discounted_cash": 18111.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10262.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8451.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11711.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8451.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9055.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10262.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9659.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NARROW RT 45MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7754.6, "maximum": 10745.66, "gross_charge": 11078.0, "discounted_cash": 16617.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9416.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8308.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7754.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10745.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7754.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8308.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9416.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8862.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE FIXED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE FIXED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1867.6, "maximum": 2587.96, "gross_charge": 2668.0, "discounted_cash": 4002.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2267.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2001.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1867.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2587.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1867.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2001.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2267.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2134.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE FIXED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.0, "maximum": 2589.9, "gross_charge": 2670.0, "discounted_cash": 4005.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2589.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE FIXED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2039.1, "maximum": 2825.61, "gross_charge": 2913.0, "discounted_cash": 4369.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2476.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2184.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2039.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2825.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2039.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2184.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2476.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2330.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE FIXED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2209.2, "maximum": 3061.32, "gross_charge": 3156.0, "discounted_cash": 4734.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2682.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2367.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2209.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3061.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2209.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2367.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2682.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2524.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE GRADI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2209.2, "maximum": 3061.32, "gross_charge": 3156.0, "discounted_cash": 4734.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2682.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2367.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2209.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3061.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2209.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2367.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2682.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2524.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE GRADI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2380.7, "maximum": 3298.97, "gross_charge": 3401.0, "discounted_cash": 5101.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2890.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2550.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2380.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3298.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2380.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2550.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2890.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2720.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE NUVASIVE GRADI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2550.8, "maximum": 3534.68, "gross_charge": 3644.0, "discounted_cash": 5466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3097.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2550.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3534.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2550.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3097.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2915.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPITAL 48MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPITAL 56MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4777.5, "maximum": 6620.25, "gross_charge": 6825.0, "discounted_cash": 10237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5801.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5118.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6620.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5118.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5801.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPITAL 56MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPITAL SM*3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3880.24, "maximum": 5376.9, "gross_charge": 5543.2, "discounted_cash": 8314.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4711.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4157.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5376.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4157.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4711.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4434.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPUT LG* 48", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3367.0, "maximum": 4665.7, "gross_charge": 4810.0, "discounted_cash": 7215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4665.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPUT MED* 4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6259.91, "maximum": 8674.44, "gross_charge": 8942.73, "discounted_cash": 13414.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7601.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6707.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6259.91, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8674.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6259.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6707.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7601.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7154.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OCCIPUT SM*485", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4768.4, "maximum": 6607.64, "gross_charge": 6812.0, "discounted_cash": 10218.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5790.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5109.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4768.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6607.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4768.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5109.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5790.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5449.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ORTHOPEDIATRIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OST WEDG 9MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1533.0, "maximum": 2124.3, "gross_charge": 2190.0, "discounted_cash": 3285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2124.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OSTEO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OSTEO 12.5MM*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1898.26, "maximum": 2630.44, "gross_charge": 2711.8, "discounted_cash": 4067.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2305.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2033.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1898.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2630.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1898.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2033.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2305.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2169.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OSTEO FEM*AR13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2327.78, "maximum": 3225.63, "gross_charge": 3325.4, "discounted_cash": 4988.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3225.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2660.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE OSTEOMED", "code_information": [{"code": "3100103832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 889.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OSTEOMED", "code_information": [{"code": "3100103833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 549.0, "discounted_cash": 823.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OSTEOMED", "code_information": [{"code": "3100103834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 491.0, "discounted_cash": 736.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OSTEOMED", "code_information": [{"code": "3100103845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 598.0, "discounted_cash": 897.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OSTEOMED", "code_information": [{"code": "3100103850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 752.0, "discounted_cash": 1128.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATE OSTEOTOMY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1685.6, "maximum": 2335.76, "gross_charge": 2408.0, "discounted_cash": 3612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1806.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1685.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2335.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1685.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1806.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1926.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE PATELLA 2.7*02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4275.5, "maximum": 5924.63, "gross_charge": 6107.87, "discounted_cash": 9161.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5191.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4580.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4275.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5924.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4275.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4580.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5191.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4886.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE PLANTAR*AR-894", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE PLANTAR*AR-894", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE PLANTAR*AR-894", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE PLANTAR*AR-894", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE RAD LT 4 H*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2356.9, "maximum": 3265.99, "gross_charge": 3367.0, "discounted_cash": 5050.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3265.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2356.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2861.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2693.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE RADIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE RADIAL 5H*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE RADICAL COL PI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1062.6, "maximum": 1472.46, "gross_charge": 1518.0, "discounted_cash": 2277.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1290.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1138.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1062.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1472.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1062.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1138.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1290.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1214.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SACRAL 12MM*51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4684.68, "maximum": 6491.62, "gross_charge": 6692.4, "discounted_cash": 10038.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5688.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5019.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4684.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6491.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4684.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5019.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5688.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5353.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SEMI-TUBE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 234.5, "maximum": 324.95, "gross_charge": 335.0, "discounted_cash": 502.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 251.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 324.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 251.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SHORT*TB-30-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SKELETAL DYNAM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1489.6, "maximum": 2064.16, "gross_charge": 2128.0, "discounted_cash": 3192.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1808.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1596.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1489.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2064.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1489.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1596.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1808.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1702.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SM LEFT*AR-895", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SM LEFT*AR-895", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SM RIGHT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SM RIGHT*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SMALL LOCK*AX0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ST LOCK 2.5*13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1010.1, "maximum": 1399.71, "gross_charge": 1443.0, "discounted_cash": 2164.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1226.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1082.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1010.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1399.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1010.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1082.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1226.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1154.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STANDARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.5, "maximum": 2769.35, "gross_charge": 2855.0, "discounted_cash": 4282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2284.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STD RT*70-0357", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2213.57, "maximum": 3067.38, "gross_charge": 3162.25, "discounted_cash": 4743.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2687.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2371.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2213.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3067.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2213.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2371.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2687.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2529.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRGHT 1.5MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 470.4, "maximum": 651.84, "gross_charge": 672.0, "discounted_cash": 1008.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 651.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 537.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 572.6, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 333.9, "maximum": 462.69, "gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 405.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 333.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 462.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 333.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 405.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 381.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 555.1, "maximum": 769.21, "gross_charge": 793.0, "discounted_cash": 1189.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 674.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 594.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 555.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 769.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 555.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 594.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 674.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 634.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 555.8, "maximum": 770.18, "gross_charge": 794.0, "discounted_cash": 1191.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 674.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 595.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 555.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 770.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 555.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 595.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 674.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 635.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER 2 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER 3D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 452.9, "maximum": 627.59, "gross_charge": 647.0, "discounted_cash": 970.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 549.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 485.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 452.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 627.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 452.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 485.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 549.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 517.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER 8 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER 9 HOLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 344.4, "maximum": 477.24, "gross_charge": 492.0, "discounted_cash": 738.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 418.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 369.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 477.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 369.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 418.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER >15 HO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1106.0, "maximum": 1532.6, "gross_charge": 1580.0, "discounted_cash": 2370.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1343.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1185.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1106.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1532.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1106.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1185.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1343.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER >15 HO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1177.4, "maximum": 1631.54, "gross_charge": 1682.0, "discounted_cash": 2523.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1429.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1261.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1177.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1631.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1177.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1261.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1429.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1345.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER CHIN P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 484.4, "maximum": 671.24, "gross_charge": 692.0, "discounted_cash": 1038.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 588.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 519.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 484.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 671.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 484.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 519.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 588.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 553.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER CHIN P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 503.3, "maximum": 697.43, "gross_charge": 719.0, "discounted_cash": 1078.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 611.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 539.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 503.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 697.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 503.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 539.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 611.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 575.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 410.2, "maximum": 568.42, "gross_charge": 586.0, "discounted_cash": 879.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 498.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 439.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 410.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 568.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 410.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 439.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 498.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 407.4, "maximum": 564.54, "gross_charge": 582.0, "discounted_cash": 873.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 436.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 564.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 436.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 585.9, "maximum": 811.89, "gross_charge": 837.0, "discounted_cash": 1255.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 811.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 669.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER DBL Y", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 473.2, "maximum": 655.72, "gross_charge": 676.0, "discounted_cash": 1014.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 574.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 473.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 655.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 473.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 574.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER DOUBLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER DOUBLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 390.6, "maximum": 541.26, "gross_charge": 558.0, "discounted_cash": 837.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 474.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 390.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 541.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 390.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 474.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 446.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER DOUBLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 434.7, "maximum": 602.37, "gross_charge": 621.0, "discounted_cash": 931.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 602.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 496.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER DOUBLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 446.6, "maximum": 618.86, "gross_charge": 638.0, "discounted_cash": 957.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 542.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 478.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 446.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 618.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 446.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 478.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 542.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 510.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 830.2, "maximum": 1150.42, "gross_charge": 1186.0, "discounted_cash": 1779.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1008.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 889.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 830.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1150.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 830.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 889.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1008.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 948.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1379.7, "maximum": 1911.87, "gross_charge": 1971.0, "discounted_cash": 2956.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1478.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1379.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1911.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1379.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1478.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1675.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1576.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1407.7, "maximum": 1950.67, "gross_charge": 2011.0, "discounted_cash": 3016.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1709.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1508.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1407.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1950.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1407.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1508.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1709.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1608.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACTU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 774.9, "maximum": 1073.79, "gross_charge": 1107.0, "discounted_cash": 1660.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 940.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 830.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 774.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1073.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 774.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 830.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 940.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 885.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACTU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1463.0, "maximum": 2027.3, "gross_charge": 2090.0, "discounted_cash": 3135.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1776.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1567.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2027.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1567.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1776.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1672.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACTU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 802.2, "maximum": 1111.62, "gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 974.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 859.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 802.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1111.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 802.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 859.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 974.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 916.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACTU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 940.8, "maximum": 1303.68, "gross_charge": 1344.0, "discounted_cash": 2016.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1142.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1303.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1142.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1075.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER FRACTU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1021.3, "maximum": 1415.23, "gross_charge": 1459.0, "discounted_cash": 2188.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1240.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1094.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1021.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1415.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1021.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1094.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1240.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1167.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER HAND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 572.6, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER HEMI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2585.1, "maximum": 3582.21, "gross_charge": 3693.0, "discounted_cash": 5539.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3139.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2769.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2585.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3582.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2585.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2769.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3139.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2954.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER HEMI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2794.4, "maximum": 3872.24, "gross_charge": 3992.0, "discounted_cash": 5988.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3393.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2994.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2794.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3872.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2794.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2994.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3393.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3193.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER HEMI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3403.4, "maximum": 4716.14, "gross_charge": 4862.0, "discounted_cash": 7293.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4132.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4716.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4132.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3889.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER HEMI M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2374.4, "maximum": 3290.24, "gross_charge": 3392.0, "discounted_cash": 5088.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2883.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2544.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2374.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3290.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2374.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2544.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2883.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER HEMI M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2749.6, "maximum": 3810.16, "gross_charge": 3928.0, "discounted_cash": 5892.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3338.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2946.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2749.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3810.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2749.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2946.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3338.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3142.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER I LE F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 785.4, "maximum": 1088.34, "gross_charge": 1122.0, "discounted_cash": 1683.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 953.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1088.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 953.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER I LE F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 742.0, "maximum": 1028.2, "gross_charge": 1060.0, "discounted_cash": 1590.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 901.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 742.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1028.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 742.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 901.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER I LE F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 755.3, "maximum": 1046.63, "gross_charge": 1079.0, "discounted_cash": 1618.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 917.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 809.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 755.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1046.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 755.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 809.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 917.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 863.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER I LE F", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L 90 D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L 90 D", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 375.9, "maximum": 520.89, "gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L GSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 443.1, "maximum": 614.01, "gross_charge": 633.0, "discounted_cash": 949.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 538.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 474.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 443.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 614.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 443.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 474.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 538.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 506.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L GSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 455.7, "maximum": 631.47, "gross_charge": 651.0, "discounted_cash": 976.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 553.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 488.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 455.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 631.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 455.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 488.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 553.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 520.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L GSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 473.2, "maximum": 655.72, "gross_charge": 676.0, "discounted_cash": 1014.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 574.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 473.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 655.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 473.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 507.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 574.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L GSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.7, "maximum": 670.27, "gross_charge": 691.0, "discounted_cash": 1036.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 587.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 518.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 670.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 518.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 587.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.1, "maximum": 662.51, "gross_charge": 683.0, "discounted_cash": 1024.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 662.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 546.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 506.1, "maximum": 701.31, "gross_charge": 723.0, "discounted_cash": 1084.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 614.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 506.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 701.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 506.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 542.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 614.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 578.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 534.1, "maximum": 740.11, "gross_charge": 763.0, "discounted_cash": 1144.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 648.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 572.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 534.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 740.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 534.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 572.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 648.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 610.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 547.4, "maximum": 758.54, "gross_charge": 782.0, "discounted_cash": 1173.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 664.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 547.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 758.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 547.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 664.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 625.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 436.1, "maximum": 604.31, "gross_charge": 623.0, "discounted_cash": 934.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 529.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 467.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 436.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 436.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 467.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 529.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 451.5, "maximum": 625.65, "gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 625.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 479.5, "maximum": 664.45, "gross_charge": 685.0, "discounted_cash": 1027.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 664.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 464.1, "maximum": 643.11, "gross_charge": 663.0, "discounted_cash": 994.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 643.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 563.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 438.9, "maximum": 608.19, "gross_charge": 627.0, "discounted_cash": 940.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 532.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 470.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 438.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 608.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 438.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 470.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 532.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 501.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 480.9, "maximum": 666.39, "gross_charge": 687.0, "discounted_cash": 1030.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 515.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 480.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 666.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 480.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 515.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 583.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 549.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 501.9, "maximum": 695.49, "gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 333.9, "maximum": 462.69, "gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 405.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 333.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 462.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 333.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 357.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 405.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 381.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 396.9, "maximum": 549.99, "gross_charge": 567.0, "discounted_cash": 850.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 481.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 425.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 549.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 396.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 425.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 481.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L MP S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 375.9, "maximum": 520.89, "gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.7, "maximum": 582.97, "gross_charge": 601.0, "discounted_cash": 901.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 434.0, "maximum": 601.4, "gross_charge": 620.0, "discounted_cash": 930.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 601.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 434.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 465.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 527.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 462.0, "maximum": 640.2, "gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 640.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 528.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER L STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 474.6, "maximum": 657.66, "gross_charge": 678.0, "discounted_cash": 1017.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 576.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 508.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 474.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 657.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 474.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 508.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 576.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 542.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOCKIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOW PR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 578.9, "maximum": 802.19, "gross_charge": 827.0, "discounted_cash": 1240.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 702.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 620.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 578.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 802.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 578.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 620.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 702.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 661.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER LOW PR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MAND S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 621.6, "maximum": 861.36, "gross_charge": 888.0, "discounted_cash": 1332.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 754.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 666.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 861.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 666.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 754.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 710.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MC5 LT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI 1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 348.6, "maximum": 483.06, "gross_charge": 498.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 483.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 398.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI 4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 260.4, "maximum": 360.84, "gross_charge": 372.0, "discounted_cash": 558.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 360.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 260.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 279.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 316.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 297.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI 4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 434.7, "maximum": 602.37, "gross_charge": 621.0, "discounted_cash": 931.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 602.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 496.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI 6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 331.1, "maximum": 458.81, "gross_charge": 473.0, "discounted_cash": 709.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 371.7, "maximum": 515.07, "gross_charge": 531.0, "discounted_cash": 796.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 515.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 424.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 499.1, "maximum": 691.61, "gross_charge": 713.0, "discounted_cash": 1069.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 534.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 691.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 534.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 570.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 297.5, "maximum": 412.25, "gross_charge": 425.0, "discounted_cash": 637.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 361.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 318.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 412.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 318.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 361.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.8, "maximum": 440.38, "gross_charge": 454.0, "discounted_cash": 681.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 340.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 440.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 340.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 363.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 390.6, "maximum": 541.26, "gross_charge": 558.0, "discounted_cash": 837.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 474.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 390.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 541.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 390.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 418.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 474.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 446.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI W", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1230.6, "maximum": 1705.26, "gross_charge": 1758.0, "discounted_cash": 2637.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1494.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1318.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1230.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1705.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1230.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1318.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1494.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1406.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI W", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 592.9, "maximum": 821.59, "gross_charge": 847.0, "discounted_cash": 1270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 719.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 635.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 592.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 821.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 592.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 635.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 719.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 677.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MINI W", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1434.3, "maximum": 1987.53, "gross_charge": 2049.0, "discounted_cash": 3073.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1741.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1536.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1434.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1987.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1434.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1536.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1741.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1639.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MP CHI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 632.8, "maximum": 876.88, "gross_charge": 904.0, "discounted_cash": 1356.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 768.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 678.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 632.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 876.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 632.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 678.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 768.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 723.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MP CHI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MP CHI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 578.9, "maximum": 802.19, "gross_charge": 827.0, "discounted_cash": 1240.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 702.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 620.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 578.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 802.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 578.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 620.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 702.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 661.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MP CHI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 605.5, "maximum": 839.05, "gross_charge": 865.0, "discounted_cash": 1297.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 735.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 648.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 605.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 839.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 605.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 648.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 735.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER MP MIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 841.4, "maximum": 1165.94, "gross_charge": 1202.0, "discounted_cash": 1803.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1021.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 901.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 841.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1165.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 841.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 901.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1021.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 961.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER OLECRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2298.8, "maximum": 3185.48, "gross_charge": 3284.0, "discounted_cash": 4926.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2791.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2463.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2298.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3185.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2298.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2463.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2791.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2627.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 501.9, "maximum": 695.49, "gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1641.5, "maximum": 2274.65, "gross_charge": 2345.0, "discounted_cash": 3517.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1993.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1758.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1641.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2274.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1641.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1758.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1993.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1876.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 319.2, "maximum": 442.32, "gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 442.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103070", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 487.2, "maximum": 675.12, "gross_charge": 696.0, "discounted_cash": 1044.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 591.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 522.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 487.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 675.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 487.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 522.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 591.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 556.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 490.7, "maximum": 679.97, "gross_charge": 701.0, "discounted_cash": 1051.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 595.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 525.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 490.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 679.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 490.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 525.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 595.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 560.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1449.0, "maximum": 2007.9, "gross_charge": 2070.0, "discounted_cash": 3105.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1759.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1552.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1449.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2007.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1449.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1552.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1759.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.5, "maximum": 2129.15, "gross_charge": 2195.0, "discounted_cash": 3292.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ORBITA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1537.9, "maximum": 2131.09, "gross_charge": 2197.0, "discounted_cash": 3295.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1867.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1647.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2131.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1647.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1867.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1757.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER PRIMAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1885.8, "maximum": 2613.18, "gross_charge": 2694.0, "discounted_cash": 4041.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2289.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2020.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1885.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2613.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1885.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2020.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2289.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2155.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER PRIMAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1484.0, "maximum": 2056.4, "gross_charge": 2120.0, "discounted_cash": 3180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1802.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1484.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2056.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1484.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1802.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER PROFIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER PROFIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3334.8, "maximum": 4621.08, "gross_charge": 4764.0, "discounted_cash": 7146.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4049.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3573.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3334.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4621.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3334.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3573.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4049.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3811.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER PROFIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 730.8, "maximum": 1012.68, "gross_charge": 1044.0, "discounted_cash": 1566.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 887.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 783.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 730.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1012.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 730.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 783.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 887.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 835.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER PROFIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3159.8, "maximum": 4378.58, "gross_charge": 4514.0, "discounted_cash": 6771.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3836.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3385.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3159.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4378.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3159.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3385.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3836.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3611.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER RADIUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1981.0, "maximum": 2745.1, "gross_charge": 2830.0, "discounted_cash": 4245.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2405.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2122.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1981.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2745.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1981.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2122.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2405.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER RECON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1007.3, "maximum": 1395.83, "gross_charge": 1439.0, "discounted_cash": 2158.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1223.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1079.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1007.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1395.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1007.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1079.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1223.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER ROTATI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 602.0, "maximum": 834.2, "gross_charge": 860.0, "discounted_cash": 1290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 731.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 645.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 602.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 834.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 602.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 645.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 731.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 688.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 556.5, "maximum": 771.15, "gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 675.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 596.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 771.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 596.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 675.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 587.3, "maximum": 813.83, "gross_charge": 839.0, "discounted_cash": 1258.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 713.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 629.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 587.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 813.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 587.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 629.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 713.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 671.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SCNDRY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3373.3, "maximum": 4674.43, "gross_charge": 4819.0, "discounted_cash": 7228.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4096.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3614.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3373.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4674.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3373.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3614.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4096.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3855.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SCNDRY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2749.6, "maximum": 3810.16, "gross_charge": 3928.0, "discounted_cash": 5892.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3338.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2946.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2749.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3810.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2749.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2946.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3338.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3142.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SCNDRY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2998.1, "maximum": 4154.51, "gross_charge": 4283.0, "discounted_cash": 6424.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3640.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3212.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2998.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4154.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2998.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3212.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3640.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3426.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SCNDRY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3250.1, "maximum": 4503.71, "gross_charge": 4643.0, "discounted_cash": 6964.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3946.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3482.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3250.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4503.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3250.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3482.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3946.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3714.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SECOND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2003.4, "maximum": 2776.14, "gross_charge": 2862.0, "discounted_cash": 4293.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2432.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2146.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2003.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2776.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2003.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2146.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2432.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2289.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SECOND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1749.3, "maximum": 2424.03, "gross_charge": 2499.0, "discounted_cash": 3748.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2424.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1749.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2124.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1999.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SMRTLC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1981.0, "maximum": 2745.1, "gross_charge": 2830.0, "discounted_cash": 4245.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2405.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2122.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1981.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2745.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1981.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2122.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2405.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER STRAGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER STRAGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 842.8, "maximum": 1167.88, "gross_charge": 1204.0, "discounted_cash": 1806.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1023.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 842.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1167.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 842.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 903.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1023.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 963.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER STRAGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1014.3, "maximum": 1405.53, "gross_charge": 1449.0, "discounted_cash": 2173.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1231.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1086.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1014.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1405.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1014.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1086.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1231.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1159.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER STRAGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1064.0, "maximum": 1474.4, "gross_charge": 1520.0, "discounted_cash": 2280.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1292.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1064.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1474.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1064.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1292.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1216.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER STRAGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1159.9, "maximum": 1607.29, "gross_charge": 1657.0, "discounted_cash": 2485.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1408.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1242.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1159.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1607.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1159.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1242.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1408.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1325.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER STRAGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1200.5, "maximum": 1663.55, "gross_charge": 1715.0, "discounted_cash": 2572.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1457.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1286.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1200.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1663.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1200.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1286.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1457.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER SUPERI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2604.7, "maximum": 3609.37, "gross_charge": 3721.0, "discounted_cash": 5581.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3162.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2790.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2604.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3609.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2604.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2790.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3162.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2976.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 348.6, "maximum": 483.06, "gross_charge": 498.0, "discounted_cash": 747.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 483.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 348.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 373.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 423.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 398.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.7, "maximum": 485.97, "gross_charge": 501.0, "discounted_cash": 751.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 376.6, "maximum": 521.86, "gross_charge": 538.0, "discounted_cash": 807.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 457.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 403.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 376.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 521.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 376.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 403.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 457.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 430.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 384.3, "maximum": 532.53, "gross_charge": 549.0, "discounted_cash": 823.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 384.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 532.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 384.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 439.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 541.8, "maximum": 750.78, "gross_charge": 774.0, "discounted_cash": 1161.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 750.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T MP M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T NARR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T NARR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T NARR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T OBL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T REGU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER T WIDE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 610.4, "maximum": 845.84, "gross_charge": 872.0, "discounted_cash": 1308.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 741.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 654.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 610.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 845.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 610.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 654.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 741.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 697.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER TEMPLA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 128.1, "maximum": 177.51, "gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER TEMPLA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 122.5, "maximum": 169.75, "gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 169.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 519.4, "maximum": 719.74, "gross_charge": 742.0, "discounted_cash": 1113.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 630.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 519.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 719.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 519.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 556.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 630.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 605.5, "maximum": 839.05, "gross_charge": 865.0, "discounted_cash": 1297.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 735.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 648.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 605.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 839.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 605.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 648.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 735.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y MP M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 419.3, "maximum": 581.03, "gross_charge": 599.0, "discounted_cash": 898.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 509.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 449.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 419.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 581.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 419.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 449.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 509.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 479.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y NARR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.6, "maximum": 550.96, "gross_charge": 568.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Y STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 376.6, "maximum": 521.86, "gross_charge": 538.0, "discounted_cash": 807.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 457.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 403.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 376.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 521.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 376.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 403.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 457.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 430.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Z GSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 531.3, "maximum": 736.23, "gross_charge": 759.0, "discounted_cash": 1138.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 645.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 569.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 531.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 736.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 531.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 569.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 645.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 607.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Z GSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 507.5, "maximum": 703.25, "gross_charge": 725.0, "discounted_cash": 1087.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 616.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 543.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 507.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 703.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 507.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 543.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 616.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STRYKER Z MIDF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 507.5, "maximum": 703.25, "gross_charge": 725.0, "discounted_cash": 1087.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 616.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 543.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 507.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 703.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 507.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 543.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 616.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 580.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STYRKER L 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE STYRKER L 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 660.1, "maximum": 914.71, "gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 914.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 660.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 707.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 801.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 754.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNDESMOS 2H*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7634.44, "maximum": 10579.15, "gross_charge": 10906.35, "discounted_cash": 16359.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9270.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8179.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7634.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10579.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7634.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8179.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9270.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8725.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1869.0, "maximum": 2589.9, "gross_charge": 2670.0, "discounted_cash": 4005.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2269.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2002.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2589.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2002.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2269.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3139.5, "maximum": 4350.45, "gross_charge": 4485.0, "discounted_cash": 6727.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3812.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3363.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3139.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4350.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3139.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3363.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3812.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3588.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES 4H/5H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1787.1, "maximum": 2476.41, "gross_charge": 2553.0, "discounted_cash": 3829.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2170.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1914.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1787.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2476.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1787.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1914.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2170.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2042.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES 4H/5H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1892.8, "maximum": 2622.88, "gross_charge": 2704.0, "discounted_cash": 4056.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2298.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1892.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2622.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1892.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2298.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2163.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES BROAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 726.6, "maximum": 1006.86, "gross_charge": 1038.0, "discounted_cash": 1557.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 882.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 778.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 726.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1006.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 726.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 778.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 882.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 830.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES BROAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 602.0, "maximum": 834.2, "gross_charge": 860.0, "discounted_cash": 1290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 731.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 645.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 602.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 834.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 602.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 645.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 731.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 688.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES BROAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 651.7, "maximum": 903.07, "gross_charge": 931.0, "discounted_cash": 1396.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 791.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 698.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 651.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 903.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 651.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 698.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 791.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES BROAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 780.5, "maximum": 1081.55, "gross_charge": 1115.0, "discounted_cash": 1672.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 947.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 836.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 780.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1081.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 780.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 836.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 947.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 892.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES DIST H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2452.8, "maximum": 3398.88, "gross_charge": 3504.0, "discounted_cash": 5256.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2978.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2452.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3398.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2452.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2628.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2978.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2803.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES DIST H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2379.3, "maximum": 3297.03, "gross_charge": 3399.0, "discounted_cash": 5098.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2889.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2549.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2379.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3297.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2379.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2549.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2889.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2719.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1472.1, "maximum": 2039.91, "gross_charge": 2103.0, "discounted_cash": 3154.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1787.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1577.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1472.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2039.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1472.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1577.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1787.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1682.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1465.1, "maximum": 2030.21, "gross_charge": 2093.0, "discounted_cash": 3139.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1779.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1569.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1465.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2030.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1465.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1569.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1779.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1674.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1493.1, "maximum": 2069.01, "gross_charge": 2133.0, "discounted_cash": 3199.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1813.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1599.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1493.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2069.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1493.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1599.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1813.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1706.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1508.5, "maximum": 2090.35, "gross_charge": 2155.0, "discounted_cash": 3232.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2090.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1531.6, "maximum": 2122.36, "gross_charge": 2188.0, "discounted_cash": 3282.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2122.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1750.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FIBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1554.0, "maximum": 2153.4, "gross_charge": 2220.0, "discounted_cash": 3330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1665.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2153.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1665.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1887.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES FOURTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 309.4, "maximum": 428.74, "gross_charge": 442.0, "discounted_cash": 663.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 375.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 331.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 428.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 331.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 375.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES HUMERU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3182.2, "maximum": 4409.62, "gross_charge": 4546.0, "discounted_cash": 6819.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3864.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3409.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3182.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4409.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3182.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3409.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3864.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3636.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES HUMERU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3164.0, "maximum": 4384.4, "gross_charge": 4520.0, "discounted_cash": 6780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3842.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3164.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4384.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3164.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3842.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES HUMERU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3164.0, "maximum": 4384.4, "gross_charge": 4520.0, "discounted_cash": 6780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3842.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3164.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4384.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3164.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3842.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES HUMERU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3264.8, "maximum": 4524.08, "gross_charge": 4664.0, "discounted_cash": 6996.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3964.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3498.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3264.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4524.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3264.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3498.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3964.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3731.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES HUMERU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3648.4, "maximum": 5055.64, "gross_charge": 5212.0, "discounted_cash": 7818.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4430.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3909.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3648.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5055.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3648.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3909.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4430.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L DIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1055.6, "maximum": 1462.76, "gross_charge": 1508.0, "discounted_cash": 2262.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1281.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1462.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1281.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L DIST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1109.5, "maximum": 1537.45, "gross_charge": 1585.0, "discounted_cash": 2377.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1347.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1188.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1109.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1537.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1109.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1188.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1347.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1268.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 941.5, "maximum": 1304.65, "gross_charge": 1345.0, "discounted_cash": 2017.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1143.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1304.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1143.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1076.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 177.8, "maximum": 246.38, "gross_charge": 254.0, "discounted_cash": 381.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 941.5, "maximum": 1304.65, "gross_charge": 1345.0, "discounted_cash": 2017.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1143.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1304.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1143.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1076.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L TI L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 941.5, "maximum": 1304.65, "gross_charge": 1345.0, "discounted_cash": 2017.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1143.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1304.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 941.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1008.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1143.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1076.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES L-BUTT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 931.0, "maximum": 1290.1, "gross_charge": 1330.0, "discounted_cash": 1995.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1130.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 931.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1290.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 931.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1130.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2667.75, "maximum": 3696.74, "gross_charge": 3811.08, "discounted_cash": 5716.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3239.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2858.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2667.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3696.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2667.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2858.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3239.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3048.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LC-DCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LC-DCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 893.9, "maximum": 1238.69, "gross_charge": 1277.0, "discounted_cash": 1915.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1085.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 957.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 893.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1238.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 893.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 957.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1085.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1021.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LC-DCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 984.9, "maximum": 1364.79, "gross_charge": 1407.0, "discounted_cash": 2110.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1195.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 984.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1364.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 984.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1195.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1125.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LC-DCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1479.8, "maximum": 2050.58, "gross_charge": 2114.0, "discounted_cash": 3171.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1796.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1585.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1479.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2050.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1479.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1585.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1796.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1691.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 2.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 939.4, "maximum": 1301.74, "gross_charge": 1342.0, "discounted_cash": 2013.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1140.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 939.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1301.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 939.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1140.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1073.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 2.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 991.2, "maximum": 1373.52, "gross_charge": 1416.0, "discounted_cash": 2124.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1203.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1062.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 991.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1373.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 991.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1062.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1203.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1132.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 2.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1034.6, "maximum": 1433.66, "gross_charge": 1478.0, "discounted_cash": 2217.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1256.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1108.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1034.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1433.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1034.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1108.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1256.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1182.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 2M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 585.9, "maximum": 811.89, "gross_charge": 837.0, "discounted_cash": 1255.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 811.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 669.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 2M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 548.1, "maximum": 759.51, "gross_charge": 783.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 759.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 626.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 3.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 796.6, "maximum": 1103.86, "gross_charge": 1138.0, "discounted_cash": 1707.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 967.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 853.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 796.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1103.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 796.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 853.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 967.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 910.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 3.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1479.8, "maximum": 2050.58, "gross_charge": 2114.0, "discounted_cash": 3171.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1796.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1585.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1479.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2050.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1479.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1585.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1796.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1691.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP 3.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 763.7, "maximum": 1058.27, "gross_charge": 1091.0, "discounted_cash": 1636.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 927.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 763.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1058.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 763.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 818.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 927.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 872.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP AD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 993.3, "maximum": 1376.43, "gross_charge": 1419.0, "discounted_cash": 2128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1206.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1064.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 993.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1376.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 993.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1064.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1206.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1135.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP AD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.7, "maximum": 1514.17, "gross_charge": 1561.0, "discounted_cash": 2341.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1514.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP BA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 834.4, "maximum": 1156.24, "gross_charge": 1192.0, "discounted_cash": 1788.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1013.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 894.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 834.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1156.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 834.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 894.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1013.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 953.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP BA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 761.6, "maximum": 1055.36, "gross_charge": 1088.0, "discounted_cash": 1632.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 924.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1055.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 924.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 870.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1929.9, "maximum": 2674.29, "gross_charge": 2757.0, "discounted_cash": 4135.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2343.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2067.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1929.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2674.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1929.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2067.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2343.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2205.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1881.6, "maximum": 2607.36, "gross_charge": 2688.0, "discounted_cash": 4032.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2284.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2607.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2284.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2150.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1980.3, "maximum": 2744.13, "gross_charge": 2829.0, "discounted_cash": 4243.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2404.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2121.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1980.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2744.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1980.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2121.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2404.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2263.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2006.9, "maximum": 2780.99, "gross_charge": 2867.0, "discounted_cash": 4300.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2436.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2150.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2006.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2780.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2006.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2150.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2436.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2293.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2082.5, "maximum": 2885.75, "gross_charge": 2975.0, "discounted_cash": 4462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2528.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2231.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2885.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2231.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2528.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.8, "maximum": 2535.58, "gross_charge": 2614.0, "discounted_cash": 3921.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1960.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2535.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1960.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2091.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1859.9, "maximum": 2577.29, "gross_charge": 2657.0, "discounted_cash": 3985.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2258.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1992.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1859.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2577.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1859.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1992.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2258.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2125.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1859.9, "maximum": 2577.29, "gross_charge": 2657.0, "discounted_cash": 3985.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2258.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1992.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1859.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2577.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1859.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1992.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2258.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2125.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1929.9, "maximum": 2674.29, "gross_charge": 2757.0, "discounted_cash": 4135.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2343.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2067.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1929.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2674.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1929.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2067.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2343.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2205.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1937.6, "maximum": 2684.96, "gross_charge": 2768.0, "discounted_cash": 4152.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2352.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2076.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1937.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2684.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1937.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2076.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2352.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2214.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1980.3, "maximum": 2744.13, "gross_charge": 2829.0, "discounted_cash": 4243.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2404.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2121.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1980.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2744.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1980.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2121.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2404.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2263.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1991.5, "maximum": 2759.65, "gross_charge": 2845.0, "discounted_cash": 4267.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2418.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2133.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1991.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2759.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1991.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2133.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2418.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3409.0, "maximum": 4723.9, "gross_charge": 4870.0, "discounted_cash": 7305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4139.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3409.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4723.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3409.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4139.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3896.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1512.7, "maximum": 2096.17, "gross_charge": 2161.0, "discounted_cash": 3241.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1836.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1620.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1512.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2096.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1512.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1620.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1836.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1728.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1534.4, "maximum": 2126.24, "gross_charge": 2192.0, "discounted_cash": 3288.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1863.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1644.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1534.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2126.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1534.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1644.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1863.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1753.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3602.9, "maximum": 4992.59, "gross_charge": 5147.0, "discounted_cash": 7720.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4374.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3860.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3602.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4992.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3602.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3860.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4374.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1537.9, "maximum": 2131.09, "gross_charge": 2197.0, "discounted_cash": 3295.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1867.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1647.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2131.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1647.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1867.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1757.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP DI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1787.1, "maximum": 2476.41, "gross_charge": 2553.0, "discounted_cash": 3829.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2170.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1914.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1787.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2476.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1787.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1914.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2170.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2042.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP DI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1138.2, "maximum": 1577.22, "gross_charge": 1626.0, "discounted_cash": 2439.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1382.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1219.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1138.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1577.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1138.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1219.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1382.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP DI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1034.6, "maximum": 1433.66, "gross_charge": 1478.0, "discounted_cash": 2217.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1256.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1108.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1034.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1433.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1034.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1108.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1256.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1182.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP DI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1892.8, "maximum": 2622.88, "gross_charge": 2704.0, "discounted_cash": 4056.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2298.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1892.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2622.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1892.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2028.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2298.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2163.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP EL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2165.1, "maximum": 3000.21, "gross_charge": 3093.0, "discounted_cash": 4639.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2629.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2319.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2165.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3000.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2165.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2319.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2629.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2474.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP EL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1925.7, "maximum": 2668.47, "gross_charge": 2751.0, "discounted_cash": 4126.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2668.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP EL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2025.1, "maximum": 2806.21, "gross_charge": 2893.0, "discounted_cash": 4339.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2459.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2169.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2025.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2806.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2025.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2169.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2459.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2314.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP FI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1488.2, "maximum": 2062.22, "gross_charge": 2126.0, "discounted_cash": 3189.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1807.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1594.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1488.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2062.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1488.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1594.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1807.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1700.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP FI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1465.1, "maximum": 2030.21, "gross_charge": 2093.0, "discounted_cash": 3139.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1779.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1569.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1465.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2030.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1465.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1569.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1779.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1674.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP FI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1508.5, "maximum": 2090.35, "gross_charge": 2155.0, "discounted_cash": 3232.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2090.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1508.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1616.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1831.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP FI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1531.6, "maximum": 2122.36, "gross_charge": 2188.0, "discounted_cash": 3282.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2122.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1750.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP HU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3264.8, "maximum": 4524.08, "gross_charge": 4664.0, "discounted_cash": 6996.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3964.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3498.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3264.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4524.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3264.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3498.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3964.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3731.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP NA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1202.6, "maximum": 1666.46, "gross_charge": 1718.0, "discounted_cash": 2577.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1460.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1288.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1202.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1666.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1202.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1288.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1460.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1374.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP PE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1318.1, "maximum": 1826.51, "gross_charge": 1883.0, "discounted_cash": 2824.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1600.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1412.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1318.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1826.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1318.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1412.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1600.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1506.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP PE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 854.7, "maximum": 1184.37, "gross_charge": 1221.0, "discounted_cash": 1831.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1037.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 915.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 854.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1184.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 854.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 915.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1037.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 976.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP RE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP RE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1055.6, "maximum": 1462.76, "gross_charge": 1508.0, "discounted_cash": 2262.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1281.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1462.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1281.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP RE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1283.1, "maximum": 1778.01, "gross_charge": 1833.0, "discounted_cash": 2749.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1558.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1374.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1283.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1778.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1283.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1374.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1558.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1466.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP RE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1339.1, "maximum": 1855.61, "gross_charge": 1913.0, "discounted_cash": 2869.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1626.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1434.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1339.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1855.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1339.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1434.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1626.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1530.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP RE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.7, "maximum": 1921.57, "gross_charge": 1981.0, "discounted_cash": 2971.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1921.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2943.5, "maximum": 4078.85, "gross_charge": 4205.0, "discounted_cash": 6307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3574.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3153.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2943.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4078.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2943.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3153.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3574.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3364.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2973.6, "maximum": 4120.56, "gross_charge": 4248.0, "discounted_cash": 6372.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3610.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3186.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2973.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4120.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2973.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3186.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3610.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3398.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP VO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1959.3, "maximum": 2715.03, "gross_charge": 2799.0, "discounted_cash": 4198.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2379.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2099.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2715.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1959.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2099.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2379.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2239.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LCP WR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2782.74, "maximum": 3856.08, "gross_charge": 3975.35, "discounted_cash": 5963.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3379.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2981.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2782.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3856.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2782.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2981.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3379.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3180.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES LUMBAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7218.4, "maximum": 10002.64, "gross_charge": 10312.0, "discounted_cash": 15468.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8765.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7734.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7218.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10002.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7218.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7734.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8765.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8249.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES OCP WR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3368.4, "maximum": 4667.64, "gross_charge": 4812.0, "discounted_cash": 7218.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4090.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3368.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4667.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3368.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3609.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4090.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3849.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 197.4, "maximum": 273.54, "gross_charge": 282.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 273.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 197.4, "maximum": 273.54, "gross_charge": 282.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 273.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES QUARTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 251.3, "maximum": 348.23, "gross_charge": 359.0, "discounted_cash": 538.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 348.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 251.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 269.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 305.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 287.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES QUARTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 270.2, "maximum": 374.42, "gross_charge": 386.0, "discounted_cash": 579.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 328.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 289.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 270.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 374.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 270.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 289.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 328.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 308.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES QUARTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 284.2, "maximum": 393.82, "gross_charge": 406.0, "discounted_cash": 609.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 345.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 304.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 284.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 393.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 284.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 304.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 345.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES QUARTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 331.1, "maximum": 458.81, "gross_charge": 473.0, "discounted_cash": 709.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 331.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 402.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES QUARTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 339.5, "maximum": 470.45, "gross_charge": 485.0, "discounted_cash": 727.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 412.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 363.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 470.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 363.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 412.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RADIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1502.9, "maximum": 2082.59, "gross_charge": 2147.0, "discounted_cash": 3220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1824.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1610.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1502.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2082.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1502.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1610.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1824.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1717.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RADIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1463.0, "maximum": 2027.3, "gross_charge": 2090.0, "discounted_cash": 3135.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1776.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1567.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2027.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1463.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1567.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1776.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1672.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RADIUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2006.9, "maximum": 2780.99, "gross_charge": 2867.0, "discounted_cash": 4300.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2436.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2150.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2006.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2780.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2006.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2150.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2436.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2293.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RECONS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1055.6, "maximum": 1462.76, "gross_charge": 1508.0, "discounted_cash": 2262.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1281.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1462.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1055.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1131.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1281.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RECONS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1220.8, "maximum": 1691.68, "gross_charge": 1744.0, "discounted_cash": 2616.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1691.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1220.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1308.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1482.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1395.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RECONS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1283.1, "maximum": 1778.01, "gross_charge": 1833.0, "discounted_cash": 2749.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1558.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1374.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1283.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1778.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1283.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1374.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1558.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1466.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES RECONS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1339.1, "maximum": 1855.61, "gross_charge": 1913.0, "discounted_cash": 2869.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1626.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1434.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1339.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1855.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1339.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1434.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1626.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1530.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES SEMI-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 248.5, "maximum": 344.35, "gross_charge": 355.0, "discounted_cash": 532.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 301.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 266.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 248.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 344.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 248.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 266.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 301.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 284.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES SEMI-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 264.6, "maximum": 366.66, "gross_charge": 378.0, "discounted_cash": 567.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 366.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 302.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES SEMI-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 274.4, "maximum": 380.24, "gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 380.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES STRAIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES STRAIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 924.0, "maximum": 1280.4, "gross_charge": 1320.0, "discounted_cash": 1980.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1280.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 990.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1122.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES STRAIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1090.6, "maximum": 1511.26, "gross_charge": 1558.0, "discounted_cash": 2337.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1324.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1168.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1090.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1511.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1090.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1168.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1324.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1246.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES STRAIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 177.8, "maximum": 246.38, "gross_charge": 254.0, "discounted_cash": 381.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES STRAIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103157", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 196.0, "maximum": 271.6, "gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES STRAIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 247.1, "maximum": 342.41, "gross_charge": 353.0, "discounted_cash": 529.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 264.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 342.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 264.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 282.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.7, "maximum": 1436.57, "gross_charge": 1481.0, "discounted_cash": 2221.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103159", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1026.2, "maximum": 1422.02, "gross_charge": 1466.0, "discounted_cash": 2199.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1246.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1099.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1026.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1422.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1026.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1099.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1246.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1610.7, "maximum": 2231.97, "gross_charge": 2301.0, "discounted_cash": 3451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1840.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 2.0M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 177.8, "maximum": 246.38, "gross_charge": 254.0, "discounted_cash": 381.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 246.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 177.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 190.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 215.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 2.4M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1090.6, "maximum": 1511.26, "gross_charge": 1558.0, "discounted_cash": 2337.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1324.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1168.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1090.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1511.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1090.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1168.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1324.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1246.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 3.5M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 867.3, "maximum": 1201.83, "gross_charge": 1239.0, "discounted_cash": 1858.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1053.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 929.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 867.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1201.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 867.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 929.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1053.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 991.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 3.5M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 908.6, "maximum": 1259.06, "gross_charge": 1298.0, "discounted_cash": 1947.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1103.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 973.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 908.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1259.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 908.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 973.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1103.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1038.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 3.5M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.8, "maximum": 1313.38, "gross_charge": 1354.0, "discounted_cash": 2031.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1083.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 3.5M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 984.9, "maximum": 1364.79, "gross_charge": 1407.0, "discounted_cash": 2110.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1195.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 984.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1364.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 984.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1195.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1125.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T 3.5M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1028.3, "maximum": 1424.93, "gross_charge": 1469.0, "discounted_cash": 2203.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1248.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1101.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1028.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1424.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1028.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1101.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1248.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1175.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 623.0, "maximum": 863.3, "gross_charge": 890.0, "discounted_cash": 1335.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 756.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 623.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 863.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 623.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 667.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 756.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 712.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1149.4, "maximum": 1592.74, "gross_charge": 1642.0, "discounted_cash": 2463.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1395.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1231.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1149.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1592.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1149.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1231.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1395.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1313.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1610.7, "maximum": 2231.97, "gross_charge": 2301.0, "discounted_cash": 3451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1840.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1610.7, "maximum": 2231.97, "gross_charge": 2301.0, "discounted_cash": 3451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1840.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 865.2, "maximum": 1198.92, "gross_charge": 1236.0, "discounted_cash": 1854.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1050.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 927.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 865.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1198.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 865.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 927.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1050.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 988.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 871.5, "maximum": 1207.65, "gross_charge": 1245.0, "discounted_cash": 1867.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 933.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 871.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1207.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 871.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 933.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 996.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 679.0, "maximum": 940.9, "gross_charge": 970.0, "discounted_cash": 1455.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 824.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 679.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 940.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 679.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 824.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 811.3, "maximum": 1124.23, "gross_charge": 1159.0, "discounted_cash": 1738.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 985.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 869.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 811.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1124.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 811.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 869.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 985.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 927.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1070.3, "maximum": 1483.13, "gross_charge": 1529.0, "discounted_cash": 2293.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1299.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1146.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1070.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1483.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1070.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1146.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1299.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1223.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 961.1, "maximum": 1331.81, "gross_charge": 1373.0, "discounted_cash": 2059.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1167.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1029.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 961.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1331.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 961.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1029.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1167.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1098.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 908.6, "maximum": 1259.06, "gross_charge": 1298.0, "discounted_cash": 1947.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1103.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 973.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 908.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1259.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 908.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 973.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1103.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1038.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 947.8, "maximum": 1313.38, "gross_charge": 1354.0, "discounted_cash": 2031.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1150.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1015.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 947.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1313.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 947.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1015.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1150.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1083.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1028.3, "maximum": 1424.93, "gross_charge": 1469.0, "discounted_cash": 2203.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1248.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1101.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1028.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1424.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1028.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1101.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1248.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1175.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1272.6, "maximum": 1763.46, "gross_charge": 1818.0, "discounted_cash": 2727.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1545.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1363.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1272.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1763.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1272.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1363.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1545.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 865.2, "maximum": 1198.92, "gross_charge": 1236.0, "discounted_cash": 1854.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1050.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 927.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 865.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1198.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 865.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 927.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1050.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 988.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 943.6, "maximum": 1307.56, "gross_charge": 1348.0, "discounted_cash": 2022.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1145.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1011.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 943.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1307.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 943.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1011.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1145.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1078.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 904.4, "maximum": 1253.24, "gross_charge": 1292.0, "discounted_cash": 1938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1253.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1098.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1033.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 943.6, "maximum": 1307.56, "gross_charge": 1348.0, "discounted_cash": 2022.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1145.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1011.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 943.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1307.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 943.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1011.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1145.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1078.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T OBLI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1026.2, "maximum": 1422.02, "gross_charge": 1466.0, "discounted_cash": 2199.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1246.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1099.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1026.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1422.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1026.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1099.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1246.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T RT A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 763.7, "maximum": 1058.27, "gross_charge": 1091.0, "discounted_cash": 1636.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 927.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 763.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1058.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 763.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 818.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 927.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 872.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T RT A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 796.6, "maximum": 1103.86, "gross_charge": 1138.0, "discounted_cash": 1707.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 967.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 853.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 796.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1103.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 796.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 853.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 967.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 910.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T RT A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 871.5, "maximum": 1207.65, "gross_charge": 1245.0, "discounted_cash": 1867.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 933.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 871.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1207.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 871.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 933.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1058.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 996.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T RT A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1016.4, "maximum": 1408.44, "gross_charge": 1452.0, "discounted_cash": 2178.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1234.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1089.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1016.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1408.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1016.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1089.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1234.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1161.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T RT A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1272.6, "maximum": 1763.46, "gross_charge": 1818.0, "discounted_cash": 2727.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1545.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1363.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1272.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1763.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1272.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1363.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1545.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T TI L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.7, "maximum": 1436.57, "gross_charge": 1481.0, "discounted_cash": 2221.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES T TI L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1610.7, "maximum": 2231.97, "gross_charge": 2301.0, "discounted_cash": 3451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1840.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES THIRD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.9, "maximum": 297.79, "gross_charge": 307.0, "discounted_cash": 460.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 260.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 230.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 297.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 230.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 260.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 245.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI CER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI CER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI CER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI CSL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1449.0, "maximum": 2007.9, "gross_charge": 2070.0, "discounted_cash": 3105.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1759.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1552.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1449.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2007.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1449.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1552.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1759.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI CSL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1865.5, "maximum": 2585.05, "gross_charge": 2665.0, "discounted_cash": 3997.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2585.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1865.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1998.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2265.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2132.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI DIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3077.9, "maximum": 4265.09, "gross_charge": 4397.0, "discounted_cash": 6595.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3737.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3297.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3077.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4265.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3077.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3297.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3737.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3517.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1537.9, "maximum": 2131.09, "gross_charge": 2197.0, "discounted_cash": 3295.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1867.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1647.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2131.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1537.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1647.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1867.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1757.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 993.3, "maximum": 1376.43, "gross_charge": 1419.0, "discounted_cash": 2128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1206.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1064.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 993.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1376.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 993.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1064.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1206.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1135.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 939.4, "maximum": 1301.74, "gross_charge": 1342.0, "discounted_cash": 2013.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1140.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 939.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1301.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 939.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1140.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1073.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 939.4, "maximum": 1301.74, "gross_charge": 1342.0, "discounted_cash": 2013.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1140.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 939.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1301.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 939.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1006.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1140.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1073.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 991.2, "maximum": 1373.52, "gross_charge": 1416.0, "discounted_cash": 2124.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1203.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1062.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 991.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1373.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 991.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1062.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1203.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1132.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 548.1, "maximum": 759.51, "gross_charge": 783.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 759.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 626.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 714.0, "maximum": 989.4, "gross_charge": 1020.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1411.2, "maximum": 1955.52, "gross_charge": 2016.0, "discounted_cash": 3024.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1411.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1955.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1411.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1612.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3236.1, "maximum": 4484.31, "gross_charge": 4623.0, "discounted_cash": 6934.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3929.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3467.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3236.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4484.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3236.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3467.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3929.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3698.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.7, "maximum": 1436.57, "gross_charge": 1481.0, "discounted_cash": 2221.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.7, "maximum": 1514.17, "gross_charge": 1561.0, "discounted_cash": 2341.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1514.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.7, "maximum": 1514.17, "gross_charge": 1561.0, "discounted_cash": 2341.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1514.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 585.9, "maximum": 811.89, "gross_charge": 837.0, "discounted_cash": 1255.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 811.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 585.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 627.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 711.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 669.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 761.6, "maximum": 1055.36, "gross_charge": 1088.0, "discounted_cash": 1632.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 924.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1055.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 761.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 924.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 870.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 834.4, "maximum": 1156.24, "gross_charge": 1192.0, "discounted_cash": 1788.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1013.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 894.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 834.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1156.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 834.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 894.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1013.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 953.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 893.9, "maximum": 1238.69, "gross_charge": 1277.0, "discounted_cash": 1915.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1085.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 957.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 893.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1238.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 893.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 957.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1085.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1021.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 984.9, "maximum": 1364.79, "gross_charge": 1407.0, "discounted_cash": 2110.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1195.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 984.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1364.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 984.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1055.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1195.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1125.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TI LCP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1726.9, "maximum": 2392.99, "gross_charge": 2467.0, "discounted_cash": 3700.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2096.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1850.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1726.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2392.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1726.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1850.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2096.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1973.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TIBIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1987.3, "maximum": 2753.83, "gross_charge": 2839.0, "discounted_cash": 4258.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2413.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2129.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1987.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2753.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1987.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2129.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2413.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2271.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TUBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TUBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TUBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.92, "maximum": 473.8, "gross_charge": 488.46, "discounted_cash": 732.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES TUBULA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 353.32, "maximum": 489.6, "gross_charge": 504.75, "discounted_cash": 757.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 429.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 353.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 489.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 353.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 429.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES VECTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES VECTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2775.5, "maximum": 3846.05, "gross_charge": 3965.0, "discounted_cash": 5947.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3370.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2973.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2775.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3846.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2775.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2973.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3370.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES VECTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES VECTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES VECTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES VECTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3139.5, "maximum": 4350.45, "gross_charge": 4485.0, "discounted_cash": 6727.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3812.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3363.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3139.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4350.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3139.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3363.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3812.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3588.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES Y TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.7, "maximum": 1436.57, "gross_charge": 1481.0, "discounted_cash": 2221.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES Y TI 2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1610.7, "maximum": 2231.97, "gross_charge": 2301.0, "discounted_cash": 3451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1840.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES Y TI L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101466", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1036.7, "maximum": 1436.57, "gross_charge": 1481.0, "discounted_cash": 2221.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1436.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1036.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1110.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1258.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYNTHES Y TI L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1610.7, "maximum": 2231.97, "gross_charge": 2301.0, "discounted_cash": 3451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2231.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1610.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1725.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1840.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE SYSTEM NUVASIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9807.0, "maximum": 13589.7, "gross_charge": 14010.0, "discounted_cash": 21015.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11908.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10507.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9807.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13589.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9807.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10507.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11908.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.0 6H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.0 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.0 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.3 3H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 878.32, "maximum": 1217.1, "gross_charge": 1254.75, "discounted_cash": 1882.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1066.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 941.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 878.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1217.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 878.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 941.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1066.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1003.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.4 6H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.4/6H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.4MM 5H*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.4MM 6H*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.4MM 7H*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 2.4MM 8H*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 3 HOLE 1.5*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 426.3, "maximum": 590.73, "gross_charge": 609.0, "discounted_cash": 913.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 517.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 456.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 426.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 426.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 456.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 517.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 487.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 3.0MM 2H*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 3.0MM 4H*AR8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 5H*AR-18720P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 6H 2.4*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 6H*AR-188279", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2283.64, "maximum": 3164.47, "gross_charge": 3262.35, "discounted_cash": 4893.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3164.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2283.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2446.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2772.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE T 8H 2.4*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TCS*5303-1405-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 936.6, "maximum": 1297.86, "gross_charge": 1338.0, "discounted_cash": 2007.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1297.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1070.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TI DIST HUM 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2635.81, "maximum": 3652.48, "gross_charge": 3765.45, "discounted_cash": 5648.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3200.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2824.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2635.81, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3652.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2635.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2824.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3200.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3012.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TI LCP 2.7MMX8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202802", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TI LCP 2.7MX10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIB 4H*3085-00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4576.84, "maximum": 6342.19, "gross_charge": 6538.35, "discounted_cash": 9807.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5557.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4903.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4576.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6342.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4576.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4903.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5557.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5230.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIB 4H*AR-9943", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2665.84, "maximum": 3694.09, "gross_charge": 3808.35, "discounted_cash": 5712.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3237.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2856.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2665.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3694.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2665.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2856.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3237.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3046.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIA 2H*3081-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4358.9, "maximum": 6040.19, "gross_charge": 6227.0, "discounted_cash": 9340.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5292.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4670.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4358.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6040.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4358.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4670.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5292.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4981.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIA 6H*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3325.14, "maximum": 4607.69, "gross_charge": 4750.2, "discounted_cash": 7125.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4037.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3562.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3325.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4607.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3325.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3562.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4037.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3800.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIAL 22MM*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4763.85, "maximum": 6601.33, "gross_charge": 6805.5, "discounted_cash": 10208.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5784.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5104.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4763.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6601.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4763.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5104.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5784.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5444.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIAL 63MM*14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIAL 83 FIXE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIAL PRC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TIBIAL PRC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3115.7, "maximum": 4317.47, "gross_charge": 4451.0, "discounted_cash": 6676.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3783.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3338.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3115.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4317.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3115.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3338.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3783.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3560.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRACK .040*80-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 213.16, "maximum": 295.38, "gross_charge": 304.52, "discounted_cash": 456.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 258.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 213.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 295.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 213.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 258.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 243.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRESTL LUXE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRESTL LUXE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRESTL LUXE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRESTL LUXE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRESTLE 3 60MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRESTLE 3 63MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA 1 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA 2 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA 3 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA 3 LEVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2667.0, "maximum": 3695.7, "gross_charge": 3810.0, "discounted_cash": 5715.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3238.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2857.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2667.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3695.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2667.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2857.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3238.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3048.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA CERVIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TRINICA LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2333.1, "maximum": 3233.01, "gross_charge": 3333.0, "discounted_cash": 4999.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2833.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2499.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2333.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3233.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2333.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2499.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2833.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2666.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TROUGH* 853000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 716.1, "maximum": 992.31, "gross_charge": 1023.0, "discounted_cash": 1534.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 869.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 767.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 716.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 992.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 716.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 767.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 869.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 818.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TUB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 342.25, "maximum": 474.27, "gross_charge": 488.94, "discounted_cash": 733.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 342.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 474.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 342.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 391.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TUB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.2, "maximum": 490.82, "gross_charge": 506.0, "discounted_cash": 759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 379.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 490.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 379.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 404.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TUB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TUBE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 191.8, "maximum": 265.78, "gross_charge": 274.0, "discounted_cash": 411.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 205.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 265.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 205.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 219.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TUBULAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 236.6, "maximum": 327.86, "gross_charge": 338.0, "discounted_cash": 507.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 287.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 327.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 287.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 270.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TUBULAR W/COLL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 172.2, "maximum": 238.62, "gross_charge": 246.0, "discounted_cash": 369.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 209.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 184.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 172.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 238.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 172.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 184.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 209.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 196.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE TY-SHAPE 2.5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1346.8, "maximum": 1866.28, "gross_charge": 1924.0, "discounted_cash": 2886.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1635.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1443.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1346.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1866.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1346.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1443.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1635.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1539.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VAL 6 HOLE*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1063.12, "maximum": 1473.18, "gross_charge": 1518.75, "discounted_cash": 2278.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1139.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1063.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1473.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1063.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1139.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1290.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VAL 6 HOLE*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1400.17, "maximum": 1940.24, "gross_charge": 2000.25, "discounted_cash": 3000.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1700.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1500.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1400.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1940.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1400.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1500.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1700.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1600.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VAL 7 HOLE*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1141.87, "maximum": 1582.31, "gross_charge": 1631.25, "discounted_cash": 2446.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1386.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1223.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1141.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1582.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1141.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1223.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1386.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1305.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VAL 7 HOLE*02.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1308.82, "maximum": 1813.65, "gross_charge": 1869.75, "discounted_cash": 2804.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1589.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1402.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1308.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1813.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1308.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1402.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1589.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1495.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VENTURE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3093.3, "maximum": 4286.43, "gross_charge": 4419.0, "discounted_cash": 6628.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3756.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3314.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3093.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4286.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3093.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3314.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3756.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3535.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VENTURE MEDTRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3327.8, "maximum": 4611.38, "gross_charge": 4754.0, "discounted_cash": 7131.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4040.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3565.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3327.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4611.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3327.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3565.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4040.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3803.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VENTURE MEDTRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4744.6, "maximum": 6574.66, "gross_charge": 6778.0, "discounted_cash": 10167.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5761.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5083.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4744.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6574.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4744.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5083.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5761.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2836.4, "maximum": 3930.44, "gross_charge": 4052.0, "discounted_cash": 6078.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3444.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3039.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2836.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3930.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2836.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3039.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3444.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3241.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR 6H*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR ARTHREX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR BEARING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1891.4, "maximum": 2620.94, "gross_charge": 2702.0, "discounted_cash": 4053.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2296.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2026.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1891.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2620.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1891.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2026.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2296.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2161.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR LT 3H*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR LT 3H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR LT 5H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR LT 5H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR LT 5H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR RT 3H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR RT 5H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR RT 5H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE VOLAR RT 5H*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1335.6, "maximum": 1850.76, "gross_charge": 1908.0, "discounted_cash": 2862.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1850.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1335.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1431.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1621.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1526.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE WEDGED*AR-8111", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE WRIGHT ULNAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2375.1, "maximum": 3291.21, "gross_charge": 3393.0, "discounted_cash": 5089.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3291.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2714.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE WRIS FUSION LC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3054.87, "maximum": 4233.17, "gross_charge": 4364.1, "discounted_cash": 6546.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3709.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3273.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3054.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4233.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3054.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3273.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3709.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3491.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE WRIST SPAN*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205968", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3266.9, "maximum": 4526.99, "gross_charge": 4667.0, "discounted_cash": 7000.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3966.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3500.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3266.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4526.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3266.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3500.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3966.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3733.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE X LG 3.0*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE X MED 3.0*AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE X-SM LEFT*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE X-SM RIGHT*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE Y 1.5M 7-HOLE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 990.67, "maximum": 1372.79, "gross_charge": 1415.25, "discounted_cash": 2122.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1202.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1061.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 990.67, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1372.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 990.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1061.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1202.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1132.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE Y 2.0 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEPHIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3187.1, "maximum": 4416.41, "gross_charge": 4553.0, "discounted_cash": 6829.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3870.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3414.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3187.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4416.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3187.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3414.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3870.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3642.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEPHIR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3455.9, "maximum": 4788.89, "gross_charge": 4937.0, "discounted_cash": 7405.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4196.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3702.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3455.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4788.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3455.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3702.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4196.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3949.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 17MM*3001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 19MM*3001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 25MM*3001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2103.92, "maximum": 2915.43, "gross_charge": 3005.6, "discounted_cash": 4508.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2554.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2103.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2915.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2103.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2254.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2554.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2404.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 31MM*3002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 33MM*3002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 48MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 51MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 53MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 55MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 57MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 59MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 61MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.67, "maximum": 2568.65, "gross_charge": 2648.1, "discounted_cash": 3972.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1986.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.67, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2568.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1986.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2118.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 63MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 68MM*3003", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZEVO 75MM*3004", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZIMMER 1 LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZIMMER 1 LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZIMMER 2 LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZIMMER 2 LEVEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE ZIMMER L NATUR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE-I CH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1150.8, "maximum": 1594.68, "gross_charge": 1644.0, "discounted_cash": 2466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1397.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1233.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1150.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1594.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1150.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1233.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1397.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1315.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE-O 20MM*0010122", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1480.5, "maximum": 2051.55, "gross_charge": 2115.0, "discounted_cash": 3172.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2051.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE-ROD OC 3.5X200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2685.41, "maximum": 3721.21, "gross_charge": 3836.3, "discounted_cash": 5754.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3260.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2877.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2685.41, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3721.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2685.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2877.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3260.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3069.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATE-T PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1016.4, "maximum": 1408.44, "gross_charge": 1452.0, "discounted_cash": 2178.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1234.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1089.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1016.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1408.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1016.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1089.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1234.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1161.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATELET AGGREGATN", "code_information": [{"code": "85576", "type": "CPT"}, {"code": "3440101048", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 24.91, "maximum": 188.18, "gross_charge": 194.0, "discounted_cash": 40.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 188.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 31.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 26.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELET DEPLETE OF HARVEST", "code_information": [{"code": "38213", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELET PHERESIS IRRADIATED", "code_information": [{"code": "P9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 899.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELET PHERESIS L/", "code_information": [{"code": "P9037", "type": "HCPCS"}, {"code": "3470103010", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "gross_charge": 1704.85, "discounted_cash": 1080.35, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELET PHERESIS LR", "code_information": [{"code": "P9035", "type": "HCPCS"}, {"code": "3470101277", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 424.98, "maximum": 2093.26, "gross_charge": 2158.0, "discounted_cash": 758.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1834.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 523.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1618.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1510.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2093.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 515.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1510.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 521.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1618.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 505.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 601.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1834.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 505.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1726.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 505.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 515.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELET SURVIVAL", "code_information": [{"code": "78191", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS LEUKOCYTES", "code_information": [{"code": "P9031", "type": "HCPCS"}, {"code": "3470101276", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 140.17, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 210.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 144.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 142.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 144.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 140.17, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 166.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 140.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 140.17, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 142.97, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS LEUKOCYTES", "code_information": [{"code": "P9033", "type": "HCPCS"}, {"code": "3440103027", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 247.0, "maximum": 997.16, "gross_charge": 1028.0, "discounted_cash": 370.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 873.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 771.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 719.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 997.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 251.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 719.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 771.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 293.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 873.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 822.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 247.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 251.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS PHERESIS PATH REDU", "code_information": [{"code": "P9073", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 885.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS, EA UNIT", "code_information": [{"code": "P9019", "type": "HCPCS"}, {"code": "3440103036", "type": "CDM"}, {"code": "384", "type": "RC"}], "standard_charges": [{"minimum": 69.66, "maximum": 667.36, "gross_charge": 688.0, "discounted_cash": 104.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 584.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 72.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 481.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 667.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 481.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 82.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 584.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 550.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 69.66, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS, HLA-M, L/R, UNIT", "code_information": [{"code": "P9052", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 1157.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS, IRRADIATED", "code_information": [{"code": "P9032", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 214.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATELETS, PHERESIS", "code_information": [{"code": "P9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 517.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLATESYNTHES RECONST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.7, "maximum": 1921.57, "gross_charge": 1981.0, "discounted_cash": 2971.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1921.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATESYNTHES RECONST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1510.6, "maximum": 2093.26, "gross_charge": 2158.0, "discounted_cash": 3237.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1834.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1618.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1510.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2093.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1510.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1618.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1834.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1726.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLATESYNTHES RECONST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1506.4, "maximum": 2087.44, "gross_charge": 2152.0, "discounted_cash": 3228.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1829.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1614.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1506.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2087.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1506.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1614.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1829.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1721.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLCG2 GENE COMMON VARIANTS", "code_information": [{"code": "81320", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 291.36, "discounted_cash": 468.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 291.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLERIXAFOR INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2562", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.58, "maximum": 123.58, "discounted_cash": 277.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 123.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH CC", "code_information": [{"code": "187", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6056.11, "maximum": 6056.11, "discounted_cash": 11123.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6056.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITH MCC", "code_information": [{"code": "186", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7880.94, "maximum": 7880.94, "discounted_cash": 17328.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7880.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLEURAL EFFUSION WITHOUT CC/MCC", "code_information": [{"code": "188", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3376.05, "maximum": 3376.05, "discounted_cash": 8334.35, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3376.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLICAMYCIN (MITHRAMYCIN) INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9270", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLIERS NEEDLE NOSE", "code_information": [{"code": "3100104761", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 153.0, "discounted_cash": 229.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF 26X9 10MM*3114-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF 26X9 13MM*3114-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF 26X9 8MM*3114-2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 22X9*311", "code_information": [{"code": "3100205810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLIF CONVEX 22X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 22X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 22X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 22X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 26X12*31", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 26X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 26X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 26X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 26X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLIF CONVEX 26X9*311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT ACCESS BIL TREE SM BWL", "code_information": [{"code": "47541", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "discounted_cash": 11580.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAG", "code_information": [{"code": "47534", "type": "CPT"}, {"code": "3480103321", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 2301.1, "maximum": 8435.12, "gross_charge": 8696.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7391.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6522.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6087.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8435.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6087.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6522.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7391.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6956.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CAT", "code_information": [{"code": "50432", "type": "CPT"}, {"code": "3480103326", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1571.3, "maximum": 4752.03, "gross_charge": 4899.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4164.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3429.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4752.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3429.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4164.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3919.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT CERV", "code_information": [{"code": "219T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 1185.04, "maximum": 1185.04, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 1185.04, "maximum": 1185.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1185.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50694", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLT HTO WEDG 9MM*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT TIB OSTEO*AR1320", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1533.0, "maximum": 2124.3, "gross_charge": 2190.0, "discounted_cash": 3285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2124.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLT, APH/PHER, L/R, CMV-NEG", "code_information": [{"code": "P9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 402.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLT, PHER, L/R CMV-NEG, IRR", "code_information": [{"code": "P9053", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 832.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLUG BIODESIGN FISTU", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100101488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLUG HOLE", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100101489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 1725.27, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLUG HOLE", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100103211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 1725.27, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PLUG TAPER", "code_information": [{"code": "3100102217", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1416.0, "discounted_cash": 2124.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PLUGS 20/24 INSERT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLURA-VAC*8888571513", "code_information": [{"code": "3100209777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.12, "discounted_cash": 630.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL DUAL", "code_information": [{"code": "93280", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PM DEVICE PROGR EVAL MULTI", "code_information": [{"code": "93281", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PM PHONE R-STRIP DEVICE EVAL", "code_information": [{"code": "93293", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA 1 BREAKPOINT", "code_information": [{"code": "81316", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PML/RARALPHA COM BREAKPOINTS", "code_information": [{"code": "81315", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 207.31, "discounted_cash": 333.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 207.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE DUP/DELET", "code_information": [{"code": "81324", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 758.36, "discounted_cash": 1218.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 758.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE FULL SEQUENCE", "code_information": [{"code": "81325", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 769.58, "discounted_cash": 1236.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 769.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMP22 GENE KNOWN FAM VARIANT", "code_information": [{"code": "81326", "type": "CPT"}], "standard_charges": [{"minimum": 46.6, "maximum": 79.66, "discounted_cash": 74.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE DUP/DELET VARIANTS", "code_information": [{"code": "81319", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 203.5, "discounted_cash": 326.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 203.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMS2 GENE FULL SEQ ANALYSIS", "code_information": [{"code": "81317", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 676.5, "discounted_cash": 1086.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 676.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMS2 KNOWN FAMILIAL VARIANTS", "code_information": [{"code": "81318", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 331.0, "discounted_cash": 531.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 331.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PMS2 MRNA SEQ ALYS", "code_information": [{"code": "161U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNE FLU HEPB COV HOME ADMIN", "code_information": [{"code": "M0201", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 59.21, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNE LEAD*1901", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100205236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMATIC INFLATOR*M", "code_information": [{"code": "3100203577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.2, "discounted_cash": 112.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PNEUMOCYSTIS CARINII AG IF", "code_information": [{"code": "87281", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH CC", "code_information": [{"code": "200", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5048.4, "maximum": 5048.4, "discounted_cash": 12024.24, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5048.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITH MCC", "code_information": [{"code": "199", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7676.82, "maximum": 7676.82, "discounted_cash": 19807.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7676.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PNEUMOTHORAX WITHOUT CC/MCC", "code_information": [{"code": "201", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4178.41, "maximum": 4178.41, "discounted_cash": 7883.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4178.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PODIATRY SURGERY 1ST", "code_information": [{"code": "3480103127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 6588.0, "discounted_cash": 9882.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PODIATRY SURGERY EA", "code_information": [{"code": "3480103128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3951.0, "discounted_cash": 5926.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [{"code": "917", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6206.13, "maximum": 6206.13, "discounted_cash": 17817.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6206.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [{"code": "918", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3178.08, "maximum": 3178.08, "discounted_cash": 9611.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3178.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLAR CARE CUBE*1070", "code_information": [{"code": "3100205886", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 342.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POLAR CARE PAD M/U X", "code_information": [{"code": "3100205885", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.76, "discounted_cash": 146.64, "setting": "both", "billing_class": "facility"}]}, {"description": "POLAR CARE UNIT+PAD", "code_information": [{"code": "3100101490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 487.0, "discounted_cash": 730.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POLIOVIRUS IPV SC/IM", "code_information": [{"code": "90713", "type": "CPT"}], "standard_charges": [{"minimum": 36.84, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLY IMPLANT ANKLE*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4304.3, "maximum": 5964.53, "gross_charge": 6149.0, "discounted_cash": 9223.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5226.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4611.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4304.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5964.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4304.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4611.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5226.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4919.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLY PATELLA 8.5MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POLYCYTE, TOPICAL ONLY 0.5CC", "code_information": [{"code": "Q4241", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYMYXIN B SULFATE", "code_information": [{"code": "3400300233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 21.7, "discounted_cash": 32.55, "setting": "both", "billing_class": "facility"}]}, {"description": "POLYSOM 6/> YRS 4/> PARAM", "code_information": [{"code": "95810", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM 6/>YRS CPAP 4/> PARM", "code_information": [{"code": "95811", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS 4/> PARAMTRS", "code_information": [{"code": "95782", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM <6 YRS CPAP/BILVL", "code_information": [{"code": "95783", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYSOM ANY AGE 1-3> PARAM", "code_information": [{"code": "95808", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POLYVALENT MULT ORG EA AG IA", "code_information": [{"code": "87451", "type": "CPT"}], "standard_charges": [{"minimum": 10.51, "maximum": 24.03, "discounted_cash": 16.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PONTIC PORCELAIN TO TITANIUM", "code_information": [{"code": "D6243", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PONTIC TITANIUM", "code_information": [{"code": "D6214", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PONTIC-INDIRECT RESIN BASED", "code_information": [{"code": "D6205", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POOLING PLATELETS OR", "code_information": [{"code": "86965", "type": "CPT"}, {"code": "3440101153", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 102.8, "maximum": 207.41, "gross_charge": 165.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 154.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORC/CERAM INLAY >= 3 SURFAC", "code_information": [{"code": "D6601", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORCELAIN/CERAMIC INLAY 2SRF", "code_information": [{"code": "D6600", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORCELAIN/CERAMIC RETAINER", "code_information": [{"code": "D6548", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORFIMER SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9600", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 36673.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PORP CENTERED*140892", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1197.0, "maximum": 1658.7, "gross_charge": 1710.0, "discounted_cash": 2565.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1453.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1658.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1282.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1453.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORP DRUM/STAPES*140", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 678.3, "maximum": 939.93, "gross_charge": 969.0, "discounted_cash": 1453.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 823.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 678.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 939.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 678.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 823.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 775.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORPHOBILNGN URINE Q", "code_information": [{"code": "84110", "type": "CPT"}, {"code": "3440100969", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.44, "maximum": 52.38, "gross_charge": 54.0, "discounted_cash": 13.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 52.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 37.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 40.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 10.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 45.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 43.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORPHYRINS URINE QUA", "code_information": [{"code": "84119", "type": "CPT"}, {"code": "3440100970", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.36, "maximum": 74.69, "gross_charge": 77.0, "discounted_cash": 21.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORPHYRINS URINE QUA", "code_information": [{"code": "84120", "type": "CPT"}, {"code": "3440100971", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.71, "maximum": 127.07, "gross_charge": 131.0, "discounted_cash": 23.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 127.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 98.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 111.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORT PLUG DRG*1708", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208563", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORT PLUG*7108", "code_information": [{"code": "3100207081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PORT/IMPL DEVICE FLU", "code_information": [{"code": "96523", "type": "CPT"}, {"code": "3340100590", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PORT/POWER CLEARVUE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.6, "maximum": 628.56, "gross_charge": 648.0, "discounted_cash": 972.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 486.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 486.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 518.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORT/POWER CLEARVUE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 453.6, "maximum": 628.56, "gross_charge": 648.0, "discounted_cash": 972.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 486.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 453.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 486.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 550.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 518.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PORTAL SKID FAST FIX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSITIONAL CHANGE OF FINGER", "code_information": [{"code": "26555", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92532", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSITIONAL NYSTAGMUS TEST", "code_information": [{"code": "92542", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSITIONER", "code_information": [{"code": "3100102218", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER", "code_information": [{"code": "3100103712", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER", "code_information": [{"code": "3100103713", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER HEAD UNIV", "code_information": [{"code": "3100101492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POSITIONER MASK COMF", "code_information": [{"code": "3100101493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POST 1 SRFC RESINBASED CMPST", "code_information": [{"code": "D2391", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST 2 SRFC RESINBASED CMPST", "code_information": [{"code": "D2392", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST 3 SRFC RESINBASED CMPST", "code_information": [{"code": "D2393", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST 30 DEG", "code_information": [{"code": "3100102219", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "POST >=4SRFC RESINBASE CMPST", "code_information": [{"code": "D2394", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST AND CORE CAST + CROWN", "code_information": [{"code": "D2952", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST FEM AUG 65 X5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2770.95, "maximum": 3839.74, "gross_charge": 3958.5, "discounted_cash": 5937.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3839.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST FEM AUG 65 X5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2770.95, "maximum": 3839.74, "gross_charge": 3958.5, "discounted_cash": 5937.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3839.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2770.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2968.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3364.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3166.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST FEM AUG 70 X10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1843.66, "maximum": 2554.78, "gross_charge": 2633.8, "discounted_cash": 3950.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2238.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1975.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2554.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1843.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1975.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2238.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2107.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST FEMORAL SZ 5 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3108.56, "maximum": 4307.57, "gross_charge": 4440.8, "discounted_cash": 6661.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3774.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3108.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4307.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3108.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3774.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3552.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POST REMOVAL", "code_information": [{"code": "D2955", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST VERT ARTHRPLST 1 LUMBAR", "code_information": [{"code": "202T", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST-CAT LASER SURG", "code_information": [{"code": "66821", "type": "CPT"}, {"code": "3410100689", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1394.86, "gross_charge": 1438.0, "discounted_cash": 889.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1222.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 613.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1078.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1006.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1394.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 605.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1006.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 610.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1078.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 593.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 705.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1222.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 593.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1150.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 593.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 605.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST-COITAL MUCOUS EXAM", "code_information": [{"code": "Q0115", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.0, "maximum": 43.61, "discounted_cash": 40.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 30M", "code_information": [{"code": "G2014", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POST-D/C CARE PLAN OVERS 60M", "code_information": [{"code": "G2015", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POSTERIOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2265.9, "maximum": 3139.89, "gross_charge": 3237.0, "discounted_cash": 4855.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2751.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2427.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2265.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3139.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2265.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2427.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2751.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2589.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3108.7, "maximum": 4307.77, "gross_charge": 4441.0, "discounted_cash": 6661.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3774.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3330.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3108.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4307.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3108.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3330.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3774.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3552.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR CMBO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1852.9, "maximum": 2567.59, "gross_charge": 2647.0, "discounted_cash": 3970.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2249.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1852.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1852.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2249.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR CMBO SZ2.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR CMBO SZ2.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR CMBO SZ2.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1853.08, "maximum": 2567.84, "gross_charge": 2647.26, "discounted_cash": 3970.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2567.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1985.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2117.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR CMBO SZ4 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1588.58, "maximum": 2201.31, "gross_charge": 2269.4, "discounted_cash": 3404.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1928.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1588.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2201.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1588.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1928.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1815.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR CMBO SZ4 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1588.58, "maximum": 2201.31, "gross_charge": 2269.4, "discounted_cash": 3404.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1928.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1588.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2201.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1588.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1702.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1928.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1815.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR COMBO/DIST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1925.0, "maximum": 2667.5, "gross_charge": 2750.0, "discounted_cash": 4125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2337.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2062.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2667.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2062.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2337.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SZ 2.5 LT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5558.55, "maximum": 7702.56, "gross_charge": 7940.79, "discounted_cash": 11911.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6749.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5955.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5558.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7702.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5558.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5955.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6749.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6352.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SZ 4 LT*19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2265.9, "maximum": 3139.89, "gross_charge": 3237.0, "discounted_cash": 4855.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2751.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2427.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2265.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3139.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2265.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2427.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2751.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2589.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SZ 4 LT*19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3013.01, "maximum": 4175.17, "gross_charge": 4304.3, "discounted_cash": 6456.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3658.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3228.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3013.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4175.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3013.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3228.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3658.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3443.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SZ 5 LT*19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2265.9, "maximum": 3139.89, "gross_charge": 3237.0, "discounted_cash": 4855.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2751.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2427.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2265.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3139.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2265.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2427.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2751.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2589.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SZ3 RT*196", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3094.0, "maximum": 4287.4, "gross_charge": 4420.0, "discounted_cash": 6630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4287.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR SZ4 RT*196", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3094.0, "maximum": 4287.4, "gross_charge": 4420.0, "discounted_cash": 6630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4287.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3757.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3536.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTERIOR VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2031.4, "maximum": 2814.94, "gross_charge": 2902.0, "discounted_cash": 4353.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2466.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2031.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2814.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2031.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2176.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2466.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2321.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [{"code": "862", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7225.53, "maximum": 7225.53, "discounted_cash": 20565.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7225.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [{"code": "863", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5390.25, "maximum": 5390.25, "discounted_cash": 11225.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5390.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [{"code": "857", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9218.21, "maximum": 9218.21, "discounted_cash": 23844.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9218.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [{"code": "856", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15690.56, "maximum": 15690.56, "discounted_cash": 49441.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15690.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "858", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7542.78, "maximum": 7542.78, "discounted_cash": 14328.6, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7542.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [{"code": "769", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5537.2, "maximum": 5537.2, "discounted_cash": 17236.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5537.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [{"code": "776", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2587.84, "maximum": 2587.84, "discounted_cash": 8001.65, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2587.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POSTSURGICAL OBTURATOR", "code_information": [{"code": "D5932", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "3400300133", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.11, "maximum": 6.79, "gross_charge": 7.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM CHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3480", "type": "HCPCS"}, {"code": "3400300134", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.11, "maximum": 6.79, "gross_charge": 7.0, "discounted_cash": 10.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "POTASSIUM HYDROXIDE PREPS", "code_information": [{"code": "Q0112", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.83, "maximum": 35.16, "discounted_cash": 9.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POTASSIUM PLASMA /", "code_information": [{"code": "84132", "type": "CPT"}, {"code": "3440100973", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.76, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 7.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POTASSIUM PLSMA / WH", "code_information": [{"code": "84132", "type": "CPT"}, {"code": "3440100972", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.76, "maximum": 39.77, "gross_charge": 41.0, "discounted_cash": 7.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POTASSIUM URINE", "code_information": [{"code": "84133", "type": "CPT"}, {"code": "3440100974", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.73, "maximum": 37.83, "gross_charge": 39.0, "discounted_cash": 7.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 37.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "POWER SHELL*SIGPSHEL", "code_information": [{"code": "3100208232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.08, "discounted_cash": 648.12, "setting": "both", "billing_class": "facility"}]}, {"description": "POWERRASP", "code_information": [{"code": "3100101494", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PPP2R2B GEN DETC ABNOR ALLEL", "code_information": [{"code": "81343", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PPV VACCINE ADMINIST", "code_information": [{"code": "G0009", "type": "HCPCS"}, {"code": "3400300330", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 57.68, "gross_charge": 44.0, "discounted_cash": 72.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 57.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 49.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRALATREXATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9307", "type": "HCPCS"}], "standard_charges": [{"minimum": 299.28, "maximum": 299.28, "discounted_cash": 464.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 299.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRALIDOXIME CHLORIDE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2730", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.21, "maximum": 89.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 89.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 0-5YR OR W/ANOMLY", "code_information": [{"code": "33018", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRCRD DRG 6YR+ W/O CGEN CAR", "code_information": [{"code": "33017", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREALBUMIN", "code_information": [{"code": "84134", "type": "CPT"}, {"code": "3440100975", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.59, "maximum": 46.56, "gross_charge": 48.0, "discounted_cash": 23.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.63, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRECISION ATTACHMENT", "code_information": [{"code": "D5862", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRECISION ATTACHMENT", "code_information": [{"code": "D6950", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRECISIONPOINT KIT*P", "code_information": [{"code": "3100204665", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 711.0, "discounted_cash": 1066.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PREDNISOLONE ACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2650", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PREDNISOLONE ORAL PER 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7510", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.29, "maximum": 0.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREDNISONE IR OR DR ORAL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7512", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREFAB PORC/CER CROWN PERM", "code_information": [{"code": "D2928", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFAB PORC/CERAM CROWN PRI", "code_information": [{"code": "D2929", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFAB POST/CORE + CROWN", "code_information": [{"code": "D2954", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFAB STAINLESS STEEL CROWN", "code_information": [{"code": "D2933", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFAB STEEL CROWN PRIMARY", "code_information": [{"code": "D2934", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFAB STNLSS STEEL CROWN PE", "code_information": [{"code": "D2931", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFAB STNLSS STEEL CRWN PRI", "code_information": [{"code": "D2930", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFABRICATED ABUTMENT", "code_information": [{"code": "D6056", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREFABRICATED RESIN CROWN", "code_information": [{"code": "D2932", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREGABALIN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300035", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 9.2, "discounted_cash": 13.8, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "PREGABALIN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300036", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.1, "discounted_cash": 15.15, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "PREGABALIN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300037", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 10.1, "discounted_cash": 15.15, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5843.38, "maximum": 5843.38, "discounted_cash": 45749.04, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5843.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [{"code": "792", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2704.04, "maximum": 2704.04, "discounted_cash": 27604.38, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2704.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRENATAL AT RISK EDUCATION", "code_information": [{"code": "H1003", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRENATAL CARE ATRISK ASSESSM", "code_information": [{"code": "H1000", "type": "HCPCS"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 176.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRENATALCARE ENHANCED SRV PK", "code_information": [{"code": "H1005", "type": "HCPCS"}], "standard_charges": [{"minimum": 176.22, "maximum": 176.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 176.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREORTHODONTIC TX VISIT", "code_information": [{"code": "D8660", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP & CANNULJ CDVR DON LUNG", "code_information": [{"code": "494T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP CADAVER RENAL ALLOGRAFT", "code_information": [{"code": "50323", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "type": "CPT"}], "standard_charges": [{"minimum": 6993.18, "maximum": 6993.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/ARTERY", "code_information": [{"code": "44721", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER WHOLE", "code_information": [{"code": "47143", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS/VENOUS", "code_information": [{"code": "48552", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP DONOR RENAL GRAFT", "code_information": [{"code": "50325", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/URETERAL", "code_information": [{"code": "50329", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/VENOUS", "code_information": [{"code": "50327", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION FOR BLADDER XRAY", "code_information": [{"code": "51605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION OF REPORT", "code_information": [{"code": "90889", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARATION PALATE MOLD", "code_information": [{"code": "42280", "type": "CPT"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART", "code_information": [{"code": "33944", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR HEART/LUNG", "code_information": [{"code": "33933", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR INTESTINE", "code_information": [{"code": "44715", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG DOUBLE", "code_information": [{"code": "32856", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE DONOR LUNG SINGLE", "code_information": [{"code": "32855", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE EMBRYO FOR TRANSFER", "code_information": [{"code": "89255", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21076", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 372.23, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21077", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 522.5, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21080", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21081", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21083", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21084", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21086", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 426.56, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21087", "type": "CPT"}], "standard_charges": [{"minimum": 157.53, "maximum": 426.56, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21088", "type": "CPT"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE FECAL MICROBIOTA", "code_information": [{"code": "44705", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE HEART-AORTA CONDUIT", "code_information": [{"code": "33404", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE PENIS STUDY", "code_information": [{"code": "54230", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2109.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPARE SPERM DUCT X-RAY", "code_information": [{"code": "55300", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 189.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREPJ TUM CAV IORT PRTL MAST", "code_information": [{"code": "19294", "type": "CPT"}], "standard_charges": [{"minimum": 7541.42, "maximum": 7541.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRESSURE NOZ 23 DEG*", "code_information": [{"code": "3100209538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.72, "discounted_cash": 157.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PRESSURE TREATMENT ESOPHAGUS", "code_information": [{"code": "43460", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRESSURIZER MIS", "code_information": [{"code": "3100101495", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRESSURIZER MIS", "code_information": [{"code": "3100103212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRESSURIZER SPONGE", "code_information": [{"code": "3100101496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRETREATMNT RBC AB W", "code_information": [{"code": "86970", "type": "CPT"}, {"code": "3440101154", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 113.49, "gross_charge": 117.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRETRTMNT RBC AB INC", "code_information": [{"code": "86971", "type": "CPT"}, {"code": "3440101155", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 49.48, "maximum": 207.41, "gross_charge": 117.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRETRTMNT RBC AB INC", "code_information": [{"code": "86972", "type": "CPT"}, {"code": "3440101156", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 49.48, "maximum": 207.41, "gross_charge": 117.0, "discounted_cash": 261.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 180.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 179.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 174.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 177.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRETRTMNT SERUM RBC", "code_information": [{"code": "86978", "type": "CPT"}, {"code": "3440101157", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 160.05, "gross_charge": 165.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 99.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 15", "code_information": [{"code": "99401", "type": "CPT"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 30", "code_information": [{"code": "99402", "type": "CPT"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 45", "code_information": [{"code": "99403", "type": "CPT"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREV MED CNSL INDIV APPRX 60", "code_information": [{"code": "99404", "type": "CPT"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREV RESIN REST, PERM TOOTH", "code_information": [{"code": "D1352", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREVENA BLACK FOAM*M", "code_information": [{"code": "3100208911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.6, "discounted_cash": 213.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA CAN 3000*M82", "code_information": [{"code": "3100209532", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.2, "discounted_cash": 172.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA CANISTER 500", "code_information": [{"code": "3100206049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.08, "discounted_cash": 177.12, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA CANISTER*PRE", "code_information": [{"code": "3100204577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.12, "discounted_cash": 121.68, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA DRESSING*PRE", "code_information": [{"code": "3100206050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.31, "discounted_cash": 897.47, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA DRESSING*PRE", "code_information": [{"code": "3100206557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2153.22, "discounted_cash": 3229.83, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA DRESSING*PRE", "code_information": [{"code": "3100207646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 886.86, "discounted_cash": 1330.29, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA PLUS 125*PRE", "code_information": [{"code": "3100204574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 940.0, "discounted_cash": 1410.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA PLUS KIT*PRE", "code_information": [{"code": "3100204578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1521.0, "discounted_cash": 2281.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENA PUMP*PRE4010", "code_information": [{"code": "3100207647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1230.24, "discounted_cash": 1845.36, "setting": "both", "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99411", "type": "CPT"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PREVENTIVE COUNSELING GROUP", "code_information": [{"code": "99412", "type": "CPT"}], "standard_charges": [{"minimum": 109.92, "maximum": 109.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ICDS SS IP", "code_information": [{"code": "575T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IIMS IP", "code_information": [{"code": "528T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL IMPLTBL SYS", "code_information": [{"code": "93260", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL ISDSS IP", "code_information": [{"code": "683T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL PM/LDLS PM", "code_information": [{"code": "93279", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS IP", "code_information": [{"code": "93285", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL SCRMS REMOTE", "code_information": [{"code": "650T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG DEV EVAL WCS IP", "code_information": [{"code": "522T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL CARDIAC MODULJ", "code_information": [{"code": "417T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93282", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93283", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG EVAL IMPLANTABLE DFB", "code_information": [{"code": "93284", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRGRMG IO RTA ELTRD RA", "code_information": [{"code": "472T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC 1ST VSL", "code_information": [{"code": "37184", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIM ART M-THRMBC SBSQ VSL", "code_information": [{"code": "37185", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIMARY CLOSURE SINUS PERF", "code_information": [{"code": "D7261", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIMATRIX", "code_information": [{"code": "Q4110", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.06, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIMIDONE", "code_information": [{"code": "80188", "type": "CPT"}, {"code": "3440100826", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.59, "maximum": 145.5, "gross_charge": 150.0, "discounted_cash": 26.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS 1ST 30", "code_information": [{"code": "99424", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT PHYS EA ADDL", "code_information": [{"code": "99425", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF 1ST 30", "code_information": [{"code": "99426", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 136.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRIN CARE MGMT STAFF EA ADDL", "code_information": [{"code": "99427", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRISMA COMP", "code_information": [{"code": "3100102221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRISMA GLOSS COMPOS", "code_information": [{"code": "3100101497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 247.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE AR-SCOPE MEASU", "code_information": [{"code": "3100104057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ARC SMART", "code_information": [{"code": "3100102278", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 593.0, "discounted_cash": 889.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ARC SMART", "code_information": [{"code": "3100103733", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE ARC SMART*G11-", "code_information": [{"code": "3100205427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL", "code_information": [{"code": "3100103815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 1174.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP", "code_information": [{"code": "3100101498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 786.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP", "code_information": [{"code": "3100103213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP PEDIC", "code_information": [{"code": "3480103049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 204.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALL TIP2.3X20", "code_information": [{"code": "3100203345", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALLTIP 175M*", "code_information": [{"code": "3100205610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BALLTIP 2.3*R", "code_information": [{"code": "3100202729", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE BAXANO", "code_information": [{"code": "3100102268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 1170.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE CONNECTOR", "code_information": [{"code": "3100102277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE COVER 15X122*P", "code_information": [{"code": "3100203641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.6, "discounted_cash": 30.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE COVER KIT*CRU9", "code_information": [{"code": "3100203193", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.16, "discounted_cash": 55.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE DOPPLER VTI", "code_information": [{"code": "3100101499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 536.25, "discounted_cash": 804.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE FORAMINAL", "code_information": [{"code": "3100101500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 786.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE GUIDE HOLDER", "code_information": [{"code": "3100101501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE HOOK ARTH", "code_information": [{"code": "3100101502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 497.0, "discounted_cash": 745.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE HOOK ARTH", "code_information": [{"code": "3100103214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE HOOK ARTHREX", "code_information": [{"code": "3100103854", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE INCREMENTING S", "code_information": [{"code": "3100101503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE INJECTION GOLD", "code_information": [{"code": "3100101504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 713.0, "discounted_cash": 1069.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE MAMMOTOME BLAD", "code_information": [{"code": "3100101505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 817.0, "discounted_cash": 1225.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE MEASURE", "code_information": [{"code": "3100104058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 711.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE MONO FLUSH TIP", "code_information": [{"code": "3100103980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 384.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL D", "code_information": [{"code": "68811", "type": "CPT"}, {"code": "3480102217", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL D", "code_information": [{"code": "68815", "type": "CPT"}, {"code": "3480102218", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL D", "code_information": [{"code": "68816", "type": "CPT"}, {"code": "3480102219", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2837.63, "gross_charge": 2674.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2593.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1871.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2005.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2272.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE NASOLACRIMAL DUCT", "code_information": [{"code": "68810", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROBE RAD CURV SHARP", "code_information": [{"code": "3100104587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2425.0, "discounted_cash": 3637.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SHOCK PULSE*SP", "code_information": [{"code": "3100204538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1995.0, "discounted_cash": 2992.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SIMPLICITY III", "code_information": [{"code": "3100101506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE SOUNDING", "code_information": [{"code": "3100101507", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE STIM MONO *270", "code_information": [{"code": "3100202298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 297.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBE TAPERED BALL", "code_information": [{"code": "3100102222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2217.0, "discounted_cash": 3325.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PROBEOSTEOTOME", "code_information": [{"code": "3100102396", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROCAINAMIDE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2690", "type": "HCPCS"}, {"code": "3400300093", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 30.31, "maximum": 187.2, "gross_charge": 43.3, "discounted_cash": 235.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 161.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.47, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 156.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 186.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 156.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 187.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 156.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCALCITONIN", "code_information": [{"code": "84145", "type": "CPT"}, {"code": "3440103087", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 27.22, "maximum": 162.96, "gross_charge": 168.0, "discounted_cash": 43.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCENTA, PER 200 MG", "code_information": [{"code": "Q4244", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300180", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 8.6, "discounted_cash": 12.9, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "PROCHLORPERAZINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0780", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.94, "maximum": 3.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCHLORPERAZINE MALEATE 5MG", "code_information": [{"code": "Q0164", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.22, "maximum": 0.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCLAIM 7 *3663", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 21000.0, "maximum": 29100.0, "gross_charge": 30000.0, "discounted_cash": 45000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25500.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21000.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29100.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21000.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25500.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCLAIM DRG GENERAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 26306.0, "maximum": 36452.6, "gross_charge": 37580.0, "discounted_cash": 56370.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31943.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28185.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26306.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36452.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26306.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28185.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31943.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30064.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCLAIM ELITE", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100104535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30296.0, "maximum": 41981.6, "gross_charge": 43280.0, "discounted_cash": 64920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36788.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30296.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41981.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30296.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36788.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34624.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCLAIM PLUS 5 *367", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 23800.0, "maximum": 32980.0, "gross_charge": 34000.0, "discounted_cash": 51000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28900.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32980.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28900.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCLAIM PLUS 7 *367", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 23800.0, "maximum": 32980.0, "gross_charge": 34000.0, "discounted_cash": 51000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28900.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32980.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28900.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROCTOSGM RGD RMVL M", "code_information": [{"code": "45315", "type": "CPT"}, {"code": "3390100654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2428.88, "gross_charge": 2504.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2428.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2003.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMD RGD ABLAT", "code_information": [{"code": "45320", "type": "CPT"}, {"code": "3390100655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5198.23, "gross_charge": 5359.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4555.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4019.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3751.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5198.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3751.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4019.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4555.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4287.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMD RGD RMVL", "code_information": [{"code": "45308", "type": "CPT"}, {"code": "3390100652", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3409.56, "gross_charge": 2504.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2428.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2003.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMD RGD RMVL", "code_information": [{"code": "45309", "type": "CPT"}, {"code": "3390100653", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2428.88, "gross_charge": 2504.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2428.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2003.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMDSC RGD DIA", "code_information": [{"code": "45300", "type": "CPT"}, {"code": "3390100648", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "gross_charge": 1471.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1426.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMDSC RGD W/B", "code_information": [{"code": "45305", "type": "CPT"}, {"code": "3390100650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2428.88, "gross_charge": 2504.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2428.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2003.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMDSC RGD W/D", "code_information": [{"code": "45303", "type": "CPT"}, {"code": "3390100649", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2428.88, "gross_charge": 2504.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2428.88, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1752.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1878.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2128.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2003.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSGMDSC RGD W/R", "code_information": [{"code": "45307", "type": "CPT"}, {"code": "3390100651", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5198.23, "gross_charge": 5359.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4555.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4019.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3751.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5198.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3751.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4019.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4555.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4287.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY BLEED", "code_information": [{"code": "45317", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2076.37, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY VOLVUL", "code_information": [{"code": "45321", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2076.37, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCTOSIGMOIDOSCOPY W/STENT", "code_information": [{"code": "45327", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2076.37, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCURE DONOR SPERM", "code_information": [{"code": "S4026", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROCUREN OR OTHER GROWTH FAC", "code_information": [{"code": "S9055", "type": "HCPCS"}], "standard_charges": [{"minimum": 2771.02, "maximum": 2771.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRODIGY GENERATOR* 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25592.0, "maximum": 35463.2, "gross_charge": 36560.0, "discounted_cash": 54840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31076.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25592.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35463.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25592.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31076.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROGENAMATRIX, PER SQ CM", "code_information": [{"code": "Q4222", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.29, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 115.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROGESTERONE", "code_information": [{"code": "84144", "type": "CPT"}, {"code": "3440100976", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 20.86, "maximum": 181.39, "gross_charge": 187.0, "discounted_cash": 33.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROGRAM INTAKE ASSESSMENT", "code_information": [{"code": "T1023", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROGRAMMER PT*TH90D0", "code_information": [{"code": "3100207616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT*TH90D0", "code_information": [{"code": "3100207620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4602.0, "discounted_cash": 6903.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT*TH90T0", "code_information": [{"code": "3100208530", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT*TH91D0", "code_information": [{"code": "3100206107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4420.0, "discounted_cash": 6630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER PT*TH91DB", "code_information": [{"code": "3100210032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROGRAMMER*TM91SCS", "code_information": [{"code": "3100207035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PROHANCE GAD / ML", "code_information": [{"code": "A9579", "type": "HCPCS"}, {"code": "3100101508", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.51, "maximum": 134.83, "gross_charge": 139.0, "discounted_cash": 208.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROINSULIN", "code_information": [{"code": "84206", "type": "CPT"}, {"code": "3440100986", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 26.69, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 42.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 28.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}, {"code": "3440100977", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 19.38, "maximum": 167.81, "gross_charge": 173.0, "discounted_cash": 31.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 167.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROLG SVC I/P UNIT 1", "code_information": [{"code": "99356", "type": "CPT"}, {"code": "3500102285", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 479.5, "maximum": 664.45, "gross_charge": 685.0, "discounted_cash": 1027.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 664.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLG SVC I/P UNIT E", "code_information": [{"code": "99357", "type": "CPT"}, {"code": "3500102282", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 239.4, "maximum": 331.74, "gross_charge": 342.0, "discounted_cash": 513.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 290.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 256.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 239.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 331.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 239.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 256.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 290.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 273.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLIFT SPACER12X28*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG SVC O/P DIR C", "code_information": [{"code": "99354", "type": "CPT"}, {"code": "3500102286", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 513.8, "maximum": 711.98, "gross_charge": 734.0, "discounted_cash": 1101.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 711.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLNG SVC O/P DIR C", "code_information": [{"code": "99355", "type": "CPT"}, {"code": "3500102281", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 257.6, "maximum": 356.96, "gross_charge": 368.0, "discounted_cash": 552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 312.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 257.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 356.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 257.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 312.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 294.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROLONGED IV INF, REQ PUMP", "code_information": [{"code": "C8957", "type": "HCPCS"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROLOTHERAPY", "code_information": [{"code": "M0076", "type": "HCPCS"}], "standard_charges": [{"minimum": 456.57, "maximum": 456.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROMAZINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2950", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.68, "maximum": 21.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE HCL 12.5MG ORAL", "code_information": [{"code": "Q0169", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.04, "maximum": 0.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROMETHAZINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2550", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.1, "maximum": 3.1, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT CRTX DTHRM", "code_information": [{"code": "67141", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROPH RTA DTCHMNT PC", "code_information": [{"code": "67145", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROPOFOL", "code_information": [{"code": "3400300276", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 22.1, "discounted_cash": 33.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PROPRANOLOL HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1800", "type": "HCPCS"}, {"code": "3400300054", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.32, "maximum": 23.18, "gross_charge": 23.9, "discounted_cash": 35.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATE KIT CASSETT", "code_information": [{"code": "3100205243", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.8, "discounted_cash": 35.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PROSTATE LASER ENUCLEATION", "code_information": [{"code": "52649", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATE SPECF ANTIG", "code_information": [{"code": "84153", "type": "CPT"}, {"code": "3440100978", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.39, "maximum": 160.05, "gross_charge": 165.0, "discounted_cash": 29.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 160.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATE SPECF ANTIG", "code_information": [{"code": "84154", "type": "CPT"}, {"code": "3440100979", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 18.39, "maximum": 193.03, "gross_charge": 199.0, "discounted_cash": 29.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 169.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 149.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 139.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 193.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 139.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 149.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 169.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 159.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH CC", "code_information": [{"code": "666", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7779.49, "maximum": 7779.49, "discounted_cash": 19174.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7779.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITH MCC", "code_information": [{"code": "665", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18675.58, "maximum": 18675.58, "discounted_cash": 34488.45, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18675.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "667", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4844.89, "maximum": 4844.89, "discounted_cash": 11718.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4844.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTATIC MICROWAVE THERMOTX", "code_information": [{"code": "53850", "type": "CPT"}], "standard_charges": [{"minimum": 2013.63, "maximum": 2013.63, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF THERMOT", "code_information": [{"code": "53852", "type": "CPT"}, {"code": "3480103192", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2013.63, "maximum": 11828.18, "gross_charge": 12194.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11828.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF THERMOT", "code_information": [{"code": "53852", "type": "CPT"}, {"code": "3480103255", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 2013.63, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF WATER V", "code_information": [{"code": "C9748", "type": "HCPCS"}, {"code": "3480103290", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2013.63, "maximum": 5929.61, "gross_charge": 6113.0, "discounted_cash": 9169.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5196.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4584.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4279.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5929.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4279.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4584.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5196.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4890.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTATIC RF WATER V", "code_information": [{"code": "C9748", "type": "HCPCS"}, {"code": "3480103291", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 2013.63, "maximum": 6873.42, "gross_charge": 7086.0, "discounted_cash": 10629.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6023.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5314.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4960.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6873.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4960.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5314.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6023.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5668.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTH RETINA RECEIVE&GEN", "code_information": [{"code": "100T", "type": "CPT"}], "standard_charges": [{"minimum": 3980.08, "maximum": 3980.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS BREAST IN", "code_information": [{"code": "19340", "type": "CPT"}, {"code": "3480101408", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 10986.22, "gross_charge": 11326.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10986.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9060.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS MODIFICATION", "code_information": [{"code": "D5875", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS RICHARDS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 626.5, "maximum": 868.15, "gross_charge": 895.0, "discounted_cash": 1342.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 760.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 671.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 626.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 868.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 626.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 671.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 760.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 716.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTHESIS RICHARDS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 634.9, "maximum": 879.79, "gross_charge": 907.0, "discounted_cash": 1360.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 770.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 680.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 879.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 634.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 680.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 770.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 725.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROSTHETIC TRAING 1ST ENC", "code_information": [{"code": "97761", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTHODONT HIGH NOBLE METAL", "code_information": [{"code": "D6210", "type": "HCPCS"}], "standard_charges": [{"minimum": 757.39, "maximum": 757.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 757.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROSTRATE SATURATION", "code_information": [{"code": "55706", "type": "CPT"}, {"code": "3480103300", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 2013.63, "maximum": 6848.2, "gross_charge": 7060.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6001.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5295.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4942.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6848.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4942.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5295.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6001.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5648.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTAMINE SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2720", "type": "HCPCS"}, {"code": "3400300271", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.13, "maximum": 30.45, "gross_charge": 31.4, "discounted_cash": 47.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 26.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 25.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTECTIVE RESTORATION", "code_information": [{"code": "D2940", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN ANALYSIS W/PROBE", "code_information": [{"code": "88372", "type": "CPT"}], "standard_charges": [{"minimum": 26.22, "maximum": 43.61, "discounted_cash": 42.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN C CONCENTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2724", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.03, "maximum": 15.03, "discounted_cash": 24.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELECTROPHORT", "code_information": [{"code": "84166", "type": "CPT"}, {"code": "3440100984", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 17.83, "maximum": 156.17, "gross_charge": 161.0, "discounted_cash": 28.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 156.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.67, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN ELECTROPHRTC", "code_information": [{"code": "84165", "type": "CPT"}, {"code": "3440100983", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 10.74, "maximum": 93.12, "gross_charge": 96.0, "discounted_cash": 17.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN TOTAL", "code_information": [{"code": "84156", "type": "CPT"}, {"code": "3440100981", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.67, "maximum": 32.98, "gross_charge": 34.0, "discounted_cash": 5.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN TOTAL SER/PL", "code_information": [{"code": "84155", "type": "CPT"}, {"code": "3440100980", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.67, "maximum": 32.98, "gross_charge": 34.0, "discounted_cash": 5.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN TOTL XCPT RF", "code_information": [{"code": "84157", "type": "CPT"}, {"code": "3440100982", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.0, "maximum": 32.98, "gross_charge": 34.0, "discounted_cash": 6.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.41, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTERN BLOT TISSUE", "code_information": [{"code": "88371", "type": "CPT"}], "standard_charges": [{"minimum": 22.23, "maximum": 43.61, "discounted_cash": 35.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTEIN WESTRN BLOT", "code_information": [{"code": "84182", "type": "CPT"}, {"code": "3440100985", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 29.21, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 46.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 37.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 31.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN COMPLEX KCENTRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7168", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 3.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN TEST", "code_information": [{"code": "85611", "type": "CPT"}], "standard_charges": [{"minimum": 3.94, "maximum": 20.47, "discounted_cash": 6.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN TIME", "code_information": [{"code": "85610", "type": "CPT"}, {"code": "3440101050", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 4.29, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTHROMBIN TIME (PO", "code_information": [{"code": "85610", "type": "CPT"}, {"code": "3440101049", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 4.29, "maximum": 34.92, "gross_charge": 36.0, "discounted_cash": 6.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTON TREATMENT COMPLEX", "code_information": [{"code": "77525", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 2171.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT INTERMEDIATE", "code_information": [{"code": "77523", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 2171.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/COMP", "code_information": [{"code": "77522", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 2171.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTON TRMT SIMPLE W/O COMP", "code_information": [{"code": "77520", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROTOZOA ANTIBODY NOS", "code_information": [{"code": "86753", "type": "CPT"}], "standard_charges": [{"minimum": 12.39, "maximum": 30.26, "discounted_cash": 19.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PROX INTERPHALAN SZ1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROX INTERPHALAN SZ2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROX INTERPHALAN SZ3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6006.0, "maximum": 8322.6, "gross_charge": 8580.0, "discounted_cash": 12870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8322.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6006.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7293.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROXIMAL FINGER*MCP1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3454.36, "maximum": 4786.75, "gross_charge": 4934.8, "discounted_cash": 7402.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4194.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3701.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3454.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4786.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3454.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3701.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4194.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3947.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PROXIMAL FINGER*MCP1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3454.36, "maximum": 4786.75, "gross_charge": 4934.8, "discounted_cash": 7402.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4194.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3701.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3454.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4786.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3454.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3701.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4194.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3947.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRP I/HERN INIT BLOCK >5 YR", "code_information": [{"code": "49507", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRPERTL PEL PACK HEMRRG TRMA", "code_information": [{"code": "49013", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT 1 ART", "code_information": [{"code": "92924", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD ANGIO/ATHRECT ADDL", "code_information": [{"code": "92925", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC 1VSL", "code_information": [{"code": "92943", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC CHRONIC ADDL", "code_information": [{"code": "92944", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD REVASC MI 1 VSL", "code_information": [{"code": "92941", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO 1 VSL", "code_information": [{"code": "92928", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT W/ANGIO ADDL", "code_information": [{"code": "92929", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92933", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92934", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIO ADDL ART", "code_information": [{"code": "92921", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIOPLAST 1 ART", "code_information": [{"code": "92920", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ CORONARY MECH THROMBECT", "code_information": [{"code": "92973", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT 1 VSL", "code_information": [{"code": "92937", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXC BONE RADIAL H/N", "code_information": [{"code": "24145", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRTL EXCHANGE TRANSFUSE NB", "code_information": [{"code": "36456", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PRX BDY CONE 20X75*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5907.72, "maximum": 8186.41, "gross_charge": 8439.6, "discounted_cash": 12659.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7173.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6329.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5907.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8186.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5907.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6329.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7173.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6751.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRX BDY CONE 24X85*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5907.72, "maximum": 8186.41, "gross_charge": 8439.6, "discounted_cash": 12659.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7173.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6329.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5907.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8186.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5907.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6329.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7173.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6751.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PS BEARING 10MM*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PS BEARING 11MM*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PS BEARING 11MM*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PS BEARING 14MM*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PS TIB BEARING7 10M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5405.4, "maximum": 7490.34, "gross_charge": 7722.0, "discounted_cash": 11583.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6563.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5791.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5405.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7490.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5405.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5791.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6563.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6177.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PS TIB BEARING7 12M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4500.86, "maximum": 6236.9, "gross_charge": 6429.8, "discounted_cash": 9644.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5465.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4822.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4500.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6236.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4500.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4822.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5465.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5143.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSA SCREENING", "code_information": [{"code": "G0103", "type": "HCPCS"}, {"code": "3440101251", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 19.31, "maximum": 187.21, "gross_charge": 193.0, "discounted_cash": 31.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSEUDOANEURYSM INJECTION TRT", "code_information": [{"code": "36002", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 705.33, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSY EVALUATION OF RECORDS", "code_information": [{"code": "90885", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 14 GENES", "code_information": [{"code": "173U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 748.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 15 GENES", "code_information": [{"code": "175U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 2146.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYC MOOD DO MRNA 144 GENES", "code_information": [{"code": "291U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2819.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYC STRS DO MRNA 72 GENES", "code_information": [{"code": "292U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2819.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYC SUICIDAL IDEA MRNA 54", "code_information": [{"code": "293U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 1220.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAG EVAL W/MED SRVCS", "code_information": [{"code": "90792", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCH DIAGNOSTIC EVALUATION", "code_information": [{"code": "90791", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCHOANALYSIS", "code_information": [{"code": "90845", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCHOED SVC, PER 15 MIN", "code_information": [{"code": "H2027", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCHOPHYSIOLOGICAL THERAPY", "code_information": [{"code": "90875", "type": "CPT"}], "standard_charges": [{"minimum": 142.4, "maximum": 142.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCHOPHYSIOLOGICAL THERAPY", "code_information": [{"code": "90876", "type": "CPT"}], "standard_charges": [{"minimum": 142.4, "maximum": 142.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCHOSES", "code_information": [{"code": "885", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4378.23, "maximum": 4378.23, "discounted_cash": 15255.26, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4378.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96130", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP EA", "code_information": [{"code": "96131", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TECH 1ST", "code_information": [{"code": "96138", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST AUTO RESULT", "code_information": [{"code": "96146", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP 1ST", "code_information": [{"code": "96136", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP EA", "code_information": [{"code": "96137", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST TECH EA", "code_information": [{"code": "96139", "type": "CPT"}], "standard_charges": [{"minimum": 433.43, "maximum": 433.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 433.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYSOC REHAB SVC, PER 15 MIN", "code_information": [{"code": "H2017", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYSOC REHAB SVC, PER DIEM", "code_information": [{"code": "H2018", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX COMPLEX INTERACTIVE", "code_information": [{"code": "90785", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS EA ADDL 30 MIN", "code_information": [{"code": "90840", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX CRISIS INITIAL 60 MIN", "code_information": [{"code": "90839", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 30 MINUTES", "code_information": [{"code": "90832", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 45 MINUTES", "code_information": [{"code": "90834", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT 60 MINUTES", "code_information": [{"code": "90837", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 30 MIN", "code_information": [{"code": "90833", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 45 MIN", "code_information": [{"code": "90836", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYTX W PT W E/M 60 MIN", "code_information": [{"code": "90838", "type": "CPT"}], "standard_charges": [{"minimum": 153.97, "maximum": 153.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 153.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT EDUCATION NOC GROUP", "code_information": [{"code": "S9446", "type": "HCPCS"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT EDUCATION NOC INDIVID", "code_information": [{"code": "S9445", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT EVAL HIGH COMPLEX", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "3330100557", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 529.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL HIGH COMPLEX 45 MIN", "code_information": [{"code": "97163", "type": "CPT"}], "standard_charges": [{"minimum": 145.07, "maximum": 145.07, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT EVAL LOW COMPLEX", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "3330100555", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 529.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL LOW COMPLEX 20 MIN", "code_information": [{"code": "97161", "type": "CPT"}], "standard_charges": [{"minimum": 145.07, "maximum": 145.07, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT EVAL MOD COMPLEX", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "3330100556", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 353.0, "discounted_cash": 529.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT EVAL MOD COMPLEX 30 MIN", "code_information": [{"code": "97162", "type": "CPT"}], "standard_charges": [{"minimum": 145.07, "maximum": 145.07, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT EVALUATION", "code_information": [{"code": "97001", "type": "CPT"}, {"code": "3330100554", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 287.0, "discounted_cash": 430.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT GAIT TRAINING EA", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "3330100425", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT IN THE HOME PER DIEM", "code_information": [{"code": "S9131", "type": "HCPCS"}], "standard_charges": [{"minimum": 145.07, "maximum": 145.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT OR MANIP FOR MAINT", "code_information": [{"code": "S8990", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT PROGRAMMER*3856", "code_information": [{"code": "3100202885", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97164", "type": "CPT"}], "standard_charges": [{"minimum": 145.07, "maximum": 145.07, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT RE-EVALUATION", "code_information": [{"code": "97002", "type": "CPT"}, {"code": "3330103021", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 135.8, "maximum": 188.18, "gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 188.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 145.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT RE-EVALUATION EST", "code_information": [{"code": "97164", "type": "CPT"}, {"code": "3330103022", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT THERAPEUTC ACTIVT", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "3330100427", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT THERAPEUTC EXERCS", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "3330100424", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 165.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT ULTRASOUND EA 15", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "3330100423", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT WHIRLPOOL 1 OR >", "code_information": [{"code": "97022", "type": "CPT"}, {"code": "3330100422", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PT-FOCUSED HLTH RISK ASSMT", "code_information": [{"code": "96160", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT/CAREGIVER TRAING HOME INR", "code_information": [{"code": "93792", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PTA GAIT TRAINING EA", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "3330103023", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 97.0, "discounted_cash": 145.5, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA MANUAL THERAPY E", "code_information": [{"code": "97140", "type": "CPT"}, {"code": "3330103026", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 183.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THERAPEUTIC ACT", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "3330103025", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTA THERAPUETIC EX E", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "3330103024", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 110.0, "discounted_cash": 165.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CQ"}, {"description": "PTEN FULL GENE ANALYSIS", "code_information": [{"code": "235U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 963.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PTEN GENE DUP/DELET VARIANT", "code_information": [{"code": "81323", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 300.0, "discounted_cash": 481.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PTEN GENE FULL SEQUENCE", "code_information": [{"code": "81321", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 600.0, "discounted_cash": 963.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PTEN GENE KNOWN FAM VARIANT", "code_information": [{"code": "81322", "type": "CPT"}], "standard_charges": [{"minimum": 46.6, "maximum": 79.66, "discounted_cash": 74.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUDENDAL NERVE/SPINE", "code_information": [{"code": "64430", "type": "CPT"}, {"code": "3480103333", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3051.62, "gross_charge": 3146.0, "discounted_cash": 1395.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2674.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 961.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2359.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3051.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 958.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2359.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1106.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2674.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2516.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 930.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 948.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1385.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92997", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUL ART BALLOON REPR PERCUT", "code_information": [{"code": "92998", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM DS IPF MRNA 190 GEN ALG", "code_information": [{"code": "81554", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 5500.0, "discounted_cash": 8835.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5500.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM FUNCT TST PLETHYSMOGRAP", "code_information": [{"code": "94726", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM FUNCTION TEST BY GAS", "code_information": [{"code": "94727", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM STRSS TST-6-MIN", "code_information": [{"code": "94618", "type": "CPT"}, {"code": "3310100273", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 401.58, "gross_charge": 414.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 351.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 310.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 401.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 310.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 351.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 331.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULM SURGERY 1ST 30", "code_information": [{"code": "3480103129", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3293.0, "discounted_cash": 4939.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [{"code": "189", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6787.15, "maximum": 6787.15, "discounted_cash": 13754.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6787.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [{"code": "175", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7366.33, "maximum": 7366.33, "discounted_cash": 15663.89, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7366.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [{"code": "176", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4702.87, "maximum": 4702.87, "discounted_cash": 9105.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4702.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULMONARY REHABILITATION PRO", "code_information": [{"code": "S9473", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULP CAP DIRECT", "code_information": [{"code": "D3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULP CAP INDIRECT", "code_information": [{"code": "D3120", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULP VITALITY TEST", "code_information": [{"code": "D0460", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION COMPLETE", "code_information": [{"code": "D3357", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION INITIAL", "code_information": [{"code": "D3355", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULPAL REGENERATION INTERIM", "code_information": [{"code": "D3356", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULPAL THERAPY ANTERIOR PRIM", "code_information": [{"code": "D3230", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULPAL THERAPY POSTERIOR PRI", "code_information": [{"code": "D3240", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULSAVAC*00515047501", "code_information": [{"code": "3100207487", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.92, "discounted_cash": 209.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSE GENERATOR 2 PO", "code_information": [{"code": "3100205118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSE GENERATOR V IN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25515.0, "maximum": 35356.5, "gross_charge": 36450.0, "discounted_cash": 54675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30982.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27337.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25515.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35356.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25515.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27337.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30982.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE GENERATOR*3028", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100206295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 25515.0, "maximum": 35356.5, "gross_charge": 36450.0, "discounted_cash": 54675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30982.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27337.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25515.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35356.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25515.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27337.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30982.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE GENERATOR*6240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 31885.0, "maximum": 44183.5, "gross_charge": 45550.0, "discounted_cash": 68325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38717.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 34162.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31885.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 44183.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31885.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 34162.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38717.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE GENERATOR*DB-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 23142.0, "maximum": 32068.2, "gross_charge": 33060.0, "discounted_cash": 49590.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28101.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 24795.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23142.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32068.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23142.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 24795.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28101.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OX MULTIPLE DE", "code_information": [{"code": "94761", "type": "CPT"}, {"code": "3310100287", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 18.9, "maximum": 26.19, "gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OX MULTIPLE DE", "code_information": [{"code": "94761", "type": "CPT"}, {"code": "3340100576", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 88.2, "maximum": 122.22, "gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OX OVERNIGHT M", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "3310100288", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 424.86, "gross_charge": 438.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 306.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 424.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 306.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 350.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULSE OX OVERNIGHT M", "code_information": [{"code": "94762", "type": "CPT"}, {"code": "3340100577", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 424.86, "gross_charge": 438.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 306.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 424.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 306.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 328.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 372.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 350.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PULSE OX SINGLE DET", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "3310100286", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 10.5, "maximum": 14.55, "gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSE OX SINGLE DET", "code_information": [{"code": "94760", "type": "CPT"}, {"code": "3340100575", "type": "CDM"}, {"code": "460", "type": "RC"}], "standard_charges": [{"minimum": 31.5, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PULSEVAC TIP", "code_information": [{"code": "3100101511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.0, "discounted_cash": 151.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSEVAC TIP", "code_information": [{"code": "3100103216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSEVAC TIP", "code_information": [{"code": "3100103217", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PULSEVAC ZIMMER FAN", "code_information": [{"code": "3100101512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP & CYLINDER PROS", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100101513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10087.0, "maximum": 13977.7, "gross_charge": 14410.0, "discounted_cash": 21615.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12248.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10807.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10087.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13977.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10087.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10807.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12248.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11528.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP 700 12X15CM*724", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16168.57, "maximum": 22405.02, "gross_charge": 23097.96, "discounted_cash": 34646.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19633.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17323.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16168.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22405.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16168.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17323.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19633.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18478.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP 700 12X18CM*724", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17947.1, "maximum": 24869.55, "gross_charge": 25638.72, "discounted_cash": 38458.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21792.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19229.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17947.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24869.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17947.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19229.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21792.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20510.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP 700 12X21CM*724", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15723.21, "maximum": 21787.88, "gross_charge": 22461.74, "discounted_cash": 33692.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19092.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16846.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15723.21, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 21787.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15723.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16846.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19092.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17969.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP 700 12X21CM*724", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17975.1, "maximum": 24908.35, "gross_charge": 25678.72, "discounted_cash": 38518.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21826.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19259.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17975.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24908.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17975.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19259.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21826.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20542.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP 700 12X21CM*724", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17947.1, "maximum": 24869.55, "gross_charge": 25638.72, "discounted_cash": 38458.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21792.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19229.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17947.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24869.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17947.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19229.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21792.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20510.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP FLOWONIX", "code_information": [{"code": "3100104084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22400.0, "discounted_cash": 33600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUMP FLOWONIX", "code_information": [{"code": "C1755", "type": "HCPCS"}, {"code": "3100102384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15120.0, "maximum": 20952.0, "gross_charge": 21600.0, "discounted_cash": 32400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18360.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15120.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20952.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15120.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16200.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18360.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP MS 700 LGX*7240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12304.16, "maximum": 17050.05, "gross_charge": 17577.38, "discounted_cash": 26366.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14940.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13183.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12304.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17050.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12304.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13183.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14940.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14061.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP MS 700 LGX*7240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12304.16, "maximum": 17050.05, "gross_charge": 17577.38, "discounted_cash": 26366.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14940.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13183.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12304.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17050.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12304.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13183.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14940.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14061.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP MS 700 LGX*7240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 20593.3, "maximum": 28536.43, "gross_charge": 29419.0, "discounted_cash": 44128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25006.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22064.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 20593.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 28536.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 20593.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22064.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25006.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 23535.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP MS 700 LGX*7240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17947.1, "maximum": 24869.55, "gross_charge": 25638.72, "discounted_cash": 38458.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21792.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19229.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17947.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24869.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17947.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19229.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21792.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20510.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP MS 700*72404257", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12148.5, "maximum": 16834.35, "gross_charge": 17355.0, "discounted_cash": 26032.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14751.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13016.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12148.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16834.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12148.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13016.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14751.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13884.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP MS 700*72404258", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12304.16, "maximum": 17050.05, "gross_charge": 17577.38, "discounted_cash": 26366.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14940.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13183.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12304.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17050.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12304.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13183.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14940.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14061.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP PAIN*8637-20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19171.6, "maximum": 26566.36, "gross_charge": 27388.0, "discounted_cash": 41082.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23279.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20541.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19171.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26566.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19171.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20541.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23279.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21910.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP PRECON 12CM X70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14654.01, "maximum": 20306.27, "gross_charge": 20934.3, "discounted_cash": 31401.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17794.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15700.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14654.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20306.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14654.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15700.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17794.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16747.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP PRECON 12MMX21C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11817.75, "maximum": 16376.02, "gross_charge": 16882.5, "discounted_cash": 25323.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14350.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12661.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11817.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16376.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11817.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12661.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14350.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13506.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP PRECON 15CM X70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11501.47, "maximum": 15937.75, "gross_charge": 16430.68, "discounted_cash": 24646.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13966.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12323.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11501.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15937.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11501.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12323.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13966.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13144.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP PRECON 18CMX12M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12148.5, "maximum": 16834.35, "gross_charge": 17355.0, "discounted_cash": 26032.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14751.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13016.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12148.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16834.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12148.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13016.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14751.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13884.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP PRECON 18X700*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11817.75, "maximum": 16376.02, "gross_charge": 16882.5, "discounted_cash": 25323.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14350.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12661.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11817.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16376.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11817.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12661.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14350.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13506.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP RECON", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12808.6, "maximum": 17749.06, "gross_charge": 18298.0, "discounted_cash": 27447.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15553.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13723.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12808.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17749.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12808.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13723.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15553.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14638.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUMP TITAN TOUCH", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9766.12, "maximum": 13533.05, "gross_charge": 13951.6, "discounted_cash": 20927.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11858.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10463.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9766.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13533.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9766.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10463.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11858.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11161.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCH BIOPSY", "code_information": [{"code": "3100101514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN EA SEP/ADDL", "code_information": [{"code": "11105", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCH BX SKIN SINGLE LESION", "code_information": [{"code": "11104", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCH SM JOINT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIR/ABSCE", "code_information": [{"code": "10160", "type": "CPT"}, {"code": "3480101293", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 484.2, "gross_charge": 439.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 373.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 329.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 307.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 425.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 307.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 329.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 373.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 351.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCTURE ASPIRATION", "code_information": [{"code": "10160", "type": "CPT"}, {"code": "3480101294", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 484.2, "gross_charge": 480.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUNCTURE OF SHUNT FO", "code_information": [{"code": "61070", "type": "CPT"}, {"code": "3430102304", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1639.3, "gross_charge": 1690.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1436.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1267.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1183.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1639.3, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1183.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1267.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1436.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1352.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUNCTURE/CLEAR WINDPIPE", "code_information": [{"code": "31612", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1282.05, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURAPLY 1 SQ CM", "code_information": [{"code": "Q4195", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.23, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 71.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURAPLY AM 1 SQ CM", "code_information": [{"code": "Q4196", "type": "HCPCS"}], "standard_charges": [{"minimum": 104.16, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 104.16, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURAPLY XT 1 SQ CM", "code_information": [{"code": "Q4197", "type": "HCPCS"}], "standard_charges": [{"minimum": 121.63, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 121.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURE TONE AUDIOMETRY AIR", "code_information": [{"code": "92552", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PURE TONE HEARING TEST AIR", "code_information": [{"code": "92551", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUSHLOCK 2.9X12.5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 882.0, "maximum": 1222.2, "gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1222.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUSHLOCK BIOCOM2.5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUSHLOCK HIP 2.4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 882.0, "maximum": 1222.2, "gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1222.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1008.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUSHLOCK SHORT", "code_information": [{"code": "3100104737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PUTTY APEX DBM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY APEX DBM", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY APEX DBM 1CC*D", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY APEX DBM 2.5CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1270.5, "maximum": 1760.55, "gross_charge": 1815.0, "discounted_cash": 2722.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1542.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1361.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1760.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1361.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1542.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1452.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 0.5CC PROG", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 10CC INTEG", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 4088.5, "discounted_cash": 6132.75, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 10CC PROGE", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3182.0, "discounted_cash": 4773.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 1CC PROGEN", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 5CC INTEGR", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2320.5, "discounted_cash": 3480.75, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 5CC INTEGR", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1020.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM 5CC PROGEN", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM BIO 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM BIO 10CC*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM BIO 5CC*77", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1418.29, "maximum": 1965.35, "gross_charge": 2026.14, "discounted_cash": 3039.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1722.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1519.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1418.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1965.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1418.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1519.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1722.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM INTEGRA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100102324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 612.0, "discounted_cash": 918.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM INTEGRA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 584.0, "discounted_cash": 876.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM INTEGRA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 4739.0, "discounted_cash": 7108.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM INTEGRA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2135.0, "discounted_cash": 3202.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBM INTEGRA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3416.0, "discounted_cash": 5124.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1701.0, "discounted_cash": 2551.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX .5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 4017.0, "discounted_cash": 6025.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 10CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 4056.0, "discounted_cash": 6084.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 2.5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2704.0, "discounted_cash": 4056.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1836.0, "discounted_cash": 2754.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DBX 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100103222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2717.0, "discounted_cash": 4075.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY DMB BIO 5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2026.0, "discounted_cash": 3039.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY EVO", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 5476.0, "discounted_cash": 8214.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY EVO", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2552.0, "discounted_cash": 3828.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY GRAFTON", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 2009.0, "discounted_cash": 3013.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PUTTY MOZIAK INTEGRA", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100101529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1868.0, "discounted_cash": 2802.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC 2ND+ INJ SITE", "code_information": [{"code": "64462", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC CONT INFUSION", "code_information": [{"code": "64463", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PVB THORACIC SINGLE INJ SITE", "code_information": [{"code": "64461", "type": "CPT"}], "standard_charges": [{"minimum": 985.68, "maximum": 985.68, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY COMPLICATED", "code_information": [{"code": "50135", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/DRG PYELOSTOMY", "code_information": [{"code": "50125", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYRIDOXINE HCL 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3415", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.0, "maximum": 15.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Pancreas Transplant, Major", "code_information": [{"code": "6.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 138664.71, "maximum": 138664.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138664.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pancreas Transplant, Minor", "code_information": [{"code": "6.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 94620.83, "maximum": 94620.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 94620.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pancreas Transplant, Moderate", "code_information": [{"code": "6.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 120375.14, "maximum": 120375.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 120375.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pancreas Transplant, Severe", "code_information": [{"code": "6.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 197206.19, "maximum": 197206.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 197206.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Partial Thickness Burns Without Skin Graft, Major", "code_information": [{"code": "844.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12916.24, "maximum": 12916.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12916.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Partial Thickness Burns Without Skin Graft, Minor", "code_information": [{"code": "844.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3880.38, "maximum": 3880.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3880.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Partial Thickness Burns Without Skin Graft, Moderate", "code_information": [{"code": "844.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9335.73, "maximum": 9335.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9335.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Partial Thickness Burns Without Skin Graft, Severe", "code_information": [{"code": "844.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35429.63, "maximum": 35429.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35429.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pathogen test for platelets", "code_information": [{"code": "Q9987", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Patient Convenience Items Other", "code_information": [{"code": "999", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 5285.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures, Major", "code_information": [{"code": "510.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55447.94, "maximum": 55447.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55447.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures, Minor", "code_information": [{"code": "510.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14598.85, "maximum": 14598.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14598.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures, Moderate", "code_information": [{"code": "510.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24761.14, "maximum": 24761.14, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24761.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pelvic Evisceration, Radical Hysterectomy And Other Radical Gynecological Procedures, Severe", "code_information": [{"code": "510.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 75058.74, "maximum": 75058.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 75058.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Penis, Testes And Scrotal Procedures, Major", "code_information": [{"code": "483.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24056.32, "maximum": 24056.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24056.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Penis, Testes And Scrotal Procedures, Minor", "code_information": [{"code": "483.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11719.32, "maximum": 11719.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11719.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Penis, Testes And Scrotal Procedures, Moderate", "code_information": [{"code": "483.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15497.18, "maximum": 15497.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15497.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Penis, Testes And Scrotal Procedures, Severe", "code_information": [{"code": "483.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46981.07, "maximum": 46981.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46981.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peptic Ulcer And Gastritis, Major", "code_information": [{"code": "241.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14985.86, "maximum": 14985.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14985.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peptic Ulcer And Gastritis, Minor", "code_information": [{"code": "241.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8001.69, "maximum": 8001.69, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8001.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peptic Ulcer And Gastritis, Moderate", "code_information": [{"code": "241.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9654.82, "maximum": 9654.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9654.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peptic Ulcer And Gastritis, Severe", "code_information": [{"code": "241.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33121.65, "maximum": 33121.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33121.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Perc av fistula, direct", "code_information": [{"code": "C9754", "type": "HCPCS"}], "standard_charges": [{"minimum": 5104.6, "maximum": 5104.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention With Ami, Major", "code_information": [{"code": "174.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26006.76, "maximum": 26006.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26006.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention With Ami, Minor", "code_information": [{"code": "174.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21160.13, "maximum": 21160.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21160.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention With Ami, Moderate", "code_information": [{"code": "174.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22250.68, "maximum": 22250.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22250.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention With Ami, Severe", "code_information": [{"code": "174.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 44562.88, "maximum": 44562.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44562.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention Without Ami, Major", "code_information": [{"code": "175.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32625.71, "maximum": 32625.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32625.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention Without Ami, Minor", "code_information": [{"code": "175.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16947.84, "maximum": 16947.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16947.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention Without Ami, Moderate", "code_information": [{"code": "175.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28028.97, "maximum": 28028.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28028.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiac Intervention Without Ami, Severe", "code_information": [{"code": "175.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 60611.11, "maximum": 60611.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60611.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With MCC Or 4+ Arteries Or Stents", "code_information": [{"code": "246", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15750.82, "maximum": 15750.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15750.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without MCC", "code_information": [{"code": "247", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10420.21, "maximum": 10420.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10420.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With MCC Or 4+ Arteries Or Stents", "code_information": [{"code": "248", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18206.46, "maximum": 18206.46, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18206.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without MCC", "code_information": [{"code": "249", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9732.21, "maximum": 9732.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9732.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Intracranial And Extracranial Vascular Procedures, Major", "code_information": [{"code": "30.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 63135.66, "maximum": 63135.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63135.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Intracranial And Extracranial Vascular Procedures, Minor", "code_information": [{"code": "30.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21606.09, "maximum": 21606.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21606.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Intracranial And Extracranial Vascular Procedures, Moderate", "code_information": [{"code": "30.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46082.74, "maximum": 46082.74, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46082.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Intracranial And Extracranial Vascular Procedures, Severe", "code_information": [{"code": "30.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 94793.84, "maximum": 94793.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 94793.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Structural Cardiac Procedures, Major", "code_information": [{"code": "183.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 76837.46, "maximum": 76837.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76837.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Structural Cardiac Procedures, Minor", "code_information": [{"code": "183.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 60558.56, "maximum": 60558.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60558.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Structural Cardiac Procedures, Moderate", "code_information": [{"code": "183.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62293.72, "maximum": 62293.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62293.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Percutaneous Structural Cardiac Procedures, Severe", "code_information": [{"code": "183.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 108021.48, "maximum": 108021.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 108021.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral And Other Vascular Disorders, Major", "code_information": [{"code": "197.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15748.35, "maximum": 15748.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15748.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral And Other Vascular Disorders, Minor", "code_information": [{"code": "197.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7181.53, "maximum": 7181.53, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7181.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral And Other Vascular Disorders, Moderate", "code_information": [{"code": "197.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9650.98, "maximum": 9650.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9650.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral And Other Vascular Disorders, Severe", "code_information": [{"code": "197.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20855.13, "maximum": 20855.13, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20855.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral, Cranial And Autonomic Nerve Disorders, Major", "code_information": [{"code": "48.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15502.31, "maximum": 15502.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15502.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral, Cranial And Autonomic Nerve Disorders, Minor", "code_information": [{"code": "48.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9666.35, "maximum": 9666.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9666.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral, Cranial And Autonomic Nerve Disorders, Moderate", "code_information": [{"code": "48.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9832.95, "maximum": 9832.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9832.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peripheral, Cranial And Autonomic Nerve Disorders, Severe", "code_information": [{"code": "48.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43765.79, "maximum": 43765.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43765.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peritoneal Adhesiolysis, Major", "code_information": [{"code": "224.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26671.86, "maximum": 26671.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26671.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peritoneal Adhesiolysis, Minor", "code_information": [{"code": "224.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16367.32, "maximum": 16367.32, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16367.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peritoneal Adhesiolysis, Moderate", "code_information": [{"code": "224.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21024.29, "maximum": 21024.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21024.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Peritoneal Adhesiolysis, Severe", "code_information": [{"code": "224.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 66749.49, "maximum": 66749.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 66749.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock, Major", "code_information": [{"code": "170.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 47529.55, "maximum": 47529.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47529.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock, Minor", "code_information": [{"code": "170.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32993.5, "maximum": 32993.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32993.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock, Moderate", "code_information": [{"code": "170.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34419.81, "maximum": 34419.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34419.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant With Ami, Heart Failure Or Shock, Severe", "code_information": [{"code": "170.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 65300.11, "maximum": 65300.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65300.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock, Major", "code_information": [{"code": "171.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35758.98, "maximum": 35758.98, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35758.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock, Minor", "code_information": [{"code": "171.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21179.35, "maximum": 21179.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21179.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock, Moderate", "code_information": [{"code": "171.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27939.26, "maximum": 27939.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27939.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock, Severe", "code_information": [{"code": "171.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46172.45, "maximum": 46172.45, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46172.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pharmacy - Extension Of 025x Drugs Requiring Detailed Coding", "code_information": [{"code": "636", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pharmacy - Extension Of 025x Self-Administerable Drugs", "code_information": [{"code": "637", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pharmacy General", "code_information": [{"code": "250", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pharmacy Ivsolutions", "code_information": [{"code": "258", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Physical Therapy, Evaluation Or Reevaluation", "code_information": [{"code": "424", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Physical Therapy, General", "code_information": [{"code": "420", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Placement Of Scalp Electrodes For Assessment And Recording Of Responses From Several Areas Of The Nerve-Brain Hearing System, Infant", "code_information": [{"code": "92586", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Plate path red/rapid bac tes", "code_information": [{"code": "P9072", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Platelets, pathogen reduced", "code_information": [{"code": "Q9988", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Poisoning Of Medicinal Agents, Major", "code_information": [{"code": "812.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10328.89, "maximum": 10328.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10328.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Poisoning Of Medicinal Agents, Minor", "code_information": [{"code": "812.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4462.18, "maximum": 4462.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4462.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Poisoning Of Medicinal Agents, Moderate", "code_information": [{"code": "812.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6881.66, "maximum": 6881.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6881.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Poisoning Of Medicinal Agents, Severe", "code_information": [{"code": "812.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18329.29, "maximum": 18329.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18329.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure, Major", "code_information": [{"code": "711.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 36102.42, "maximum": 36102.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 36102.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure, Minor", "code_information": [{"code": "711.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12101.2, "maximum": 12101.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12101.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure, Moderate", "code_information": [{"code": "711.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17565.52, "maximum": 17565.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17565.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Trauma, Other Device Infections With O.R. Procedure, Severe", "code_information": [{"code": "711.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 66869.95, "maximum": 66869.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 66869.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Traumatic, Other Device Infections, Major", "code_information": [{"code": "721.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15845.75, "maximum": 15845.75, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15845.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Traumatic, Other Device Infections, Minor", "code_information": [{"code": "721.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7862.0, "maximum": 7862.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7862.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Traumatic, Other Device Infections, Moderate", "code_information": [{"code": "721.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10273.79, "maximum": 10273.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10273.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Post-Operative, Post-Traumatic, Other Device Infections, Severe", "code_information": [{"code": "721.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26357.89, "maximum": 26357.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26357.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnoses Without Procedure, Major", "code_information": [{"code": "561.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7405.79, "maximum": 7405.79, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7405.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnoses Without Procedure, Minor", "code_information": [{"code": "561.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3955.99, "maximum": 3955.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3955.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnoses Without Procedure, Moderate", "code_information": [{"code": "561.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5573.24, "maximum": 5573.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5573.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnoses Without Procedure, Severe", "code_information": [{"code": "561.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21128.09, "maximum": 21128.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21128.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnosis With O.R. Procedure, Major", "code_information": [{"code": "548.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42903.34, "maximum": 42903.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42903.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnosis With O.R. Procedure, Minor", "code_information": [{"code": "548.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5187.51, "maximum": 5187.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5187.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnosis With O.R. Procedure, Moderate", "code_information": [{"code": "548.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11824.4, "maximum": 11824.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11824.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Postpartum And Post Abortion Diagnosis With O.R. Procedure, Severe", "code_information": [{"code": "548.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 49382.6, "maximum": 49382.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 49382.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Preventive Care Services, Vaccine Administration", "code_information": [{"code": "771", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services, Major", "code_information": [{"code": "850.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 47391.15, "maximum": 47391.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 47391.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services, Minor", "code_information": [{"code": "850.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23054.19, "maximum": 23054.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23054.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services, Moderate", "code_information": [{"code": "850.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38657.73, "maximum": 38657.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38657.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Health Services, Severe", "code_information": [{"code": "850.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 89614.01, "maximum": 89614.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89614.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedures For Obesity, Major", "code_information": [{"code": "403.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28213.5, "maximum": 28213.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28213.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedures For Obesity, Minor", "code_information": [{"code": "403.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14422.0, "maximum": 14422.0, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14422.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedures For Obesity, Moderate", "code_information": [{"code": "403.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15586.88, "maximum": 15586.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15586.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedures For Obesity, Severe", "code_information": [{"code": "403.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 56406.5, "maximum": 56406.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56406.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procenta, per 100 mg", "code_information": [{"code": "Q4310", "type": "HCPCS"}], "standard_charges": [{"minimum": 3409.6, "maximum": 3409.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3409.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x And 097x) Clinic", "code_information": [{"code": "983", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x And 097x) Consultation", "code_information": [{"code": "988", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x And 097x) Hospital Visit", "code_information": [{"code": "987", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Professional Fees (Extension Of 096x And 097x) Outpatient Services", "code_information": [{"code": "982", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea During Sleep Study", "code_information": [{"code": "436T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Programming Evaluation Of Implanted Neurostimulator Pulse Generator System For Central Sleep Apnea In One Session", "code_information": [{"code": "435T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pulmonary Embolism, Major", "code_information": [{"code": "134.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15481.8, "maximum": 15481.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15481.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pulmonary Embolism, Minor", "code_information": [{"code": "134.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7450.64, "maximum": 7450.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7450.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pulmonary Embolism, Moderate", "code_information": [{"code": "134.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10277.63, "maximum": 10277.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10277.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pulmonary Embolism, Severe", "code_information": [{"code": "134.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29259.21, "maximum": 29259.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29259.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pulmonary Function, General", "code_information": [{"code": "460", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Pulmonary rehab w exer", "code_information": [{"code": "G0424", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Pulse Generator Analysis Of A Vagus Nerve Blocking Therapy System For Treatment Of Obesity", "code_information": [{"code": "317T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Puraply or puraply am", "code_information": [{"code": "Q4172", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Puraply, puraply antimic", "code_information": [{"code": "C9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Q FEVER ANTIBODY", "code_information": [{"code": "86638", "type": "CPT"}], "standard_charges": [{"minimum": 12.12, "maximum": 30.26, "discounted_cash": 19.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUADPRO HARVESTER *A", "code_information": [{"code": "3100207270", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1338.75, "discounted_cash": 2008.13, "setting": "both", "billing_class": "facility"}]}, {"description": "QUADPRO HARVESTER *A", "code_information": [{"code": "3100207315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1338.75, "discounted_cash": 2008.13, "setting": "both", "billing_class": "facility"}]}, {"description": "QUADPRO HARVESTER *A", "code_information": [{"code": "3100207316", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "billing_class": "facility"}]}, {"description": "QUADRANT TIP LIGHT*2", "code_information": [{"code": "3100206686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 876.0, "discounted_cash": 1314.0, "setting": "both", "billing_class": "facility"}]}, {"description": "QUAN MR TIS WO MRI 1ORGN", "code_information": [{"code": "648T", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1526.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUAN MR TIS WO MRI MLT ORGN", "code_information": [{"code": "697T", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 1526.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI 1ORGN", "code_information": [{"code": "649T", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 1526.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUAN MR TISS W/MRI MLT ORGN", "code_information": [{"code": "698T", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 1526.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUAN US TIS CHARAC W/DX US", "code_information": [{"code": "690T", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUAN US TIS CHARAC W/O DX US", "code_information": [{"code": "689T", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUANT OF THERA DRUG,", "code_information": [{"code": "80299", "type": "CPT"}, {"code": "3440103084", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 18.64, "maximum": 104.76, "gross_charge": 108.0, "discounted_cash": 29.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 104.76, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 75.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 91.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 86.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "QUICK STRIP", "code_information": [{"code": "3100102223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "QUICKSET KIT 16CC*AB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5446.35, "maximum": 7547.08, "gross_charge": 7780.5, "discounted_cash": 11670.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6613.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5835.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5446.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7547.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5446.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5835.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6613.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6224.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUICKSET KIT 5CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2802.8, "maximum": 3883.88, "gross_charge": 4004.0, "discounted_cash": 6006.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3883.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUICKSET KIT 5CC*AR-", "code_information": [{"code": "3100202398", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4004.0, "discounted_cash": 6006.0, "setting": "both", "billing_class": "facility"}]}, {"description": "QUICKSET KIT 8CC*ABS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3630.9, "maximum": 5031.39, "gross_charge": 5187.0, "discounted_cash": 7780.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4408.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3890.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3630.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5031.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3630.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3890.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4408.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4149.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "QUINUPRISTIN/DALFOPRISTIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2770", "type": "HCPCS"}], "standard_charges": [{"minimum": 493.97, "maximum": 493.97, "discounted_cash": 793.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 493.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT ART/GRFT ANGIO", "code_information": [{"code": "93457", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93594", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93593", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R HRT CORONARY ARTERY ANGIO", "code_information": [{"code": "93456", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&B SEMIPRIVIATE", "code_information": [{"code": "3340100556", "type": "CDM"}, {"code": "120", "type": "RC"}], "standard_charges": [{"gross_charge": 1448.0, "discounted_cash": 2172.0, "setting": "both", "billing_class": "facility"}]}, {"description": "R&B TELEMETRY", "code_information": [{"code": "3340100555", "type": "CDM"}, {"code": "120", "type": "RC"}], "standard_charges": [{"gross_charge": 2108.0, "discounted_cash": 3162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93460", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT ART/VENTRICLE ANGIO", "code_information": [{"code": "93461", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD ABNL NT CNJ", "code_information": [{"code": "93597", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH CHD NML NT CNJ", "code_information": [{"code": "93596", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R&L HRT CATH W/VENTRICLGRPHY", "code_information": [{"code": "93453", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "R-T SPCTRL ALYS PRST8 TISS", "code_information": [{"code": "443T", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RA TRACER ID OF SENTINL NODE", "code_information": [{"code": "38792", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RABIES IG HEAT TREATED", "code_information": [{"code": "90376", "type": "CPT"}], "standard_charges": [{"minimum": 479.72, "maximum": 479.72, "discounted_cash": 770.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 479.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"minimum": 250.98, "maximum": 250.98, "discounted_cash": 411.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 250.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC", "code_information": [{"code": "90375", "type": "CPT"}], "standard_charges": [{"minimum": 285.65, "maximum": 285.65, "discounted_cash": 465.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 285.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "discounted_cash": 448.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM", "code_information": [{"code": "90675", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 322.77, "discounted_cash": 521.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 322.77, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD EXC LESION UP TO 1.25 CM", "code_information": [{"code": "D7410", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM DSTL/SHFT HUM", "code_information": [{"code": "24150", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E <5CM", "code_information": [{"code": "24077", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR 3 CM/>", "code_information": [{"code": "26118", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR < 3 CM", "code_information": [{"code": "26117", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUM RADIAL H/N", "code_information": [{"code": "24152", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAD RESECTION TUMOR", "code_information": [{"code": "21936", "type": "CPT"}, {"code": "3480101480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2542.29, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIAL FORCEP", "code_information": [{"code": "3100103223", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.2, "discounted_cash": 48.3, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL HEAD BIOMET E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2100.0, "maximum": 2910.0, "gross_charge": 3000.0, "discounted_cash": 4500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2550.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2910.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2550.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL IMP SZ 1*3481", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7322.77, "maximum": 10147.26, "gross_charge": 10461.1, "discounted_cash": 15691.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8891.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7845.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7322.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10147.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7322.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7845.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8891.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8368.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL IMPLANT SZ 2L", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7322.63, "maximum": 10147.07, "gross_charge": 10460.9, "discounted_cash": 15691.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8891.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7845.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7322.63, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10147.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7322.63, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7845.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8891.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8368.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL IMPLANT SZ 2R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7322.77, "maximum": 10147.26, "gross_charge": 10461.1, "discounted_cash": 15691.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8891.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7845.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7322.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10147.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7322.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7845.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8891.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8368.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL JAW W NDL", "code_information": [{"code": "3100101531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.0, "discounted_cash": 141.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIAL STEM EXPLOR M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2489.9, "maximum": 3450.29, "gross_charge": 3557.0, "discounted_cash": 5335.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3023.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2667.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2489.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3450.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2489.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2667.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3023.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2845.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION APPLICATOR", "code_information": [{"code": "D5983", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION CONE LOCATOR", "code_information": [{"code": "D5985", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION HANDLING", "code_information": [{"code": "77790", "type": "CPT"}, {"code": "3270102305", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 46.2, "maximum": 196.25, "gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77370", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION SHIELD", "code_information": [{"code": "D5984", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY DOSE PLAN", "code_information": [{"code": "77300", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 586.07, "maximum": 586.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 586.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77262", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77263", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT", "code_information": [{"code": "77332", "type": "CPT"}, {"code": "3270102303", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 138.46, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 207.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 143.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 141.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 142.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 164.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 138.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 138.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 141.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77333", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77334", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77401", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 183.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77402", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 183.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77407", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77412", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 411.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6003", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6004", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6005", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6006", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6007", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6008", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6009", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6010", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6012", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "G6014", "type": "HCPCS"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TX DELIVERY IMRT", "code_information": [{"code": "G6015", "type": "HCPCS"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 586.07, "maximum": 586.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 586.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECT ABD TUMOR<5CM", "code_information": [{"code": "22904", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADICAL RESECTION OF ELBOW", "code_information": [{"code": "24149", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIO/SURGICAL IMPLANT INDEX", "code_information": [{"code": "D6190", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIOLOGY PORT IMAGES(S)", "code_information": [{"code": "77417", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY", "code_information": [{"code": "849", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15297.68, "maximum": 15297.68, "discounted_cash": 30048.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15297.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIOTHERAPY DOSE PLAN IMRT", "code_information": [{"code": "77301", "type": "CPT"}], "standard_charges": [{"minimum": 2192.96, "maximum": 2192.96, "discounted_cash": 2120.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2192.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RADIUM RA223 DICHLORIDE THER", "code_information": [{"code": "A9606", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.0, "maximum": 155.0, "discounted_cash": 258.9, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 155.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RANCHO 1H*103451", "code_information": [{"code": "3100209131", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 677.7, "discounted_cash": 1016.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RANCHO 3H*103453", "code_information": [{"code": "3100209132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 865.35, "discounted_cash": 1298.03, "setting": "both", "billing_class": "facility"}]}, {"description": "RANIBIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2778", "type": "HCPCS"}], "standard_charges": [{"minimum": 173.38, "maximum": 173.38, "discounted_cash": 301.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 173.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RANITIDINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2780", "type": "HCPCS"}, {"code": "3400300064", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 5.25, "maximum": 12.23, "gross_charge": 7.5, "discounted_cash": 11.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAPICIDE PA PART A/B", "code_information": [{"code": "3100104623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 292.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RAPICIDE PA PART A/B", "code_information": [{"code": "401937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 195.0, "discounted_cash": 292.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RAPICIDE PA TEST STR", "code_information": [{"code": "3100104624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RAPID DESENSITIZATION", "code_information": [{"code": "95180", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RAR DO WHL GN&MTCDRL DNA ALS", "code_information": [{"code": "265U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 8796.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DO ID OPT GEN MAPG&SEQ", "code_information": [{"code": "267U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 10826.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS EA COMP", "code_information": [{"code": "213U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 4353.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DS GEN DNA ALYS PROBAND", "code_information": [{"code": "212U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 8795.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "260U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2029.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DS ID OPT GENOME MAPG", "code_information": [{"code": "264U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 2029.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS EA COMP", "code_information": [{"code": "215U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 4136.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RARE DS XOM DNA ALYS PROBAND", "code_information": [{"code": "214U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 8393.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RASBURICASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2783", "type": "HCPCS"}], "standard_charges": [{"minimum": 367.48, "maximum": 367.48, "discounted_cash": 590.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 367.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RASP DISTAL 10MM*121", "code_information": [{"code": "3100208945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP DISTAL 8MM*121-", "code_information": [{"code": "3100209786", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP PROMIMAL 10MM*1", "code_information": [{"code": "3100208944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP PROMIMAL 8MM*12", "code_information": [{"code": "3100209787", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.0, "discounted_cash": 1143.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP STRYKER", "code_information": [{"code": "3100101536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 786.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RASP STRYKER", "code_information": [{"code": "3100103224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 567.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RB82 RUBIDIUM", "code_information": [{"code": "A9555", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RBC DEGLYCEROLIZED", "code_information": [{"code": "P9039", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 499.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC DEPLETION OF HARVEST", "code_information": [{"code": "38212", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 10 BLD GROUPS", "code_information": [{"code": "84U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1156.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNOTYP 16 BLD GROUPS", "code_information": [{"code": "246U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1156.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC DNA GNTYP 12 BLD GRP GEN", "code_information": [{"code": "282U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1156.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC DNA HEA 35 AG 11 BLD GRP", "code_information": [{"code": "1U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1156.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC IRRADIATED", "code_information": [{"code": "P9038", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 348.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC MECHANICAL FRAGILITY", "code_information": [{"code": "85547", "type": "CPT"}], "standard_charges": [{"minimum": 8.6, "maximum": 20.92, "discounted_cash": 13.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85555", "type": "CPT"}], "standard_charges": [{"minimum": 7.47, "maximum": 20.92, "discounted_cash": 12.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC OSMOTIC FRAGILITY", "code_information": [{"code": "85557", "type": "CPT"}], "standard_charges": [{"minimum": 13.36, "maximum": 20.92, "discounted_cash": 21.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX ID DILUTION", "code_information": [{"code": "86976", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ DRUGS", "code_information": [{"code": "86975", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC SERUM PRETX INCUBJ/INHIB", "code_information": [{"code": "86977", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC, FRZ/DEG/WSH, L/R, IRRAD", "code_information": [{"code": "P9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 791.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RBC, L/R, CMV-NEG, IRRAD", "code_information": [{"code": "P9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 388.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96931", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96932", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96933", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96934", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96935", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RCM CELULR SUBCELULR IMG SKN", "code_information": [{"code": "96936", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RE-CEMENT OR RE-BOND CROWN", "code_information": [{"code": "D2920", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RE-EVAL POST-OP VISIT", "code_information": [{"code": "D0171", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RE-EVAL,EST PT,PROBLEM FOCUS", "code_information": [{"code": "D0170", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORATION OF CHEST", "code_information": [{"code": "32120", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RE-EXPLORE PARATHYROIDS", "code_information": [{"code": "60502", "type": "CPT"}], "standard_charges": [{"minimum": 5635.04, "maximum": 5635.04, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGN EXTENSOR TEN", "code_information": [{"code": "26437", "type": "CPT"}, {"code": "3480103043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF HAND", "code_information": [{"code": "25335", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27455", "type": "CPT"}, {"code": "3340102422", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2228.1, "maximum": 5894.92, "gross_charge": 3183.0, "discounted_cash": 4774.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2705.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2387.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2228.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3087.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2228.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2387.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2705.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2546.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF KNEE", "code_information": [{"code": "27457", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF LOWER LEG", "code_information": [{"code": "27712", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REALIGNMENT OF THIGH BONE", "code_information": [{"code": "27454", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REAM TUBE HOLLOW 309", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 495.39, "maximum": 686.46, "gross_charge": 707.7, "discounted_cash": 1061.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 601.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 530.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 495.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 686.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 495.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 530.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 601.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 566.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REAMER", "code_information": [{"code": "3100101537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 2448.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER", "code_information": [{"code": "3100104573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 10MM*20043201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 432.6, "maximum": 599.46, "gross_charge": 618.0, "discounted_cash": 927.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 525.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 463.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 432.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 599.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 432.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 463.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 525.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REAMER 14MM*20004600", "code_information": [{"code": "3100208104", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 16MM*20004600", "code_information": [{"code": "3100208197", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 2.0 X 110*XFO", "code_information": [{"code": "3100202947", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 504.66, "discounted_cash": 756.99, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER 6MM*200134", "code_information": [{"code": "3100208103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 894.0, "discounted_cash": 1341.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARTH CANN 10M", "code_information": [{"code": "3100205274", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 678.0, "discounted_cash": 1017.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARTH CANN 11M", "code_information": [{"code": "3100205958", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 678.0, "discounted_cash": 1017.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARTH CANN 12M", "code_information": [{"code": "3100205959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 678.0, "discounted_cash": 1017.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARTH CANNULA", "code_information": [{"code": "3100205273", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARTH LOW PROF", "code_information": [{"code": "3100101538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER ARTHREX CANNU", "code_information": [{"code": "3100101539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 677.25, "discounted_cash": 1015.88, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER BONE TAP 6.5*", "code_information": [{"code": "3100204888", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CAN 6MM*AR-89", "code_information": [{"code": "3100203502", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANN 3.2*AR-8", "code_information": [{"code": "3100207122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANN 3.2MM*CS", "code_information": [{"code": "3100203483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 915.0, "discounted_cash": 1372.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANN 4.0*AR-8", "code_information": [{"code": "3100205731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANN 4.0*AR-8", "code_information": [{"code": "3100206325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CANN 4.0MM*CS", "code_information": [{"code": "3100203482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CIRCULAR MTP", "code_information": [{"code": "3100101540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE SZ1*R", "code_information": [{"code": "3100209583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE SZ2*R", "code_information": [{"code": "3100209584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE SZ3*R", "code_information": [{"code": "3100209707", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE SZ4*R", "code_information": [{"code": "3100209383", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2304.4, "discounted_cash": 3456.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE*AR415", "code_information": [{"code": "3100207603", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE-016*X", "code_information": [{"code": "3100202949", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1593.66, "discounted_cash": 2390.49, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONCAVE-018*X", "code_information": [{"code": "3100202948", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1593.66, "discounted_cash": 2390.49, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX SZ1*RM", "code_information": [{"code": "3100209585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX SZ2*RM", "code_information": [{"code": "3100209586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX SZ3*RM", "code_information": [{"code": "3100209706", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1146.0, "discounted_cash": 1719.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX SZ4*RM", "code_information": [{"code": "3100209382", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2304.4, "discounted_cash": 3456.6, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CONVEX*AR4158", "code_information": [{"code": "3100207604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER CORING 9MM*AR", "code_information": [{"code": "3100207477", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER FUSION 30/35D", "code_information": [{"code": "3100205200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER GUIDE BUSHING", "code_information": [{"code": "3100204456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER GUIDE SCREW*1", "code_information": [{"code": "3100204455", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HEAD ANG*AR-9", "code_information": [{"code": "3100206377", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HEAD ANG*AR-9", "code_information": [{"code": "3100207090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HEAD RIA", "code_information": [{"code": "3100101541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1109.0, "discounted_cash": 1663.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HOLLOW", "code_information": [{"code": "3100104699", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1211.0, "discounted_cash": 1816.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER HOLLOW COMPLE", "code_information": [{"code": "3100101542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1076.0, "discounted_cash": 1614.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER LOW PROFILE", "code_information": [{"code": "3100101543", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER METATARSAL", "code_information": [{"code": "3100101544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1417.5, "discounted_cash": 2126.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PHALANGEAL", "code_information": [{"code": "3100101545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1417.5, "discounted_cash": 2126.25, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER PILOTED HEADE", "code_information": [{"code": "3100101546", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER TUBE", "code_information": [{"code": "3100104700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 758.0, "discounted_cash": 1137.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REAMER X-POST4.6*118", "code_information": [{"code": "3100208942", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.0, "discounted_cash": 1233.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REATTACH INTEGSHOR G", "code_information": [{"code": "3100101547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4223.0, "discounted_cash": 6334.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REATTACH TOOTH FRAGMENT", "code_information": [{"code": "D2921", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBASE HYBRID PROSTHESIS", "code_information": [{"code": "D5725", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBOUND MATRIX, PER SQ CM", "code_information": [{"code": "Q4296", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRU", "code_information": [{"code": "69632", "type": "CPT"}, {"code": "3340102418", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69633", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69636", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD EARDRUM STRUCTURES", "code_information": [{"code": "69637", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69310", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REBUILD OUTER EAR CANAL", "code_information": [{"code": "69320", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEIPT&PREP CAR-T CLL ADMN", "code_information": [{"code": "539T", "type": "CPT"}], "standard_charges": [{"minimum": 186.01, "maximum": 186.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 186.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT CAST OR PREFAB POST", "code_information": [{"code": "D2915", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT FIXED RETAINER MAN", "code_information": [{"code": "D8699", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT FIXED RETAINER MAX", "code_information": [{"code": "D8698", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT INLAY ONLAY OR PART", "code_information": [{"code": "D2910", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT SPACE MAINT - MAN", "code_information": [{"code": "D1552", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT SPACE MAINT - MAX", "code_information": [{"code": "D1551", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT SUPP CROWN", "code_information": [{"code": "D6092", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT SUPP PART DENTURE", "code_information": [{"code": "D6093", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT UNILAT SPACE MAINT", "code_information": [{"code": "D1553", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECEMENT/BOND PART DENTURE", "code_information": [{"code": "D6930", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35301", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35302", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35303", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35305", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35306", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35311", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35321", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35331", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35351", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35355", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35361", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35363", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35371", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35372", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECHARGER KIT*RS5200", "code_information": [{"code": "3100206011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECHARGER PROGRAMMER", "code_information": [{"code": "3100204038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1671.0, "discounted_cash": 2506.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RECHARGING SYSTEM*RS", "code_information": [{"code": "3100210031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5980.0, "discounted_cash": 8970.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECON LAT COLL LIG E", "code_information": [{"code": "24344", "type": "CPT"}, {"code": "3480101566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6065.8, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/GRAFT", "code_information": [{"code": "21194", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST LWR JAW W/O FIXATION", "code_information": [{"code": "21195", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONST SHLDR TOTAL", "code_information": [{"code": "23472", "type": "CPT"}, {"code": "3480101544", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 22630.21, "gross_charge": 15094.0, "discounted_cash": 28525.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12829.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19663.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10565.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14641.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10565.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19587.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22630.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12829.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12075.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19016.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19397.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ANKLE JOINT", "code_information": [{"code": "27702", "type": "CPT"}], "standard_charges": [{"minimum": 14671.65, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT BRONCHUS", "code_information": [{"code": "31775", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT FOOT", "code_information": [{"code": "28360", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42200", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42205", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42210", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42215", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42220", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CLEFT PALATE", "code_information": [{"code": "42225", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21182", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21183", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT CRANIAL BONE", "code_information": [{"code": "21184", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24360", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24362", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW MED LIGMNT", "code_information": [{"code": "24346", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT EXTRA FINGER", "code_information": [{"code": "26587", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT FINGER JOINT", "code_information": [{"code": "26545", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24365", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT HEAD OF RADIUS", "code_information": [{"code": "24366", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40527", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21255", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LWR JAW", "code_information": [{"code": "21199", "type": "CPT"}, {"code": "3340102465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3105.66, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MAXILLA SEGMENT", "code_information": [{"code": "D7947", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE NO GRAFT", "code_information": [{"code": "D7948", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT MIDFACE W/GRAFT", "code_information": [{"code": "D7949", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21172", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ORBIT/FOREHEAD", "code_information": [{"code": "21175", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT SHLD JNT", "code_information": [{"code": "23470", "type": "CPT"}, {"code": "3480101543", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 32598.79, "gross_charge": 33607.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28565.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25205.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23524.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32598.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23524.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25205.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28565.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26885.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ULNA/RADIOULNAR", "code_information": [{"code": "25337", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT UPPER JAW BONE", "code_information": [{"code": "21206", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 1", "code_information": [{"code": "53420", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA STAGE 2", "code_information": [{"code": "53425", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT VENA CAVA", "code_information": [{"code": "34502", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31780", "type": "CPT"}], "standard_charges": [{"minimum": 3345.07, "maximum": 3345.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WINDPIPE", "code_information": [{"code": "31781", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25441", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25442", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25443", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25444", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT WRIST JOINT", "code_information": [{"code": "25445", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION ANKLE JOINT", "code_information": [{"code": "27703", "type": "CPT"}], "standard_charges": [{"minimum": 14671.65, "maximum": 14671.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION BREAS", "code_information": [{"code": "19350", "type": "CPT"}, {"code": "3480101410", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6324.4, "gross_charge": 6520.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6324.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4564.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4890.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5542.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION BREAS", "code_information": [{"code": "19357", "type": "CPT"}, {"code": "3480101411", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 21398.7, "gross_charge": 15967.0, "discounted_cash": 26973.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13571.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18593.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11975.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11176.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15487.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18341.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11176.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18521.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11975.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17982.1, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21398.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13571.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17982.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12773.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17982.1, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18341.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION BREAS", "code_information": [{"code": "19366", "type": "CPT"}, {"code": "3480101413", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 12909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7541.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION BREAS", "code_information": [{"code": "19380", "type": "CPT"}, {"code": "3480101416", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 10986.22, "gross_charge": 11326.0, "discounted_cash": 9981.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6880.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10986.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7928.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6854.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8494.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7918.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9627.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9060.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6654.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6787.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27428", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION KNEE", "code_information": [{"code": "27429", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MAXILLA TOTAL", "code_information": [{"code": "D7946", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MIDFA", "code_information": [{"code": "21141", "type": "CPT"}, {"code": "3480101459", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2900.8, "maximum": 7111.29, "gross_charge": 4144.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3522.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2900.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4019.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2900.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3108.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3522.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3315.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MIDFA", "code_information": [{"code": "21142", "type": "CPT"}, {"code": "3480101460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2981.3, "maximum": 7111.29, "gross_charge": 4259.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3620.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3194.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2981.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4131.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2981.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3194.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3620.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3407.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION MIDFA", "code_information": [{"code": "21145", "type": "CPT"}, {"code": "3480101461", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2751.0, "maximum": 6211.31, "gross_charge": 3930.0, "discounted_cash": 5895.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3340.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2947.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2751.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3812.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2751.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2947.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3340.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3144.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ANUS", "code_information": [{"code": "46753", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF BILE DUCTS", "code_information": [{"code": "47800", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21120", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21121", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21122", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF CHIN", "code_information": [{"code": "21123", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF DI", "code_information": [{"code": "27420", "type": "CPT"}, {"code": "3480101700", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF DI", "code_information": [{"code": "27422", "type": "CPT"}, {"code": "3480101701", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14004.86, "gross_charge": 14438.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14004.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11550.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EY", "code_information": [{"code": "67973", "type": "CPT"}, {"code": "3340102368", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6745.38, "gross_charge": 6954.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5910.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5215.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4867.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6745.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4867.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5215.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5910.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5563.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67971", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67974", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF EYELID", "code_information": [{"code": "67975", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HI", "code_information": [{"code": "27122", "type": "CPT"}, {"code": "3480103103", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2602.6, "maximum": 4985.78, "gross_charge": 3718.0, "discounted_cash": 5577.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3160.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2788.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2602.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3606.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2602.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2788.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3160.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2974.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF HIP SOCKET", "code_information": [{"code": "27120", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JA", "code_information": [{"code": "21246", "type": "CPT"}, {"code": "3480103136", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21245", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21248", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW", "code_information": [{"code": "21249", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21242", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF JAW JOINT", "code_information": [{"code": "21243", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MA", "code_information": [{"code": "21193", "type": "CPT"}, {"code": "3480101462", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3105.66, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MA", "code_information": [{"code": "21196", "type": "CPT"}, {"code": "3480101463", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2665.6, "maximum": 7111.29, "gross_charge": 3808.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3236.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2856.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2665.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3693.76, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2665.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2856.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3236.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3046.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MIDFACE", "code_information": [{"code": "21188", "type": "CPT"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40840", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40842", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40843", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40844", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF MOUTH", "code_information": [{"code": "40845", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NAIL BED", "code_information": [{"code": "11762", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF NOSE", "code_information": [{"code": "30400", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF ORBIT", "code_information": [{"code": "21256", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF PYLORUS", "code_information": [{"code": "43800", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF STERNUM", "code_information": [{"code": "21740", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF THROAT", "code_information": [{"code": "42950", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53415", "type": "CPT"}], "standard_charges": [{"minimum": 6427.58, "maximum": 6427.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "53430", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54308", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54312", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54316", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54318", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54322", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54324", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF URETHRA", "code_information": [{"code": "54326", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF WINDPIPE", "code_information": [{"code": "31766", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION TONGUE FOLD", "code_information": [{"code": "41520", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION, TOE(", "code_information": [{"code": "28344", "type": "CPT"}, {"code": "3480101772", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RECOVERY RM EA AD 15", "code_information": [{"code": "3360102296", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY RM EXTENDED", "code_information": [{"code": "3350000003", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 93.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY RM INITL 30", "code_information": [{"code": "3360102297", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 1033.0, "discounted_cash": 1549.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY RM PHSE 2 E", "code_information": [{"code": "3350000002", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 50.0, "discounted_cash": 75.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECOVERY RM PHSE 2 I", "code_information": [{"code": "3350000001", "type": "CDM"}, {"code": "710", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 159.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH CC", "code_information": [{"code": "333", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13084.28, "maximum": 13084.28, "discounted_cash": 23216.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13084.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITH MCC", "code_information": [{"code": "332", "type": "MS-DRG"}], "standard_charges": [{"minimum": 25582.01, "maximum": 25582.01, "discounted_cash": 40500.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25582.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECTAL RESECTION WITHOUT CC/MCC", "code_information": [{"code": "334", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8622.43, "maximum": 8622.43, "discounted_cash": 17920.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8622.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECTAL SENSATION TEST", "code_information": [{"code": "91120", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [{"code": "811", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7714.94, "maximum": 7714.94, "discounted_cash": 15670.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7714.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [{"code": "812", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4744.67, "maximum": 4744.67, "discounted_cash": 10055.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4744.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS", "code_information": [{"code": "P9021", "type": "HCPCS"}, {"code": "3470101274", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 146.2, "maximum": 621.77, "gross_charge": 641.0, "discounted_cash": 219.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 544.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 151.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 480.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 621.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 149.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 150.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 480.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 173.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 544.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 512.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 149.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS AUTO", "code_information": [{"code": "P9021", "type": "HCPCS"}, {"code": "3470101275", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 146.2, "maximum": 621.77, "gross_charge": 641.0, "discounted_cash": 219.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 544.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 151.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 480.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 621.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 149.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 448.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 150.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 480.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 173.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 544.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 512.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 149.12, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS LR", "code_information": [{"code": "P9016", "type": "HCPCS"}, {"code": "3470101272", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 188.68, "maximum": 949.63, "gross_charge": 979.0, "discounted_cash": 290.49, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 832.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 200.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 685.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 949.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 197.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 685.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 199.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 734.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.66, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 230.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 832.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 193.66, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 197.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED BLOOD CELLS LR/I", "code_information": [{"code": "P9040", "type": "HCPCS"}, {"code": "3470101278", "type": "CDM"}, {"code": "390", "type": "RC"}], "standard_charges": [{"minimum": 188.68, "maximum": 1119.38, "gross_charge": 1154.0, "discounted_cash": 405.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 980.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 865.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 807.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1119.38, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 807.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 278.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 865.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 270.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 321.79, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 980.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 270.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 923.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 270.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 275.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS MULTIPLE", "code_information": [{"code": "78121", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED CELL MASS SINGLE", "code_information": [{"code": "78120", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED CELL SEQUESTRATION", "code_information": [{"code": "78140", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RED CELL SURVIVAL STUDY", "code_information": [{"code": "78130", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDO COMPL CARDIAC ANOMALY", "code_information": [{"code": "33622", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDO ENDOVAS VENA CAVA FILTR", "code_information": [{"code": "37192", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCE BOWEL OBSTRUCTION", "code_information": [{"code": "44050", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCE TESTIS TORSION", "code_information": [{"code": "54600", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1927.74, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCT COMPND FACIAL BONE FX", "code_information": [{"code": "D7780", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCT SIMPLE FACIAL BONE FX", "code_information": [{"code": "D7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FACIAL BONES", "code_information": [{"code": "21209", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21137", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21138", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF FOREHEAD", "code_information": [{"code": "21139", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF RECTAL PROLAPSE", "code_information": [{"code": "45900", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62115", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REDUCTION OF SKULL DEFECT", "code_information": [{"code": "62117", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": "49014", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REFIL/MAINT IMPL PUM", "code_information": [{"code": "96522", "type": "CPT"}, {"code": "3340100589", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 652.81, "gross_charge": 673.0, "discounted_cash": 328.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 572.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 226.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 471.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 652.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 471.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 260.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 572.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 538.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REFILL & MAINT PORT", "code_information": [{"code": "96521", "type": "CPT"}, {"code": "3340100588", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 652.81, "gross_charge": 673.0, "discounted_cash": 328.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 572.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 226.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 471.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 652.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 471.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 260.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 572.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 538.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 218.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REFILL KIT*8551", "code_information": [{"code": "3100208277", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REFITTING OF OBTURATOR", "code_information": [{"code": "D5933", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REGADENOSON INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2785", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.05, "maximum": 7.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGIONAL BLOCK ANESTHESIA", "code_information": [{"code": "D9211", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR H MLT INJ", "code_information": [{"code": "490T", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 299.49, "maximum": 299.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 299.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REGUARD, TOPICAL USE PER SQ", "code_information": [{"code": "Q4255", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REHABILITATION PROGRAM 1/2 D", "code_information": [{"code": "H2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.68, "maximum": 6.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13768.59, "maximum": 13768.59, "discounted_cash": 16852.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13768.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITHOUT CC/MCC", "code_information": [{"code": "946", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6555.97, "maximum": 6555.97, "discounted_cash": 11306.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6555.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT ARTERY EACH", "code_information": [{"code": "35697", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 11018.2, "maximum": 11018.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11018.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE CLAVICLE", "code_information": [{"code": "23490", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE HIP BONES", "code_information": [{"code": "27187", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE HUMERUS", "code_information": [{"code": "24498", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE PULMONARY ARTERY", "code_information": [{"code": "33690", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS AND ULNA", "code_information": [{"code": "25492", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE SHOULDER BONES", "code_information": [{"code": "23491", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE THIGH", "code_information": [{"code": "27495", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE TIBIA", "code_information": [{"code": "27745", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINFORCE ULNA", "code_information": [{"code": "25491", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINNERVATE LARYNX", "code_information": [{"code": "31590", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINSERT OCULAR IMPLANT", "code_information": [{"code": "65155", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REINSERT SPINAL FIXA", "code_information": [{"code": "22849", "type": "CPT"}, {"code": "3480101523", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2233.0, "maximum": 7959.27, "gross_charge": 3190.0, "discounted_cash": 4785.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2711.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2392.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2233.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3094.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2233.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2392.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2711.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2552.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REL PALM W/REL 1 DIG", "code_information": [{"code": "26123", "type": "CPT"}, {"code": "3480101623", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7014.07, "gross_charge": 7231.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REL PALM W/REL EA AD", "code_information": [{"code": "26125", "type": "CPT"}, {"code": "3480101624", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 6223.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE ELBOW JOINT", "code_information": [{"code": "24006", "type": "CPT"}, {"code": "3340102407", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE ENCIRCLING MATERIAL", "code_information": [{"code": "67115", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 902.02, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE EYE TISSUE", "code_information": [{"code": "67343", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69720", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5831.73, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69725", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5831.73, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FACIAL NERVE", "code_information": [{"code": "69955", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FINGER CONTRACTURE", "code_information": [{"code": "26525", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FOOT/TOE NERVE", "code_information": [{"code": "64726", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE FOREARM/HAND TENDON", "code_information": [{"code": "26449", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE HAND/FINGER", "code_information": [{"code": "26445", "type": "CPT"}, {"code": "3480101638", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4829.63, "gross_charge": 4979.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4829.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3983.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE KNUCKLE CONTRACTURE", "code_information": [{"code": "26520", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE MUSCLES OF HAND", "code_information": [{"code": "26593", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT CONTRACTURE", "code_information": [{"code": "28270", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3930.57, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28220", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDON", "code_information": [{"code": "28225", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28222", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF FOOT TENDONS", "code_information": [{"code": "28226", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LOWER LEG TENDONS", "code_information": [{"code": "27681", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28260", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28264", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 7559.22, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61550", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SKULL SEAMS", "code_information": [{"code": "61552", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF TOE JOINT", "code_information": [{"code": "28272", "type": "CPT"}, {"code": "3340102480", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5716.21, "gross_charge": 5893.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5716.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4714.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50715", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50722", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE OF URETER", "code_information": [{"code": "50940", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM & FINGER TENDON", "code_information": [{"code": "26442", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRAC", "code_information": [{"code": "26121", "type": "CPT"}, {"code": "3340102404", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7566.97, "gross_charge": 7801.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.97, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26040", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM CONTRACTURE", "code_information": [{"code": "26045", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE PALM/FINGER", "code_information": [{"code": "26440", "type": "CPT"}, {"code": "3480101637", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE SHOULDER JOINT", "code_information": [{"code": "23020", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE SPINAL CORD LUMBAR", "code_information": [{"code": "63200", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE TARSAL TUNNE", "code_information": [{"code": "28035", "type": "CPT"}, {"code": "3480103138", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4698.68, "gross_charge": 4844.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4698.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3875.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE THUMB CONTRACTURE", "code_information": [{"code": "26508", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE WRIST/FOREAR", "code_information": [{"code": "25295", "type": "CPT"}, {"code": "3340102366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5564.89, "gross_charge": 5737.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEASE/REVISE URETER", "code_information": [{"code": "50725", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELEIVA CATH ENT SOL", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100101548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1530.76, "maximum": 2121.19, "gross_charge": 2186.8, "discounted_cash": 3280.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1858.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1640.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1530.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2121.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1530.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1640.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1858.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1749.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEIVA CATH ENT SOL", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100103225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1514.1, "maximum": 2098.11, "gross_charge": 2163.0, "discounted_cash": 3244.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1838.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1622.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1514.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2098.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1514.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1622.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1838.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELESE, PER SQ CM", "code_information": [{"code": "Q4257", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RELIEVA BALLOON", "code_information": [{"code": "3100104266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 503.0, "discounted_cash": 754.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVA BALLOON 16X4", "code_information": [{"code": "3100205055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVA BALLOON SINU", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100101549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3048.5, "maximum": 4224.35, "gross_charge": 4355.0, "discounted_cash": 6532.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3701.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3266.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3048.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4224.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3048.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3266.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3701.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3484.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA CATH ENT GDE", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100101550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 777.0, "maximum": 1076.7, "gross_charge": 1110.0, "discounted_cash": 1665.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 943.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 832.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 777.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1076.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 777.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 832.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 943.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA CATH ENT GDE", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100103226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 656.6, "maximum": 909.86, "gross_charge": 938.0, "discounted_cash": 1407.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 797.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 656.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 909.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 656.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 797.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 750.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA CATH ENT TIP", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100101551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 672.0, "maximum": 931.2, "gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 931.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA CATH ENT VOR", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100101552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 325.5, "maximum": 451.05, "gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 451.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA CATH ENT VOR", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100103227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA GUIDE LUMA S", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100101553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 900.9, "maximum": 1248.39, "gross_charge": 1287.0, "discounted_cash": 1930.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1093.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 965.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 900.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1248.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 900.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 965.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1093.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1029.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVA SIDEKICK", "code_information": [{"code": "3100101554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVA SIDEKICK", "code_information": [{"code": "3100103228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVA SPINPLUS *RS", "code_information": [{"code": "3100204239", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5655.0, "discounted_cash": 8482.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVA TRACT BALLOO", "code_information": [{"code": "3100206542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELIEVE BLADDER CONT", "code_information": [{"code": "52640", "type": "CPT"}, {"code": "3480103189", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE BLADDER CONT", "code_information": [{"code": "52640", "type": "CPT"}, {"code": "3480103251", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELIEVE INNER EYE PRESSURE", "code_information": [{"code": "65820", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOAD GIA MED/THICK", "code_information": [{"code": "3100208231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.76, "discounted_cash": 953.64, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD GIA VAS/MED*E", "code_information": [{"code": "3100208230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 635.76, "discounted_cash": 953.64, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 910.92, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 910.92, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ALL WRIST BONE P", "code_information": [{"code": "25215", "type": "CPT"}, {"code": "3480101592", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM BONE FIXATION W/", "code_information": [{"code": "20694", "type": "CPT"}, {"code": "3480101444", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM BONE FOR GRAFT M", "code_information": [{"code": "20902", "type": "CPT"}, {"code": "3480101445", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8687.35, "gross_charge": 8074.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM EXOSTOSIS ANY SITE", "code_information": [{"code": "D7471", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM FB MUSC/TENDON D", "code_information": [{"code": "20525", "type": "CPT"}, {"code": "3480101428", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM FB MUSC/TENDON S", "code_information": [{"code": "20520", "type": "CPT"}, {"code": "3480101427", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "gross_charge": 1177.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1141.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1000.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 941.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM FIXED UNILAT SPACE MAINT", "code_information": [{"code": "D1556", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM FNGRLESION DIST", "code_information": [{"code": "26210", "type": "CPT"}, {"code": "3480101628", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM FOREARM LESION S", "code_information": [{"code": "25075", "type": "CPT"}, {"code": "3480101584", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4569.67, "gross_charge": 4711.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4569.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3297.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3533.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4004.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3768.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM GRAFT FOREARM W/", "code_information": [{"code": "25125", "type": "CPT"}, {"code": "3480101590", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM IMP TOOTH W MUCOPER FLP", "code_information": [{"code": "D7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL ICPMS", "code_information": [{"code": "93297", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV EVAL SCRMS", "code_information": [{"code": "93298", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS PHYS", "code_information": [{"code": "578T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG DEV ICDS TECH", "code_information": [{"code": "579T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/IDS", "code_information": [{"code": "93296", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM INTERROG EVL PM/LDLS PM", "code_information": [{"code": "93294", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM DEV", "code_information": [{"code": "99454", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM MNTR PHYSIOL PARAM SETUP", "code_information": [{"code": "99453", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR ALYS", "code_information": [{"code": "608T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM MNTR PULM FLU MNTR SETUP", "code_information": [{"code": "607T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM MNTR WRLS P-ART PRS SNR", "code_information": [{"code": "93264", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM NONODONTO CYST > 1.25 CM", "code_information": [{"code": "D7461", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM NONODONTO CYST TO 1.25CM", "code_information": [{"code": "D7460", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA DEV SETUP&EDUCAJ", "code_information": [{"code": "604T", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM OCT RTA TECHL SPRT MIN 8", "code_information": [{"code": "605T", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ODONTOGEN CYST > 1.25 CM", "code_information": [{"code": "D7451", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM ODONTOGEN CYST TO 1.25CM", "code_information": [{"code": "D7450", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM OF SUPPORT IMPLA", "code_information": [{"code": "20670", "type": "CPT"}, {"code": "3480101440", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM OF SUPPORT IMPLA", "code_information": [{"code": "20680", "type": "CPT"}, {"code": "3480101441", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2895.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR 1ST 20 MIN", "code_information": [{"code": "99457", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM PHYSIOL MNTR EA ADDL 20", "code_information": [{"code": "99458", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM SHLDR FB DEEP", "code_information": [{"code": "23331", "type": "CPT"}, {"code": "3480101537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4883.9, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 10465.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM SPINE FIX DEV AN", "code_information": [{"code": "22855", "type": "CPT"}, {"code": "3480101527", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1906.1, "maximum": 5178.02, "gross_charge": 2723.0, "discounted_cash": 4084.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2314.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2042.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1906.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2641.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1906.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2042.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2314.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2178.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM SPINE FIX DEV PO", "code_information": [{"code": "22852", "type": "CPT"}, {"code": "3480101526", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1198.4, "maximum": 5178.02, "gross_charge": 1712.0, "discounted_cash": 2568.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1455.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1284.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1198.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1660.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1198.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1284.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1455.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1369.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM TENDON LESION GA", "code_information": [{"code": "25111", "type": "CPT"}, {"code": "3480101586", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST 20 MIN", "code_information": [{"code": "98980", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR 1ST SETUP&EDU", "code_information": [{"code": "98975", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DEV SPLY RESP", "code_information": [{"code": "98976", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR DV SPLY MSCSKL", "code_information": [{"code": "98977", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM THER MNTR EA ADDL 20 MIN", "code_information": [{"code": "98981", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA I&R PHY/QHP", "code_information": [{"code": "706T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA SETUP&EDU", "code_information": [{"code": "704T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM TX AMBLYOPIA TECH SPRT", "code_information": [{"code": "705T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM UNILAT DENT 1 PC RESIN", "code_information": [{"code": "D5286", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM UNILAT DENT FLEX BASE", "code_information": [{"code": "D5284", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM WRIST/FOREARM EX", "code_information": [{"code": "25116", "type": "CPT"}, {"code": "3480101588", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6336.04, "gross_charge": 6532.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6336.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5225.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REM WRIST/FOREARM FL", "code_information": [{"code": "25115", "type": "CPT"}, {"code": "3480101587", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOT IMAGE SUBMIT BY PT", "code_information": [{"code": "G2010", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOT IMG SUB BY PT, NON E/M", "code_information": [{"code": "G2250", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.86, "maximum": 65.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93228", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG REV/REPORT", "code_information": [{"code": "93270", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOTE 30 DAY ECG TECH SUPP", "code_information": [{"code": "93229", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOTE CONTROL KIT*S", "code_information": [{"code": "3100205325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE CONTROL KIT*S", "code_information": [{"code": "3100206721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE CONTROL*2301", "code_information": [{"code": "3100205339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2158.8, "discounted_cash": 3238.2, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE CONTROL*DB-55", "code_information": [{"code": "3100208809", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2352.0, "discounted_cash": 3528.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOTE KIT SCS", "code_information": [{"code": "3100102390", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOV & REPLACE EXT", "code_information": [{"code": "50387", "type": "CPT"}, {"code": "3480103293", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6848.2, "gross_charge": 7060.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6001.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5295.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4942.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6848.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4942.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5295.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6001.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5648.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV & REPLACE EXT", "code_information": [{"code": "50387", "type": "CPT"}, {"code": "3480103294", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5906.33, "gross_charge": 6089.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5175.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4566.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4262.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5906.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4262.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4566.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5175.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4871.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV FB EXT EYE CON", "code_information": [{"code": "65205", "type": "CPT"}, {"code": "3340102311", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "gross_charge": 271.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY LMBR/SAC", "code_information": [{"code": "63307", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERT IDRL BDY THRCLMBR", "code_information": [{"code": "63306", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERT XDRL BDY LMBR/SAC", "code_information": [{"code": "63303", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV VERTBR DCMPRN THRCLMBR", "code_information": [{"code": "63087", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC PENIS PROS COMP", "code_information": [{"code": "54411", "type": "CPT"}], "standard_charges": [{"minimum": 21321.73, "maximum": 21321.73, "discounted_cash": 30876.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOV/REPLC UR SPHINCTR COMP", "code_information": [{"code": "53448", "type": "CPT"}], "standard_charges": [{"minimum": 6427.58, "maximum": 6427.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVABLE PROSTHODONTIC PROC", "code_information": [{"code": "D5899", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVABLE RETAINER ADJUST", "code_information": [{"code": "D8681", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL ABDOMEN LYMPH NODES", "code_information": [{"code": "38564", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL ALLOGRAFT PANCREAS", "code_information": [{"code": "48556", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL AND REPLACEM", "code_information": [{"code": "54410", "type": "CPT"}, {"code": "3480102060", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 42487.94, "gross_charge": 43802.0, "discounted_cash": 30876.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37231.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21283.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32851.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30661.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42487.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30661.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32851.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24495.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37231.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35041.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20584.08, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20995.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL BILIARY DRG CATH", "code_information": [{"code": "47537", "type": "CPT"}], "standard_charges": [{"minimum": 932.72, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL COMPLETE IIMS", "code_information": [{"code": "530T", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL CONTOURING B", "code_information": [{"code": "21029", "type": "CPT"}, {"code": "3480101455", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL CVA - PORT", "code_information": [{"code": "36590", "type": "CPT"}, {"code": "3480101886", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2668.47, "gross_charge": 2751.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2668.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL DUCT GLBLDR CALCULI", "code_information": [{"code": "47544", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL EAR CANAL LE", "code_information": [{"code": "69145", "type": "CPT"}, {"code": "3480102224", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL EMBEDDED FB", "code_information": [{"code": "67938", "type": "CPT"}, {"code": "3480102215", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 590.73, "gross_charge": 609.0, "discounted_cash": 445.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 517.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 307.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 456.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 426.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 426.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 306.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 456.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 353.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 517.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 487.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FB SKIN/AREOLAR TISS", "code_information": [{"code": "D7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY", "code_information": [{"code": "30310", "type": "CPT"}, {"code": "3480101829", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY GUM", "code_information": [{"code": "41805", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY JAWBONE", "code_information": [{"code": "41806", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40804", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL FOREIGN BODY MOUTH", "code_information": [{"code": "40805", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL HAND LESION", "code_information": [{"code": "26115", "type": "CPT"}, {"code": "3480101621", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL HAND LESION", "code_information": [{"code": "26116", "type": "CPT"}, {"code": "3480101622", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS ELECTRODE ONLY", "code_information": [{"code": "531T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IIMS IMPLT MNTR ONLY", "code_information": [{"code": "532T", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL IMPACTED CER", "code_information": [{"code": "69210", "type": "CPT"}, {"code": "3480102226", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 277.43, "gross_charge": 174.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL INFUS PUMP", "code_information": [{"code": "62365", "type": "CPT"}, {"code": "3430100741", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8425.42, "gross_charge": 8686.0, "discounted_cash": 10196.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7383.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7028.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6514.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6080.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8425.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6080.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7001.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6514.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8089.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7383.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6948.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN COMPLEX", "code_information": [{"code": "50225", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL KIDNEY OPEN RADICAL", "code_information": [{"code": "50230", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL MAMMARY IMPL", "code_information": [{"code": "19330", "type": "CPT"}, {"code": "3480101407", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NAIL & MATR", "code_information": [{"code": "11750", "type": "CPT"}, {"code": "3480101331", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1323.08, "gross_charge": 1364.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1159.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1023.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 954.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1323.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 954.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1023.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1159.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1091.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NAIL SNGL S", "code_information": [{"code": "11730", "type": "CPT"}, {"code": "3480101330", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38550", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3504.82, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NECK/ARMPIT LESION", "code_information": [{"code": "38555", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3504.82, "discounted_cash": 9981.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NEUROSTIM EL", "code_information": [{"code": "63661", "type": "CPT"}, {"code": "3480102162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1970.24, "maximum": 6156.59, "gross_charge": 6347.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5394.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4760.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4442.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6156.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4442.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4760.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5394.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5077.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL NON-BIODEGRA", "code_information": [{"code": "11982", "type": "CPT"}, {"code": "3480101338", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 121.8, "maximum": 483.83, "gross_charge": 174.0, "discounted_cash": 609.87, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 483.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ADENOIDS", "code_information": [{"code": "42836", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2399.89, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ALL COMPO", "code_information": [{"code": "54406", "type": "CPT"}, {"code": "3480102058", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9422.58, "gross_charge": 9714.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8256.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7285.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6799.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9422.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6799.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7285.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8256.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7771.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL FISSURE", "code_information": [{"code": "46200", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANAL SETO", "code_information": [{"code": "46030", "type": "CPT"}, {"code": "3480101970", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "gross_charge": 1538.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1307.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1153.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1076.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1491.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1076.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1153.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1307.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1230.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE BONE", "code_information": [{"code": "28130", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE IMPLANT", "code_information": [{"code": "27704", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANKLE/HEEL LESION", "code_information": [{"code": "28100", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ANORECTAL LESION", "code_information": [{"code": "45108", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM ARTERY CLOT", "code_information": [{"code": "34111", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARM FOREI", "code_information": [{"code": "24201", "type": "CPT"}, {"code": "3340102369", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3891.64, "gross_charge": 4012.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3891.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2808.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3009.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3410.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3209.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34001", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34051", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34101", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34151", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ARTERY CLOT", "code_information": [{"code": "34201", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BIVALVING", "code_information": [{"code": "29710", "type": "CPT"}, {"code": "3480101785", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 274.05, "maximum": 642.14, "gross_charge": 662.0, "discounted_cash": 411.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 562.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 283.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 496.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 463.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 642.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 463.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 282.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 496.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 326.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 562.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 529.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 274.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 279.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER", "code_information": [{"code": "51570", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51575", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER & NODES", "code_information": [{"code": "51585", "type": "CPT"}], "standard_charges": [{"minimum": 7264.63, "maximum": 7264.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7264.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER CYST", "code_information": [{"code": "51500", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4772.18, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51520", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51525", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4758.39, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE FOR GRAFT", "code_information": [{"code": "20900", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23140", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23145", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BONE LESION", "code_information": [{"code": "23146", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61514", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN ABSCESS", "code_information": [{"code": "61522", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61510", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61516", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61521", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61524", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61526", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61530", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61534", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61536", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61537", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61538", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61539", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61540", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61543", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN TISSUE", "code_information": [{"code": "61566", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BROW WRINKLES", "code_information": [{"code": "15826", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CALCIUM DEPOSITS", "code_information": [{"code": "23000", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX", "code_information": [{"code": "57530", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CERVIX RADICAL", "code_information": [{"code": "57531", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CHEST LINING", "code_information": [{"code": "32310", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35875", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF CLOT IN GRAFT", "code_information": [{"code": "35876", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLLAR BONE", "code_information": [{"code": "23125", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44150", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON", "code_information": [{"code": "44160", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44151", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44155", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF COLON/ILEOSTOMY", "code_information": [{"code": "44156", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART/LUNG", "code_information": [{"code": "33930", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR LIVER", "code_information": [{"code": "47133", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ELBOW BUR", "code_information": [{"code": "24105", "type": "CPT"}, {"code": "3480101556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPID CATH", "code_information": [{"code": "62355", "type": "CPT"}, {"code": "3430100739", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2908.06, "gross_charge": 2998.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2908.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2098.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2548.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2398.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54860", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4233.32, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIDIDYMIS", "code_information": [{"code": "54861", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EPIGLOTTIS", "code_information": [{"code": "31420", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43107", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43108", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43113", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS", "code_information": [{"code": "43124", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43130", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ESOPHAGUS POUCH", "code_information": [{"code": "43135", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31200", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31201", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2713.61, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ETHMOID SINUS", "code_information": [{"code": "31205", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EXTERNAL EAR", "code_information": [{"code": "69120", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65101", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65110", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE LESION", "code_information": [{"code": "65400", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 708.89, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYELID LE", "code_information": [{"code": "67800", "type": "CPT"}, {"code": "3340102353", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 867.18, "gross_charge": 894.0, "discounted_cash": 445.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 759.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 307.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 670.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 867.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 306.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 670.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 353.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 759.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 715.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FACE WRINKLES", "code_information": [{"code": "15828", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FALLOPIAN TUBE", "code_information": [{"code": "58700", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20920", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FB REACTION", "code_information": [{"code": "D7540", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FINGER TENDON", "code_information": [{"code": "26180", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FASCIA", "code_information": [{"code": "28062", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28190", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28192", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT FOREIGN BODY", "code_information": [{"code": "28193", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOOT JOINT LINING", "code_information": [{"code": "28072", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREARM L", "code_information": [{"code": "25120", "type": "CPT"}, {"code": "3340102379", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FOREIGN BODY", "code_information": [{"code": "27372", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FORHEAD W", "code_information": [{"code": "15824", "type": "CPT"}, {"code": "3480101378", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5126.45, "gross_charge": 5285.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5126.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31080", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31081", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31084", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31085", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31087", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47600", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47605", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47610", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47612", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GALLBLADDER", "code_information": [{"code": "47620", "type": "CPT"}], "standard_charges": [{"minimum": 5632.81, "maximum": 5632.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5632.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF HUMERUS", "code_information": [{"code": "23195", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEAD OF R", "code_information": [{"code": "24130", "type": "CPT"}, {"code": "3480101558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33120", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33130", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", "code_information": [{"code": "33542", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEEL SPUR", "code_information": [{"code": "28119", "type": "CPT"}, {"code": "3340102413", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5716.21, "gross_charge": 5893.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5716.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4714.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP JOINT LINING", "code_information": [{"code": "27054", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27091", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23150", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23155", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HUMERUS LESION", "code_information": [{"code": "23156", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IMPLANT FROM HAND", "code_information": [{"code": "26320", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INFUSION PUMP", "code_information": [{"code": "36262", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INNER EYE LESION", "code_information": [{"code": "66770", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTACT IM", "code_information": [{"code": "19328", "type": "CPT"}, {"code": "3480101406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRANASAL LESION", "code_information": [{"code": "30118", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF INTRAUTRI", "code_information": [{"code": "58301", "type": "CPT"}, {"code": "3480102103", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 167.32, "maximum": 402.55, "gross_charge": 415.0, "discounted_cash": 491.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 338.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 311.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 402.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 333.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 337.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 311.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 327.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 389.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 327.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 332.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 327.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 333.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66605", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5841.07, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66625", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66630", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF IRIS", "code_information": [{"code": "66635", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF ISCHIAL BURSA", "code_information": [{"code": "27060", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW BONE LESION", "code_information": [{"code": "21044", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF JAW JOINT", "code_information": [{"code": "21050", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY", "code_information": [{"code": "50340", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50234", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY & URETER", "code_information": [{"code": "50236", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50280", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KIDNEY LESION", "code_information": [{"code": "50290", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEE CARTILAGE", "code_information": [{"code": "27333", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF KNEECAP", "code_information": [{"code": "27350", "type": "CPT"}, {"code": "3340102452", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31360", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX", "code_information": [{"code": "31365", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX & PHARYNX", "code_information": [{"code": "31390", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31512", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 10632.83, "maximum": 10632.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10632.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG ARTERY CLOT", "code_information": [{"code": "34203", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG EXTRAPLEURAL", "code_information": [{"code": "32445", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION", "code_information": [{"code": "32540", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32140", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LUNG LESION(S)", "code_information": [{"code": "32150", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38700", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 9981.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LYMPH NODES NECK", "code_information": [{"code": "38720", "type": "CPT"}], "standard_charges": [{"minimum": 3504.82, "maximum": 3504.82, "discounted_cash": 9981.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL", "code_information": [{"code": "28140", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF METATARSAL HEADS", "code_information": [{"code": "28114", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64790", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE", "code_information": [{"code": "30160", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE LESION", "code_information": [{"code": "30125", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30110", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30115", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IM", "code_information": [{"code": "65175", "type": "CPT"}, {"code": "3480103142", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4922.75, "gross_charge": 5075.0, "discounted_cash": 5918.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4079.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4922.75, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4024.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4063.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3945.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4695.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3945.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4060.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3945.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4024.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OMENTUM", "code_information": [{"code": "49255", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARIAN CYST(S)", "code_information": [{"code": "58925", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4828.25, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY/TUBE(S)", "code_information": [{"code": "58720", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS", "code_information": [{"code": "48155", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC STONE", "code_information": [{"code": "48020", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": [{"code": "51597", "type": "CPT"}], "standard_charges": [{"minimum": 7264.63, "maximum": 7264.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7264.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIS CONTENTS", "code_information": [{"code": "58240", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PENIS", "code_information": [{"code": "54125", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5158.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PERINEAL", "code_information": [{"code": "53442", "type": "CPT"}, {"code": "3480102042", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8056.82, "gross_charge": 8306.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7060.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6229.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5814.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8056.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5814.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6229.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7060.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6644.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61546", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8741.14, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55801", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55821", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROSTATE", "code_information": [{"code": "55831", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PROTHESIS", "code_information": [{"code": "27488", "type": "CPT"}, {"code": "3480101707", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2107.7, "maximum": 5894.92, "gross_charge": 3011.0, "discounted_cash": 4516.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2559.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2258.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2107.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2920.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2107.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2258.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2559.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2408.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45110", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45112", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM", "code_information": [{"code": "45120", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RECTUM AND COLON", "code_information": [{"code": "45121", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57540", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RESIDUAL CERVIX", "code_information": [{"code": "57550", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB", "code_information": [{"code": "21615", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY", "code_information": [{"code": "42330", "type": "CPT"}, {"code": "3340102382", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4134.14, "gross_charge": 4262.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4134.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3409.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42335", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3522.18, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SALIVARY STONE", "code_information": [{"code": "42340", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3522.18, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM", "code_information": [{"code": "55150", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1927.74, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SCROTUM LESION", "code_information": [{"code": "55120", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1927.74, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SHUNT", "code_information": [{"code": "49429", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4404.17, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN TAGS", "code_information": [{"code": "11200", "type": "CPT"}, {"code": "3340102405", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 372.23, "gross_charge": 293.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 284.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN TAGS", "code_information": [{"code": "11200", "type": "CPT"}, {"code": "3480103205", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 640.2, "gross_charge": 660.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 640.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 528.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKIN WRINKLES", "code_information": [{"code": "15829", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3196.88, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SKULL LESION", "code_information": [{"code": "61500", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SLOUGHED OFF BONE", "code_information": [{"code": "D7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44120", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44121", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SMALL INTESTINE", "code_information": [{"code": "44125", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPINAL SHUNT", "code_information": [{"code": "63746", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN PARTIAL", "code_information": [{"code": "38101", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38100", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SPLEEN TOTAL", "code_information": [{"code": "38102", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43620", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43621", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43632", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43634", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF SUTURE FROM ANUS", "code_information": [{"code": "46754", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2771.02, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15922", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR GLAND", "code_information": [{"code": "68500", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR SAC", "code_information": [{"code": "68520", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON FOR GRAFT", "code_information": [{"code": "20924", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TENDON LESION", "code_information": [{"code": "27630", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}, {"code": "3340102438", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8826.03, "gross_charge": 9099.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7734.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6824.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6369.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8826.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6369.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6824.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7734.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7279.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}, {"code": "3480103264", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11955.25, "gross_charge": 12325.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10476.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9243.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8627.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11955.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8627.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9243.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10476.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60520", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60521", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60270", "type": "CPT"}, {"code": "3340102403", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3224.9, "maximum": 5635.04, "gross_charge": 4607.0, "discounted_cash": 6910.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3915.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3455.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3224.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4468.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3224.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3455.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3915.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3685.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60271", "type": "CPT"}, {"code": "3340102439", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5635.04, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TISSUE FO", "code_information": [{"code": "20926", "type": "CPT"}, {"code": "3480101446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 5836.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TMJ CONDYLE", "code_information": [{"code": "D7840", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TOE LESIO", "code_information": [{"code": "28108", "type": "CPT"}, {"code": "3340102390", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5716.21, "gross_charge": 5893.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5716.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4714.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONGUE", "code_information": [{"code": "41140", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TORUS PALATINUS", "code_information": [{"code": "D7472", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31225", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF UPPER JAW", "code_information": [{"code": "31230", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50650", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER", "code_information": [{"code": "50660", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50610", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50620", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "50630", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"minimum": 1571.3, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53210", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA", "code_information": [{"code": "53215", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53250", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA GLAND", "code_information": [{"code": "53270", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA L", "code_information": [{"code": "53230", "type": "CPT"}, {"code": "3480103145", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8607.78, "gross_charge": 8874.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7542.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6655.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6211.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8607.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6211.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6655.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7542.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7099.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETHRA LESION", "code_information": [{"code": "53235", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34401", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34421", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34451", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34471", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VEIN CLOT", "code_information": [{"code": "34490", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF VITREOUS,", "code_information": [{"code": "67010", "type": "CPT"}, {"code": "3480102203", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST BON", "code_information": [{"code": "25210", "type": "CPT"}, {"code": "3340102420", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25250", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2919.2, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF WRIST PROSTHESIS", "code_information": [{"code": "25251", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PACEMAKER ELECTRODE", "code_information": [{"code": "33235", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PELVIC LYMPH NODES", "code_information": [{"code": "38562", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PILONIDAL LE", "code_information": [{"code": "11771", "type": "CPT"}, {"code": "3480101335", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PROSTHETIC M", "code_information": [{"code": "11008", "type": "CPT"}, {"code": "3480101298", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 467.6, "maximum": 2771.02, "gross_charge": 668.0, "discounted_cash": 1002.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 567.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 501.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 467.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 647.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 467.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 501.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 567.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 534.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL PULSE GEN ONLY ISDSS", "code_information": [{"code": "682T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SHLDR TISS S", "code_information": [{"code": "23075", "type": "CPT"}, {"code": "3480101534", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3808.22, "gross_charge": 3926.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3808.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2748.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2944.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3337.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SPINE ETTRD", "code_information": [{"code": "63662", "type": "CPT"}, {"code": "3480102163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3472.07, "maximum": 6156.59, "gross_charge": 6347.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5394.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4760.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4442.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6156.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4442.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4760.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5394.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5077.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SS DFB ELECTRODE", "code_information": [{"code": "573T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL SUTR/STAPLE REQ ANES", "code_information": [{"code": "15851", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUMOR DEEP I", "code_information": [{"code": "21556", "type": "CPT"}, {"code": "3480101476", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6767.69, "gross_charge": 6977.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6767.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4883.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5232.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5930.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5581.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL TUNNELED CV", "code_information": [{"code": "36589", "type": "CPT"}, {"code": "3340102363", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1584.01, "gross_charge": 1633.0, "discounted_cash": 961.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1388.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1224.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1143.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1584.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1143.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1224.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1388.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1306.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF", "code_information": [{"code": "57287", "type": "CPT"}, {"code": "3480102091", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 10753.42, "gross_charge": 11086.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9423.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8314.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7760.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10753.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7760.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8314.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9423.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8868.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29700", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVAL/REVISION OF CAST", "code_information": [{"code": "29705", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25135", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & GRAFT WRIST LESION", "code_information": [{"code": "25136", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMINAL LYMPH NODES", "code_information": [{"code": "38747", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST 2 STAGE", "code_information": [{"code": "46285", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANAL FIST INT", "code_information": [{"code": "46275", "type": "CPT"}, {"code": "3340102364", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6481.54, "gross_charge": 6682.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5679.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5011.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4677.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6481.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4677.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5011.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5679.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5345.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANEURYSM SINUS", "code_information": [{"code": "61613", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27625", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ANKLE JOINT LINING", "code_information": [{"code": "27626", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33840", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33845", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTA CONSTRICTION", "code_information": [{"code": "33851", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38740", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3196.88, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ARMPIT LYMPH NODES", "code_information": [{"code": "38745", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3196.88, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BILAT SPACE MAIN, MAN", "code_information": [{"code": "D1527", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BILAT SPACE MAIN, MAX", "code_information": [{"code": "D1526", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}, {"code": "3480103183", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 11828.18, "gross_charge": 12194.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11828.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8535.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10364.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}, {"code": "3480103242", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 14548.06, "gross_charge": 14998.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14548.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10498.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11248.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12748.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11998.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/CREATE POUCH", "code_information": [{"code": "51596", "type": "CPT"}], "standard_charges": [{"minimum": 7264.63, "maximum": 7264.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7264.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"minimum": 7264.63, "maximum": 7264.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7264.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLOOD CLOT FROM EYE", "code_information": [{"code": "65930", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CANAL FLUID", "code_information": [{"code": "61050", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY SHUNT", "code_information": [{"code": "62256", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BROKEN IMP RET SCREW", "code_information": [{"code": "D6096", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 11018.2, "maximum": 11018.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11018.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20910", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CARTILAGE FOR GRAFT", "code_information": [{"code": "20912", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2385.2, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4828.25, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23180", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CONTRACEPTIVE", "code_information": [{"code": "11976", "type": "CPT"}, {"code": "3340102445", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1082.52, "gross_charge": 1116.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 948.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 837.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1082.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 781.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 837.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 948.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 892.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CORONOID PROCESS", "code_information": [{"code": "21070", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 448.56, "discounted_cash": 1058.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DEVICE GASTRI", "code_information": [{"code": "43774", "type": "CPT"}, {"code": "3340102346", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2237.9, "maximum": 8334.85, "gross_charge": 3197.0, "discounted_cash": 5862.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2717.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4040.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2397.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2237.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3101.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2237.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4025.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2397.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4650.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2717.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2557.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3908.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3986.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE DIGIT NERVE LESION", "code_information": [{"code": "64776", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69140", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69550", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69552", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69554", "type": "CPT"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MAXILLA", "code_information": [{"code": "21032", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE S", "code_information": [{"code": "22103", "type": "CPT"}, {"code": "3480101483", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 15312.42, "gross_charge": 15786.0, "discounted_cash": 23679.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15312.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12628.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EXTRA SPINE S", "code_information": [{"code": "22116", "type": "CPT"}, {"code": "3480101485", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 7959.27, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67120", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE IMPLANT MATERIAL", "code_information": [{"code": "67121", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "65900", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE LESION", "code_information": [{"code": "66130", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1367.49, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/ATTACH IMPLANT", "code_information": [{"code": "65105", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/INSERT IMPLANT", "code_information": [{"code": "65103", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65112", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65114", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LESIONS", "code_information": [{"code": "67801", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 1549.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68110", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68130", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68135", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/", "code_information": [{"code": "27357", "type": "CPT"}, {"code": "3340102434", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/BURSA", "code_information": [{"code": "27062", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/FIXATION", "code_information": [{"code": "27358", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FEMUR LESION/GRAFT", "code_information": [{"code": "27356", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FIXED BILAT MAINT MAX", "code_information": [{"code": "D1557", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FIXED BILAT MAN", "code_information": [{"code": "D1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FIXED ORTHO APPLIANCE", "code_information": [{"code": "D8695", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM BONE LESION", "code_information": [{"code": "25145", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREARM FOREIGN BODY", "code_information": [{"code": "25248", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN B", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "3480101291", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 711.98, "gross_charge": 734.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 711.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 513.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 550.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 623.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 587.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "3340102396", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 933.14, "gross_charge": 962.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 817.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 721.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 673.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 933.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 673.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 721.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 817.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 769.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY", "code_information": [{"code": "10120", "type": "CPT"}, {"code": "3480103299", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1235.78, "gross_charge": 1274.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 955.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 891.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1235.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 891.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 955.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1082.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1019.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4404.17, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65210", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65220", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65222", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65235", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65260", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65265", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY LARYNX", "code_information": [{"code": "31511", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 303.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4624.44, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38760", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3504.82, "discounted_cash": 9981.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE GROIN LYMPH NODES", "code_information": [{"code": "38765", "type": "CPT"}], "standard_charges": [{"minimum": 3504.82, "maximum": 3504.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HAND BONE LES", "code_information": [{"code": "26200", "type": "CPT"}, {"code": "3340102397", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4245.69, "gross_charge": 4377.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4245.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3720.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3501.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES DEEP", "code_information": [{"code": "27066", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP BONE LES SUPER", "code_information": [{"code": "27065", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27086", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP FOREIGN BODY", "code_information": [{"code": "27087", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15940", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15944", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15946", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23174", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE HUMERUS LESION", "code_information": [{"code": "23184", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT OF EYE", "code_information": [{"code": "65920", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP & FISS", "code_information": [{"code": "46257", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRP W/FISTU", "code_information": [{"code": "46258", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IN/EX HEM GRPS & FISS", "code_information": [{"code": "46261", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE IRIS AND LESION", "code_information": [{"code": "66600", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 11018.2, "maximum": 11018.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11018.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27334", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID STRUCTURES", "code_information": [{"code": "69505", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE MIDDLE EAR NERVE", "code_information": [{"code": "69676", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NAIL PHALANX", "code_information": [{"code": "11752", "type": "CPT"}, {"code": "3480101332", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5639.58, "gross_charge": 5814.0, "discounted_cash": 8721.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5639.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4360.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4941.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4651.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NAIL PLATE ADD-ON", "code_information": [{"code": "11732", "type": "CPT"}], "standard_charges": [{"minimum": 226.95, "maximum": 226.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30300", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30320", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE NERVE LESION", "code_information": [{"code": "64784", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22102", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK", "code_information": [{"code": "22100", "type": "CPT"}, {"code": "3480101482", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15312.42, "gross_charge": 15786.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15312.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11050.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11839.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13418.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12628.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK", "code_information": [{"code": "22110", "type": "CPT"}, {"code": "3480101484", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2198.0, "maximum": 7959.27, "gross_charge": 3140.0, "discounted_cash": 4710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2669.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2355.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2198.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3045.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2198.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2355.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2669.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2512.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22112", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PHARYNX FOREIGN BODY", "code_information": [{"code": "42809", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYS", "code_information": [{"code": "11772", "type": "CPT"}, {"code": "3480103096", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5895.66, "gross_charge": 6078.0, "discounted_cash": 4349.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2998.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5895.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4254.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2986.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4558.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3450.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5166.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4862.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2899.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2957.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PROSTATE REGROWTH", "code_information": [{"code": "52630", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5791.23, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8741.14, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RADIUS HEAD I", "code_information": [{"code": "24164", "type": "CPT"}, {"code": "3480101560", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE WF", "code_information": [{"code": "50389", "type": "CPT"}, {"code": "3480103168", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1865.31, "gross_charge": 1923.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1634.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1442.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1346.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1865.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1346.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1442.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1634.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1538.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE WF", "code_information": [{"code": "50389", "type": "CPT"}, {"code": "3480103213", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2294.05, "gross_charge": 2365.0, "discounted_cash": 1045.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2010.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 720.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1773.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1655.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2294.05, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1655.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1773.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 829.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2010.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1892.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 697.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 711.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15931", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15933", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15934", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15935", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SCIATIC NERVE LESION", "code_information": [{"code": "64786", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SCREW RETAINED PLATE", "code_information": [{"code": "D7298", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHLD BONE PAR", "code_information": [{"code": "23130", "type": "CPT"}, {"code": "3480101536", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14004.86, "gross_charge": 14438.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14004.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11550.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23182", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FOREIGN BODY", "code_information": [{"code": "23330", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER JOINT LINING", "code_information": [{"code": "23105", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SKIN TAGS ADD", "code_information": [{"code": "11201", "type": "CPT"}, {"code": "3340102406", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 45.5, "maximum": 277.43, "gross_charge": 65.0, "discounted_cash": 97.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 63.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 55.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM DUCT POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2109.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM POUCH LESION", "code_information": [{"code": "55680", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE FIXATIO", "code_information": [{"code": "22850", "type": "CPT"}, {"code": "3480101524", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1250.2, "maximum": 5178.02, "gross_charge": 1786.0, "discounted_cash": 2679.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1518.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1339.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1250.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1732.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1250.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1339.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1518.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 SCRL", "code_information": [{"code": "63011", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE STENT VIA TRANSURETH", "code_information": [{"code": "50386", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64804", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64809", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64818", "type": "CPT"}], "standard_charges": [{"minimum": 6624.27, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64821", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2242.36, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE SYMPATHETIC NERVES", "code_information": [{"code": "64822", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2242.36, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68540", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TEAR GLAND LESION", "code_information": [{"code": "68550", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TENDON SHEATH", "code_information": [{"code": "26160", "type": "CPT"}, {"code": "3480101626", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15950", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15951", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15952", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15953", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15956", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THIGH PRESSURE SORE", "code_information": [{"code": "15958", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2771.02, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID DUCT LESION", "code_information": [{"code": "60281", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5635.04, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TORUS MANDIBULARIS", "code_information": [{"code": "D7473", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE TUNN CNTRL DE", "code_information": [{"code": "36589", "type": "CPT"}, {"code": "3480103334", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1950.67, "gross_charge": 2011.0, "discounted_cash": 961.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1709.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1508.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1407.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1950.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1407.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1508.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1709.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1608.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UNIL PART DENTURE,MAN", "code_information": [{"code": "D5283", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UNIL PART DENTURE,MAX", "code_information": [{"code": "D5282", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UNILAT SPACE MAINTAIN", "code_information": [{"code": "D1520", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER CALCULUS", "code_information": [{"code": "51065", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1571.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE URO SPHINCTER", "code_information": [{"code": "53446", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS LESION", "code_information": [{"code": "59100", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA GLAND", "code_information": [{"code": "56740", "type": "CPT"}, {"code": "3480103057", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8564.13, "gross_charge": 8829.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7504.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6180.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8564.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6180.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7504.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7063.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINAL FOREIGN BODY", "code_information": [{"code": "57415", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGUS N ELTRD", "code_information": [{"code": "64570", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2624.17, "discounted_cash": 10476.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2624.17, "discounted_cash": 5732.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2624.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTILAT TUBE", "code_information": [{"code": "69424", "type": "CPT"}, {"code": "3480102046", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33978", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63090", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN THRC", "code_information": [{"code": "63085", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY THRC", "code_information": [{"code": "63305", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY CRVCL", "code_information": [{"code": "63300", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRLMB", "code_information": [{"code": "63302", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63103", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63308", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3345.07, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JNT LIN", "code_information": [{"code": "25105", "type": "CPT"}, {"code": "3480101585", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT CARTILAGE", "code_information": [{"code": "25107", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT IMPLANT", "code_information": [{"code": "25449", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST JOINT LINING", "code_information": [{"code": "26130", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE WRIST TENDON", "code_information": [{"code": "25110", "type": "CPT"}, {"code": "3340102459", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5564.89, "gross_charge": 5737.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5564.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4015.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4302.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4876.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4589.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 13004.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT BONE LE", "code_information": [{"code": "26205", "type": "CPT"}, {"code": "3480101627", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 7231.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FINGER LESION", "code_information": [{"code": "26215", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28102", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28103", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28106", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOOT LESION", "code_information": [{"code": "28107", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25126", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT LEG BONE LESION", "code_information": [{"code": "27638", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/INSERT DRUG IMPLANT", "code_information": [{"code": "11983", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPAIR HEARING AID", "code_information": [{"code": "69711", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE UR SPHINCTER", "code_information": [{"code": "53447", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4758.39, "discounted_cash": 30876.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/TRANSPLANT TENDON", "code_information": [{"code": "23440", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE/TREAT LUNG LESIONS", "code_information": [{"code": "32141", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVL FB EYE CONJ S", "code_information": [{"code": "65205", "type": "CPT"}, {"code": "3340102340", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "gross_charge": 271.0, "discounted_cash": 195.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 134.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 155.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 130.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 132.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVL TOOL CEMENT*0", "code_information": [{"code": "3100104229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVL TUNELD PERITO", "code_information": [{"code": "49422", "type": "CPT"}, {"code": "3340102309", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5173.98, "gross_charge": 5334.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4533.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4000.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3733.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5173.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3733.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4000.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4533.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4267.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN MULT LEADS", "code_information": [{"code": "33229", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 29825.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV/REPL PENIS CONTAIN PROS", "code_information": [{"code": "54416", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 21321.73, "discounted_cash": 30876.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMV/REPLC PENIS PROS COMPL", "code_information": [{"code": "54417", "type": "CPT"}], "standard_charges": [{"minimum": 21321.73, "maximum": 21321.73, "discounted_cash": 19648.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21321.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMVL FB / DACROLITH", "code_information": [{"code": "68530", "type": "CPT"}, {"code": "3340102326", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 867.18, "gross_charge": 894.0, "discounted_cash": 445.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 759.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 307.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 670.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 867.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 625.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 306.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 670.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 353.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 759.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 715.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 297.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 303.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMVL INSJ IMPLTBL GLUC SENS", "code_information": [{"code": "448T", "type": "CPT"}], "standard_charges": [{"minimum": 595.41, "maximum": 595.41, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL ABSCESS OPEN DRAIN", "code_information": [{"code": "50020", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8555.57, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL BX SURG EXPOSURE KDN", "code_information": [{"code": "50205", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH CC", "code_information": [{"code": "683", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4359.79, "maximum": 4359.79, "discounted_cash": 10057.04, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4359.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITH MCC", "code_information": [{"code": "682", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7173.27, "maximum": 7173.27, "discounted_cash": 16755.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7173.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL FAILURE WITHOUT CC/MCC", "code_information": [{"code": "684", "type": "MS-DRG"}], "standard_charges": [{"minimum": 2948.13, "maximum": 2948.13, "discounted_cash": 6793.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2948.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RENAL PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "3440100798", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 8.68, "maximum": 90.21, "gross_charge": 93.0, "discounted_cash": 13.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 90.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 69.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 74.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENAL SCOPE W/TUMOR RESECT", "code_information": [{"code": "50562", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENIN", "code_information": [{"code": "84244", "type": "CPT"}, {"code": "3440100987", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.99, "maximum": 192.06, "gross_charge": 198.0, "discounted_cash": 35.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 192.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 148.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 168.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 23.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80416", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 209.32, "discounted_cash": 336.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 209.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RENIN STIMULATION PANEL", "code_information": [{"code": "80417", "type": "CPT"}], "standard_charges": [{"minimum": 43.99, "maximum": 68.09, "discounted_cash": 70.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 43.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58345", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPEN FALLOPIAN TUBE", "code_information": [{"code": "58350", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPENING OF ABDOMEN", "code_information": [{"code": "49002", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPERATION BYPASS GRAFT", "code_information": [{"code": "35700", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REOPERATION CAROTID ADD-ON", "code_information": [{"code": "35390", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP BROKE COMP DENT BASE MAN", "code_information": [{"code": "D5511", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP BROKE COMP DENT BASE MAX", "code_information": [{"code": "D5512", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP CAST PART FRAME MAN", "code_information": [{"code": "D5621", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP CAST PART FRAME MAX", "code_information": [{"code": "D5622", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP CVA DEV", "code_information": [{"code": "36576", "type": "CPT"}, {"code": "3480101883", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2668.47, "gross_charge": 2751.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2668.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP EAR,EYE,NOSE 2.5", "code_information": [{"code": "12013", "type": "CPT"}, {"code": "3480101343", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 360.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP EAR,EYE,NOSE 5.1", "code_information": [{"code": "12014", "type": "CPT"}, {"code": "3480101344", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 300.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP EAR,EYE,NOSE,FAC", "code_information": [{"code": "12011", "type": "CPT"}, {"code": "3480101342", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 300.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP EXTREM", "code_information": [{"code": "35190", "type": "CPT"}, {"code": "3480101877", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2718.95, "maximum": 8756.19, "gross_charge": 9027.0, "discounted_cash": 8411.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7672.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5798.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6770.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6318.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8756.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5719.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6318.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5775.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6770.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6673.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7672.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7221.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5607.67, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5719.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP INTMD WND FACE 2", "code_information": [{"code": "12052", "type": "CPT"}, {"code": "3480101353", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1024.32, "gross_charge": 1056.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP INTMD WND FACE <", "code_information": [{"code": "12051", "type": "CPT"}, {"code": "3480101352", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 853.6, "gross_charge": 880.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 704.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP OF ORTHO APPLIANCE MAN", "code_information": [{"code": "D8697", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP OF ORTHO APPLIANCE MAX", "code_information": [{"code": "D8696", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP PARTIAL DENTURE CLASP", "code_information": [{"code": "D5630", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER FISTU", "code_information": [{"code": "46715", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP PERF ANOPER/VESTIB FISTU", "code_information": [{"code": "46716", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP RESIN PART DENT BASE MAN", "code_information": [{"code": "D5611", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REP RESIN PART DENT BASE MAX", "code_information": [{"code": "D5612", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR & REVISE NERVE ADD-ON", "code_information": [{"code": "64874", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANAL FISTULA", "code_information": [{"code": "46288", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR AND RECONSTRU", "code_information": [{"code": "26548", "type": "CPT"}, {"code": "3480101642", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7014.07, "gross_charge": 7231.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANOMALY W/CONDUIT", "code_information": [{"code": "33608", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ANORECTAL FIST W/PLUG", "code_information": [{"code": "46707", "type": "CPT"}], "standard_charges": [{"minimum": 2670.89, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ART INTRAMURAL", "code_information": [{"code": "33507", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERIAL TRUNK", "code_information": [{"code": "33786", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35082", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35092", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE AORTA", "code_information": [{"code": "35103", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY W/TUNNEL", "code_information": [{"code": "33505", "type": "CPT"}], "standard_charges": [{"minimum": 29530.2, "maximum": 29530.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BICEPS LONG T", "code_information": [{"code": "23430", "type": "CPT"}, {"code": "3480101540", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER & VAGINA", "code_information": [{"code": "57289", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4354.77, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER DEFEC", "code_information": [{"code": "57288", "type": "CPT"}, {"code": "3480102092", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11561.43, "gross_charge": 11919.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10131.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8939.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8343.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11561.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8343.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8939.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10131.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9535.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4758.39, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57320", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7423.94, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER-VAGINA LESION", "code_information": [{"code": "57330", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": [{"code": "51900", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL", "code_information": [{"code": "35226", "type": "CPT"}, {"code": "3340102357", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 717.96, "maximum": 2718.95, "gross_charge": 2243.0, "discounted_cash": 1076.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1906.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 742.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1682.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1570.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2175.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1570.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1682.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 854.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1906.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1794.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 717.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 732.32, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35180", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35182", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35184", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35188", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2718.95, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35201", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35206", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35207", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35211", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35221", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35231", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35236", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35241", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35246", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35251", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35256", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35261", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35271", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35276", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35281", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35286", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL FISTULA", "code_information": [{"code": "44650", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44620", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL OPENING", "code_information": [{"code": "44626", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44660", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BROW DEFECT", "code_information": [{"code": "67900", "type": "CPT"}, {"code": "3410100714", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6464.08, "gross_charge": 6664.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5664.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4998.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4664.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6464.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4664.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4998.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5664.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5331.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR BY ENLARGEMENT", "code_information": [{"code": "33610", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CARPAL BONE SHORTEN", "code_information": [{"code": "25394", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40700", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40701", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40702", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40720", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLEFT LIP/NASAL", "code_information": [{"code": "40761", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CLITORIS", "code_information": [{"code": "56805", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CMPLX 5CM ARM", "code_information": [{"code": "13122", "type": "CPT"}, {"code": "3480101357", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 595.41, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR COMPLEX EA AD", "code_information": [{"code": "13133", "type": "CPT"}, {"code": "3340102334", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "gross_charge": 604.0, "discounted_cash": 906.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 513.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 453.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 422.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 585.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 422.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 453.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 513.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 483.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR CORPOREAL TEAR", "code_information": [{"code": "54437", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARM ARTERY", "code_information": [{"code": "35045", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35001", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35005", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35011", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35021", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35081", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35091", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35102", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35121", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35131", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35141", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35151", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFORMITY OF TOE", "code_information": [{"code": "28313", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DEGENERATED K", "code_information": [{"code": "27418", "type": "CPT"}, {"code": "3340102479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12838.92, "gross_charge": 13236.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11250.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9927.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9265.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12838.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9265.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9927.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11250.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10588.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DIAPHRAGM LACERATION", "code_information": [{"code": "39501", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DISLOCATED JAW", "code_information": [{"code": "21490", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33611", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DOUBLE VENTRICLE", "code_information": [{"code": "33612", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61618", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR DURA", "code_information": [{"code": "61619", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM", "code_information": [{"code": "69631", "type": "CPT"}, {"code": "3480102234", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69635", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ECTROPION EXC", "code_information": [{"code": "67916", "type": "CPT"}, {"code": "3480102213", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ECTROPION EXT", "code_information": [{"code": "67917", "type": "CPT"}, {"code": "3480102214", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ELBOW LAT LIG", "code_information": [{"code": "24343", "type": "CPT"}, {"code": "3340102355", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2919.2, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EPIGASTRIC HE", "code_information": [{"code": "49570", "type": "CPT"}, {"code": "3480102004", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 12753.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43305", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS AND FISTULA", "code_information": [{"code": "43312", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43425", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43410", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS WOUND", "code_information": [{"code": "43415", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67901", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67902", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67906", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67908", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67914", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67915", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67921", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67922", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67923", "type": "CPT"}, {"code": "3340102424", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4922.75, "gross_charge": 5075.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4922.75, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4060.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67924", "type": "CPT"}, {"code": "3340102389", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4922.75, "gross_charge": 5075.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4922.75, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3552.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3806.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4313.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4060.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67930", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID WOUND", "code_information": [{"code": "67935", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69740", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5831.73, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FACIAL NERVE", "code_information": [{"code": "69745", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5831.73, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FIBULA NONUNION", "code_information": [{"code": "27726", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER DEFORMITY", "code_information": [{"code": "26590", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26418", "type": "CPT"}, {"code": "3480101636", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4829.63, "gross_charge": 4979.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4829.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3983.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26432", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER TENDON", "code_information": [{"code": "26433", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND T", "code_information": [{"code": "26350", "type": "CPT"}, {"code": "3480101632", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8417.66, "gross_charge": 8678.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8417.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6942.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND T", "code_information": [{"code": "26356", "type": "CPT"}, {"code": "3480101633", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8417.66, "gross_charge": 8678.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8417.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6942.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND T", "code_information": [{"code": "26357", "type": "CPT"}, {"code": "3480101634", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8417.66, "gross_charge": 8678.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8417.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6942.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26370", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FINGER/HAND TENDON", "code_information": [{"code": "26373", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45805", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FISTULA W/COLOSTOMY", "code_information": [{"code": "45825", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FIXED RETAINER MAX", "code_information": [{"code": "D8701", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOOT DISLOCATION", "code_information": [{"code": "28555", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDO", "code_information": [{"code": "25270", "type": "CPT"}, {"code": "3480101595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDO", "code_information": [{"code": "25272", "type": "CPT"}, {"code": "3340102460", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON SHEATH", "code_information": [{"code": "25275", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25263", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25265", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR FOREARM TENDON/MUSCLE", "code_information": [{"code": "25274", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33770", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33771", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33774", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33775", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33776", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33777", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33778", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33779", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33780", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GREAT VESSELS DEFECT", "code_information": [{"code": "33781", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", "code_information": [{"code": "41872", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 361.79, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JNT", "code_information": [{"code": "26540", "type": "CPT"}, {"code": "3480101640", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JNT WITH", "code_information": [{"code": "26542", "type": "CPT"}, {"code": "3480101641", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND JOINT W/", "code_information": [{"code": "26541", "type": "CPT"}, {"code": "3480103091", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7566.97, "gross_charge": 7801.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.97, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND TENDON", "code_information": [{"code": "26410", "type": "CPT"}, {"code": "3480101635", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4829.63, "gross_charge": 4979.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4829.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3485.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3734.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4232.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3983.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33641", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECTS", "code_information": [{"code": "33647", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33500", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART VESSEL FISTULA", "code_information": [{"code": "33501", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT", "code_information": [{"code": "33732", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART-VEIN DEFECT(S)", "code_information": [{"code": "33730", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HERNIA EPIGAS", "code_information": [{"code": "49572", "type": "CPT"}, {"code": "3480102005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 12753.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR HUMERUS WITH GRAFT", "code_information": [{"code": "24435", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 12563.69, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IMPLANT", "code_information": [{"code": "D6090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INCOMPLETE CI", "code_information": [{"code": "54163", "type": "CPT"}, {"code": "3480102054", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INCOMPLETE CI", "code_information": [{"code": "54163", "type": "CPT"}, {"code": "3480103261", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ING HERNIA SLIDING", "code_information": [{"code": "49525", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL FEMOR", "code_information": [{"code": "49550", "type": "CPT"}, {"code": "3480101998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL INCIS", "code_information": [{"code": "49560", "type": "CPT"}, {"code": "3480102000", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 12753.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL INCIS", "code_information": [{"code": "49561", "type": "CPT"}, {"code": "3480102001", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5762.31, "maximum": 9895.94, "gross_charge": 10202.0, "discounted_cash": 15303.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9895.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8161.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL INGUI", "code_information": [{"code": "49500", "type": "CPT"}, {"code": "3480101995", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9187.05, "gross_charge": 8502.0, "discounted_cash": 11580.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7982.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7874.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7951.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7720.21, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9187.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7720.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7720.21, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7874.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL INGUI", "code_information": [{"code": "49505", "type": "CPT"}, {"code": "3480101996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9895.94, "gross_charge": 10202.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9895.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8161.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INITIAL INGUI", "code_information": [{"code": "49505", "type": "CPT"}, {"code": "3480103212", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11955.25, "gross_charge": 12325.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10476.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9243.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8627.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11955.25, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8627.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9243.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10476.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INTERM 2.6-7", "code_information": [{"code": "12042", "type": "CPT"}, {"code": "3340102343", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "gross_charge": 697.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 592.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 487.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 676.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 487.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 592.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 557.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INTERMEDIATE", "code_information": [{"code": "12035", "type": "CPT"}, {"code": "3480101348", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1024.32, "gross_charge": 1056.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INTMD WOUND 2", "code_information": [{"code": "12032", "type": "CPT"}, {"code": "3480101346", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 853.6, "gross_charge": 880.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 704.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INTRM WOUNDS", "code_information": [{"code": "12031", "type": "CPT"}, {"code": "3480101345", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1024.32, "gross_charge": 1056.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR INTRMED WOUND", "code_information": [{"code": "12034", "type": "CPT"}, {"code": "3480101347", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 853.6, "gross_charge": 880.0, "discounted_cash": 610.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 419.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 484.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 704.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 415.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66680", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR IRIS & CILIARY BODY", "code_information": [{"code": "66682", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LAC PALATE<2 CM", "code_information": [{"code": "42180", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LAMINECTOMY DEFECT", "code_information": [{"code": "63295", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB DUAL", "code_information": [{"code": "33220", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEAD PACE-DEFIB ONE", "code_information": [{"code": "33218", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LEG FASCIA DEFECT", "code_information": [{"code": "27656", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47350", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47360", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47361", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LIVER WOUND", "code_information": [{"code": "47362", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG EPIPHYSES", "code_information": [{"code": "27734", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LOWER LEG TENDONS", "code_information": [{"code": "27676", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LUMBAR HERNIA", "code_information": [{"code": "49540", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5762.31, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR LUNG HERNIA", "code_information": [{"code": "32800", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33320", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR BLOOD VESSEL(S)", "code_information": [{"code": "33322", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAJOR VESSEL", "code_information": [{"code": "33321", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MAXILLOFACIAL DEFECTS", "code_information": [{"code": "D7955", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69666", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MIDDLE EAR STRUCTURES", "code_information": [{"code": "69667", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40830", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40831", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2319.34, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH/NOSE FISTULA", "code_information": [{"code": "30600", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL SEPTUM", "code_information": [{"code": "30630", "type": "CPT"}, {"code": "3340102481", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6311.79, "gross_charge": 6507.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6311.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4554.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4880.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5530.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5205.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NASAL STENOSIS", "code_information": [{"code": "30465", "type": "CPT"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64832", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE ADD-ON", "code_information": [{"code": "64837", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NERVE/SHORTEN BONE", "code_information": [{"code": "64876", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION CARPAL BONE", "code_information": [{"code": "25431", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION HAND", "code_information": [{"code": "26546", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NONUNION/MALU", "code_information": [{"code": "24430", "type": "CPT"}, {"code": "3480103044", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR NOSE TO LIP FISTULA", "code_information": [{"code": "42260", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46750", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46751", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46760", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL SPHINCTER", "code_information": [{"code": "46761", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46700", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANAL STRICTURE", "code_information": [{"code": "46705", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENT", "code_information": [{"code": "27695", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ANKLE LIGAMENTS", "code_information": [{"code": "27696", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33414", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF AORTIC VALVE", "code_information": [{"code": "33417", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ARM NERVES", "code_information": [{"code": "64861", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ARM/LEG NE", "code_information": [{"code": "64857", "type": "CPT"}, {"code": "3340102423", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6624.27, "maximum": 9722.31, "gross_charge": 10023.0, "discounted_cash": 10196.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8519.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7028.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7517.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7016.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9722.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7016.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7001.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7517.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8089.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8519.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8018.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6797.6, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6933.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BICEPS TEN", "code_information": [{"code": "24340", "type": "CPT"}, {"code": "3480101563", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER OPENING", "code_information": [{"code": "51880", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BLADDER WOUND", "code_information": [{"code": "51860", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BODY CAST", "code_information": [{"code": "29720", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL BULGE", "code_information": [{"code": "57268", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2670.89, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL LESION", "code_information": [{"code": "44605", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF BOWEL POUCH", "code_information": [{"code": "57270", "type": "CPT"}], "standard_charges": [{"minimum": 2670.89, "maximum": 2670.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46744", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46746", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF CLOACAL ANOMALY", "code_information": [{"code": "46748", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF COMPONENT(", "code_information": [{"code": "54408", "type": "CPT"}, {"code": "3480102059", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11307.29, "gross_charge": 11657.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9908.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8742.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8159.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11307.29, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8159.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8742.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9908.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9325.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39503", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39540", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIAPHRAGM HERNIA", "code_information": [{"code": "39541", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF DIGIT NERV", "code_information": [{"code": "64831", "type": "CPT"}, {"code": "3340102371", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9722.31, "gross_charge": 10023.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8519.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7517.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7016.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9722.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7016.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7517.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8519.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8018.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43300", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ESOPHAGUS", "code_information": [{"code": "43310", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EXTENSOR T", "code_information": [{"code": "26426", "type": "CPT"}, {"code": "3480103031", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7014.07, "gross_charge": 7231.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE SOCKET WOUND", "code_information": [{"code": "65290", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65270", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65272", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65273", "type": "CPT"}], "standard_charges": [{"minimum": 1524.13, "maximum": 1524.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65275", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65280", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65285", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6993.18, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF EYE WOUND", "code_information": [{"code": "65286", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 708.89, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64864", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FACIAL NERVE", "code_information": [{"code": "64865", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIBULA EPIPHYSIS", "code_information": [{"code": "27732", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FIXED RETAINER MAN", "code_information": [{"code": "D8702", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT BONES", "code_information": [{"code": "28320", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDO", "code_information": [{"code": "28208", "type": "CPT"}, {"code": "3340102399", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5716.21, "gross_charge": 5893.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5716.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4714.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF FOOT TENDON", "code_information": [{"code": "28200", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAMMERTOE", "code_information": [{"code": "28286", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64834", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64835", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HAND OR FOOT NERVE", "code_information": [{"code": "64836", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DAMAGE", "code_information": [{"code": "33545", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33665", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33692", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33694", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33697", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33702", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33710", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33300", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART WOUND", "code_information": [{"code": "33305", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF IMPERFORATED ANUS", "code_information": [{"code": "46742", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KIDNEY WOUND", "code_information": [{"code": "50500", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEE LIGAMENTS", "code_information": [{"code": "27409", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF KNEECAP TE", "code_information": [{"code": "27380", "type": "CPT"}, {"code": "3340102453", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8745.52, "gross_charge": 9016.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8745.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6311.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6762.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7663.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27740", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG EPIPHYSES", "code_information": [{"code": "27742", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG NERVE", "code_information": [{"code": "64840", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27658", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27659", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27664", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LEG TENDON EACH", "code_information": [{"code": "27665", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOW BACK NERVES", "code_information": [{"code": "64862", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27725", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MESENTERY", "code_information": [{"code": "44850", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF METATARSAL", "code_information": [{"code": "28322", "type": "CPT"}, {"code": "3340102408", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 16531.71, "gross_charge": 17043.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14486.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12782.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11930.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16531.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11930.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12782.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14486.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13634.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NAIL BED", "code_information": [{"code": "11760", "type": "CPT"}, {"code": "3480101333", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 762.66, "gross_charge": 300.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PENIS", "code_information": [{"code": "54440", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF PERINEUM", "code_information": [{"code": "56810", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTOCELE", "code_information": [{"code": "45560", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45500", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RECTUM", "code_information": [{"code": "45505", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3271.2, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED SPLEEN", "code_information": [{"code": "38115", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF RUPTURED UTERUS", "code_information": [{"code": "58520", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SHOULDER", "code_information": [{"code": "23420", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SHOULDER C", "code_information": [{"code": "23450", "type": "CPT"}, {"code": "3340102401", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 22090.78, "gross_charge": 22774.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19357.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17080.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15941.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22090.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15941.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17080.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19357.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18219.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPERM DUCT", "code_information": [{"code": "55400", "type": "CPT"}, {"code": "3340102428", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2109.3, "maximum": 5891.78, "gross_charge": 6074.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5162.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4555.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4251.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5891.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4251.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4555.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5162.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4859.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63700", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63702", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TENNIS ELB", "code_information": [{"code": "24357", "type": "CPT"}, {"code": "3480101567", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2919.2, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF THIGH", "code_information": [{"code": "27470", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA", "code_information": [{"code": "27720", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TIBIA EPIPHYSIS", "code_information": [{"code": "27730", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TOE DISLOCATION", "code_information": [{"code": "28675", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TUNICA VAG", "code_information": [{"code": "55060", "type": "CPT"}, {"code": "3480102073", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF TYMPANIC M", "code_information": [{"code": "69610", "type": "CPT"}, {"code": "3480102232", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER", "code_information": [{"code": "50900", "type": "CPT"}], "standard_charges": [{"minimum": 4163.42, "maximum": 4163.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETER LESION", "code_information": [{"code": "51535", "type": "CPT"}], "standard_charges": [{"minimum": 1767.1, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": "53275", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53502", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53505", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53510", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRAL LESION", "code_information": [{"code": "57230", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4354.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF UTERUS", "code_information": [{"code": "59350", "type": "CPT"}], "standard_charges": [{"minimum": 2385.2, "maximum": 2385.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "56800", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF VAGINA", "code_information": [{"code": "57200", "type": "CPT"}, {"code": "3480103104", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8564.13, "gross_charge": 8829.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7504.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6180.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8564.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6180.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7504.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7063.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26560", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3676.59, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26561", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WEB FINGER", "code_information": [{"code": "26562", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31750", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3345.07, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31755", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3345.07, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE", "code_information": [{"code": "31760", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE DEFECT", "code_information": [{"code": "31825", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3345.07, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31800", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3345.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR OVIDUCT", "code_information": [{"code": "58750", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42182", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PALATE", "code_information": [{"code": "42235", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT LAP", "code_information": [{"code": "57423", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT OPEN", "code_information": [{"code": "57284", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PARAVAG DEFECT VAG", "code_information": [{"code": "57285", "type": "CPT"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54380", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS", "code_information": [{"code": "54385", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PENIS AND BLADDER", "code_information": [{"code": "54390", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PROSTH VALVE CLOT", "code_information": [{"code": "33496", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PUL VENOUS STENOSIS", "code_information": [{"code": "33726", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ARTERY", "code_information": [{"code": "33917", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS & ULNA", "code_information": [{"code": "25415", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RADIUS OR ULN", "code_information": [{"code": "25400", "type": "CPT"}, {"code": "3340102466", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12838.92, "gross_charge": 13236.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11250.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9927.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9265.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12838.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9265.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9927.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11250.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10588.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECT/BLADDER FISTULA", "code_information": [{"code": "45800", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTOURETHRAL FISTULA", "code_information": [{"code": "45820", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57305", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECURRENT INC", "code_information": [{"code": "49565", "type": "CPT"}, {"code": "3480102002", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9895.94, "gross_charge": 10202.0, "discounted_cash": 15303.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9895.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8161.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RECURRENT ING", "code_information": [{"code": "49520", "type": "CPT"}, {"code": "3480101997", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RETINAL DETACH CPLX", "code_information": [{"code": "67113", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF", "code_information": [{"code": "23410", "type": "CPT"}, {"code": "3480101538", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14004.86, "gross_charge": 14438.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14004.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11550.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR ROTATOR CUFF", "code_information": [{"code": "23412", "type": "CPT"}, {"code": "3480101539", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTD POPLITEAL ART", "code_information": [{"code": "35152", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR RUPTURED TEND", "code_information": [{"code": "24342", "type": "CPT"}, {"code": "3480101565", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42500", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SCIATIC NERVE", "code_information": [{"code": "64858", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SCLP/TRNK <2.", "code_information": [{"code": "12001", "type": "CPT"}, {"code": "3480101339", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 300.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33813", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33814", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33852", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", "code_information": [{"code": "33853", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHLD CAPSULE", "code_information": [{"code": "23460", "type": "CPT"}, {"code": "3480101542", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHLD CAPSULE-", "code_information": [{"code": "23455", "type": "CPT"}, {"code": "3480101541", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23462", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23465", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SHOULDER CAPSULE", "code_information": [{"code": "23466", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID", "code_information": [{"code": "63707", "type": "CPT"}, {"code": "3480102165", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1576.4, "maximum": 5178.02, "gross_charge": 2252.0, "discounted_cash": 3378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1914.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1689.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1576.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2184.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1576.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1689.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1914.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1801.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR SPINAL FLUID", "code_information": [{"code": "63709", "type": "CPT"}, {"code": "3480102166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1887.2, "maximum": 7959.27, "gross_charge": 2696.0, "discounted_cash": 4044.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2291.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1887.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2615.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1887.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2022.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2291.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2156.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", "code_information": [{"code": "21743", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH OPENING", "code_information": [{"code": "43870", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4624.44, "discounted_cash": 5862.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR STOMACH-BOWEL FISTULA", "code_information": [{"code": "43880", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33418", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TCAT MITRAL VALVE", "code_information": [{"code": "33419", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TEAR DUCTS", "code_information": [{"code": "68700", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TENDON/MUSCLE", "code_information": [{"code": "25260", "type": "CPT"}, {"code": "3480103046", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TESTIS INJURY", "code_information": [{"code": "54670", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1927.74, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT ESOPHAGUS", "code_information": [{"code": "42953", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR THROAT WOUND", "code_information": [{"code": "42900", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TNDN/MUSCL UP", "code_information": [{"code": "24341", "type": "CPT"}, {"code": "3480101564", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TOE DISLOCATION", "code_information": [{"code": "28645", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41250", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41251", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TONGUE LACERATION", "code_information": [{"code": "41252", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 372.23, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR TUNNELED CV CATH", "code_information": [{"code": "36575", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1376.83, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL HER", "code_information": [{"code": "49585", "type": "CPT"}, {"code": "3480102006", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 12753.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL HER", "code_information": [{"code": "49587", "type": "CPT"}, {"code": "3480102007", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4772.18, "maximum": 9895.94, "gross_charge": 10202.0, "discounted_cash": 15303.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9895.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7141.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7651.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8671.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8161.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49600", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5762.31, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49605", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49606", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49610", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UMBILICAL LESION", "code_information": [{"code": "49611", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR UPPER JAW FISTULA", "code_information": [{"code": "30580", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57310", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7423.94, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URETHROVAGINAL LESION", "code_information": [{"code": "57311", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR URO SPHINCTER", "code_information": [{"code": "53449", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6427.58, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA", "code_information": [{"code": "57335", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VAGINA/PERINEUM", "code_information": [{"code": "57210", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VALVE FEMORAL VEIN", "code_information": [{"code": "34501", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VENOUS ANOMALY", "code_information": [{"code": "33724", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33802", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL DEFECT", "code_information": [{"code": "33803", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR VESSEL GRAFT DEFECT", "code_information": [{"code": "35870", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WEBBED TOE(S)", "code_information": [{"code": "28345", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31613", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3345.07, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WINDPIPE OPENING", "code_information": [{"code": "31614", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3345.07, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WOUND TRUNK 7", "code_information": [{"code": "12004", "type": "CPT"}, {"code": "3480101341", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 300.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR WRIST JNT(S)", "code_information": [{"code": "25447", "type": "CPT"}, {"code": "3480101600", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9736.86, "gross_charge": 10038.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8532.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7528.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7026.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9736.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7026.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7528.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8532.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8030.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, DISLOCATING", "code_information": [{"code": "27675", "type": "CPT"}, {"code": "3480101723", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6336.04, "gross_charge": 6532.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6336.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4572.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4899.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5552.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5225.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, INTRINSIC MU", "code_information": [{"code": "26591", "type": "CPT"}, {"code": "3480101643", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8417.66, "gross_charge": 8678.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8417.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6074.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6508.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7376.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6942.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, PRIMARY, OPE", "code_information": [{"code": "27650", "type": "CPT"}, {"code": "3480101720", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, PRIMARY, OPE", "code_information": [{"code": "27652", "type": "CPT"}, {"code": "3480101721", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, PRIMARY, TOR", "code_information": [{"code": "27405", "type": "CPT"}, {"code": "3480101698", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14004.86, "gross_charge": 14438.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14004.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10106.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10828.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12272.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11550.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, PRIMARY, TOR", "code_information": [{"code": "27407", "type": "CPT"}, {"code": "3480101699", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 19903.43, "gross_charge": 20519.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19903.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14363.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15389.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17441.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, SECONDARY DI", "code_information": [{"code": "27698", "type": "CPT"}, {"code": "3480101728", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 8687.35, "gross_charge": 6068.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5157.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4551.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4247.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5885.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4247.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4551.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5157.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4854.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR, SECONDARY, A", "code_information": [{"code": "27654", "type": "CPT"}, {"code": "3480101722", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT EYE LESION", "code_information": [{"code": "66225", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5841.07, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FEMUR HEAD/NECK", "code_information": [{"code": "27170", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26420", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26428", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT FINGER TENDON", "code_information": [{"code": "26434", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TE", "code_information": [{"code": "26358", "type": "CPT"}, {"code": "3480103077", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8687.35, "gross_charge": 7801.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.97, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26352", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26372", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26392", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT HAND TENDON", "code_information": [{"code": "26412", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF BRONCHUS", "code_information": [{"code": "31770", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28202", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF FOOT TENDON", "code_information": [{"code": "28210", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF THIGH", "code_information": [{"code": "27472", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27722", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT OF TIBIA", "code_information": [{"code": "27724", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25420", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS & ULNA", "code_information": [{"code": "25426", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6065.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT RADIUS OR ULNA", "code_information": [{"code": "25425", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/GRAFT WRIST B", "code_information": [{"code": "25440", "type": "CPT"}, {"code": "3480101599", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 23883.34, "gross_charge": 24622.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23883.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19697.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/RELINE OCCLUSAL GUARD", "code_information": [{"code": "D9942", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/REVISE WRIST JOINT", "code_information": [{"code": "25320", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPAIR/TRANSPOSE NERVE", "code_information": [{"code": "64856", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPEAT CONTROL OF NOSEBLEED", "code_information": [{"code": "30906", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPL SEMI/PRECISION ATTACH", "code_information": [{"code": "D6091", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33362", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33363", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33364", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE OPEN", "code_information": [{"code": "33365", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE PERQ", "code_information": [{"code": "33361", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33367", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33368", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE AORTIC VALVE W/BYP", "code_information": [{"code": "33369", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"minimum": 8235.17, "maximum": 8235.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE BROKEN RETAINER MAN", "code_information": [{"code": "D8704", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE BROKEN RETAINER MAX", "code_information": [{"code": "D8703", "type": "HCPCS"}], "standard_charges": [{"minimum": 518.87, "maximum": 518.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 518.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE DENTURE TEETH COMPLT", "code_information": [{"code": "D5520", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49451", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE ELBOW JOINT", "code_information": [{"code": "24363", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE G/C TUBE PER", "code_information": [{"code": "49450", "type": "CPT"}, {"code": "3480103325", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2146.61, "gross_charge": 2213.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1881.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1659.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1549.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2146.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1549.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1659.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1881.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1770.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE GJ TUBE PERC", "code_information": [{"code": "49452", "type": "CPT"}, {"code": "3480103332", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2145.64, "gross_charge": 2212.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1880.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1548.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2145.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1548.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1659.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1880.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1769.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE PART DENTURE TEETH", "code_information": [{"code": "D5640", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE PICVAD CATH", "code_information": [{"code": "36585", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1735.06, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TISSUE EXPAN", "code_information": [{"code": "11970", "type": "CPT"}, {"code": "3480101336", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TRICUSPID VALVE", "code_information": [{"code": "33465", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV", "code_information": [{"code": "36578", "type": "CPT"}, {"code": "3340102447", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6531.98, "gross_charge": 6734.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5723.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5050.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4713.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6531.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4713.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5050.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5723.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5387.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36581", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2910.3, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV CATH", "code_information": [{"code": "36583", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2910.3, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/BP", "code_information": [{"code": "33983", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD PUMP EXT", "code_information": [{"code": "33981", "type": "CPT"}], "standard_charges": [{"minimum": 55608.54, "maximum": 55608.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55608.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62194", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/IRRIGATE CATHETER", "code_information": [{"code": "62225", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 8235.17, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACE/REVISE BRAIN SHUNT", "code_information": [{"code": "62230", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8235.17, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33405", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33406", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT AORTIC VALVE OPN", "code_information": [{"code": "33410", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT NASAL PROSTHESIS", "code_information": [{"code": "D5926", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33411", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33412", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF AORTIC VALVE", "code_information": [{"code": "33413", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF CONTACT LENS", "code_information": [{"code": "92326", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF MITRAL VALVE", "code_information": [{"code": "33430", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT OF PRECISION ATT", "code_information": [{"code": "D5867", "type": "HCPCS"}], "standard_charges": [{"minimum": 410.29, "maximum": 410.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 410.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT, COMPLET", "code_information": [{"code": "36580", "type": "CPT"}, {"code": "3480101884", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2668.47, "gross_charge": 2751.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2668.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1925.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2063.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2338.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2200.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT, COMPLET", "code_information": [{"code": "36582", "type": "CPT"}, {"code": "3480101885", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9077.26, "gross_charge": 9358.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7954.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7018.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6550.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9077.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6550.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7018.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7954.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7486.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2910.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANT FOREARM COMPLETE", "code_information": [{"code": "20805", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION ARM COMPLETE", "code_information": [{"code": "20802", "type": "CPT"}], "standard_charges": [{"minimum": 12563.69, "maximum": 12563.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20816", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION DIGIT COMPLETE", "code_information": [{"code": "20822", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION FOOT COMPLETE", "code_information": [{"code": "20838", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION HAND COMPLETE", "code_information": [{"code": "20808", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION OF PENIS", "code_information": [{"code": "54438", "type": "CPT"}], "standard_charges": [{"minimum": 6427.58, "maximum": 6427.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20824", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLANTATION THUMB COMPLETE", "code_information": [{"code": "20827", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLC TTH&ACRLC MANDIBULAR", "code_information": [{"code": "D5671", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPLC TTH&ACRLC ON MTL FRMWK", "code_information": [{"code": "D5670", "type": "HCPCS"}], "standard_charges": [{"minimum": 784.98, "maximum": 784.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 784.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS CAR MODULJ TRANVNS ELT", "code_information": [{"code": "415T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS IO LENS PROSTH", "code_information": [{"code": "66825", "type": "CPT"}, {"code": "3410100690", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5691.96, "gross_charge": 5868.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4987.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4401.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4107.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5691.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4107.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4401.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4987.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4694.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS PREV IMPLTBL SUBQ DFB", "code_information": [{"code": "33273", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOS PREV SS IMPL DFB ELTRD", "code_information": [{"code": "574T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSG PERQ R/L HRT VAD", "code_information": [{"code": "33993", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION GASTROSTOMY TUBE", "code_information": [{"code": "43761", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION L VENTRIC LEAD", "code_information": [{"code": "33226", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 8741.14, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 910.92, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CA", "code_information": [{"code": "36597", "type": "CPT"}, {"code": "3480103102", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2884.78, "gross_charge": 2974.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2527.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2230.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2081.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2884.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2081.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2230.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2527.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2379.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1376.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPOSITIONING OF TEETH", "code_information": [{"code": "D7290", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR ELBW MED LIGMNT W/TISSU", "code_information": [{"code": "24345", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR OF ANAL FISTULA W/GLUE", "code_information": [{"code": "46706", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH DBL PROC", "code_information": [{"code": "46712", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PER/VAG POUCH SNGL PROC", "code_information": [{"code": "46710", "type": "CPT"}], "standard_charges": [{"minimum": 3271.2, "maximum": 3271.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR PUL ART UNIFOCAL W/CPB", "code_information": [{"code": "33926", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPR RADIUS OR ULNA", "code_information": [{"code": "25405", "type": "CPT"}, {"code": "3480101598", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 23883.34, "gross_charge": 24622.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23883.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17235.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18466.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20928.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19697.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPRDTVE MED ALYS 24 CHRMSM", "code_information": [{"code": "254U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 1219.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPRGRMG IO RTA ELTRD RA", "code_information": [{"code": "473T", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 148.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPRIZA, 1CM", "code_information": [{"code": "Q4143", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.15, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT 7/>", "code_information": [{"code": "92604", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPROGRAM COCHLEAR IMPLT <7", "code_information": [{"code": "92602", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REPTILASE TEST", "code_information": [{"code": "85635", "type": "CPT"}], "standard_charges": [{"minimum": 9.85, "maximum": 20.92, "discounted_cash": 15.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREMOVE WRIST TENDON LESION", "code_information": [{"code": "25112", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA BLOCKED", "code_information": [{"code": "49557", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR FEM HERNIA REDUCE", "code_information": [{"code": "49555", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREPAIR ING HERNIA BLOCKED", "code_information": [{"code": "49521", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "discounted_cash": 11580.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REREVISE EYE MUSCLES ADD-ON", "code_information": [{"code": "67332", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUM/CHEST", "code_information": [{"code": "32504", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT APICAL LUNG TUMOR", "code_information": [{"code": "32503", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT BACK TUM < 5 CM", "code_information": [{"code": "21935", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT CLAVICLE TUMOR", "code_information": [{"code": "23200", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT DISTAL FINGER TUMOR", "code_information": [{"code": "26262", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE", "code_information": [{"code": "28341", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT ENLARGED TOE TISSUE", "code_information": [{"code": "28340", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM 2 CM/>", "code_information": [{"code": "21016", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FACE/SCALP TUM < 2 CM", "code_information": [{"code": "21015", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FEMUR/KNEE TUMOR", "code_information": [{"code": "27365", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FIBULA TUMOR", "code_information": [{"code": "27646", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR 3 CM/>", "code_information": [{"code": "28047", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 6065.8, "maximum": 6065.8, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM W/INNOM BONE", "code_information": [{"code": "27077", "type": "CPT"}], "standard_charges": [{"minimum": 21269.22, "maximum": 21269.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21269.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUMOR", "code_information": [{"code": "27075", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM < 5 CM", "code_information": [{"code": "27049", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM 5 CM/>", "code_information": [{"code": "27616", "type": "CPT"}], "standard_charges": [{"minimum": 2542.29, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT LEG/ANKLE TUM < 5 CM", "code_information": [{"code": "27615", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL CYST", "code_information": [{"code": "39200", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", "code_information": [{"code": "39220", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT METATARSAL TUMOR", "code_information": [{"code": "28173", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", "code_information": [{"code": "61586", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2470.2, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58950", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58952", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PROX FINGER TUMOR", "code_information": [{"code": "26260", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT PROX HUMERUS TUMOR", "code_information": [{"code": "23220", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RADIUS/ULNAR TUMOR", "code_information": [{"code": "25170", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT RECURRENT GYN MAL", "code_information": [{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT SCAPULA TUMOR", "code_information": [{"code": "23210", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR 5 CM/>", "code_information": [{"code": "23078", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR < 5 CM", "code_information": [{"code": "23077", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"minimum": 4111.8, "maximum": 4111.8, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM < 5 CM", "code_information": [{"code": "27329", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4111.8, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/DEBRIDE PANCREAS", "code_information": [{"code": "48105", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61600", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61601", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61605", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61606", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61607", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE CRANIAL LESION", "code_information": [{"code": "61608", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61615", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECT/EXCISE LESION SKULL", "code_information": [{"code": "61616", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECTION OF ELBOW JOINT", "code_information": [{"code": "24155", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESECTION OF PALATE", "code_information": [{"code": "42120", "type": "CPT"}, {"code": "3480101917", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7111.29, "gross_charge": 6299.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESERVOIR", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100104546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4356.05, "maximum": 6036.25, "gross_charge": 6222.94, "discounted_cash": 9334.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5289.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4667.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4356.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6036.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4356.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4667.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5289.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4978.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESERVOIR 700*724041", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3924.37, "maximum": 5438.06, "gross_charge": 5606.25, "discounted_cash": 8409.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4765.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4204.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3924.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5438.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3924.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4204.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4765.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4485.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESERVOIR PENILE PRO", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100101555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4289.74, "maximum": 5944.35, "gross_charge": 6128.2, "discounted_cash": 9192.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5208.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4596.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4289.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5944.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4289.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4596.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5208.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4902.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESERVOIR*720182-01", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5232.5, "maximum": 7250.75, "gross_charge": 7475.0, "discounted_cash": 11212.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6353.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5606.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5232.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7250.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5232.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5606.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6353.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5980.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESERVOIR/PUMP IMPLA", "code_information": [{"code": "62370", "type": "CPT"}, {"code": "3480103303", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 303.49, "maximum": 951.57, "gross_charge": 981.0, "discounted_cash": 457.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 833.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 315.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 735.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 686.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 951.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 310.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 686.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 313.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 735.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 304.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 833.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 304.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 304.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 310.9, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21480", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 277.43, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESET DISLOCATED JAW", "code_information": [{"code": "21485", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1670.09, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESHAPING BONE ORTHOGNATHIC", "code_information": [{"code": "D7940", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN 4/> SURF OR W INCIS AN", "code_information": [{"code": "D2335", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN INFILTRATION OF LESION", "code_information": [{"code": "D2990", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN ONE SURFACE-ANTERIOR", "code_information": [{"code": "D2330", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN RETAINER", "code_information": [{"code": "D6549", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN THREE SURFACES-ANTERIO", "code_information": [{"code": "D2332", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN TWO SURFACES-ANTERIOR", "code_information": [{"code": "D2331", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESIN VERTEBRAL", "code_information": [{"code": "3100101556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RESOLUTIO ULTRA CLIP", "code_information": [{"code": "3100206438", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RESOLVE MATRIX PER SQ CM", "code_information": [{"code": "A2024", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RESP SYNCYTIAL VIRUS AG IA", "code_information": [{"code": "87420", "type": "CPT"}], "standard_charges": [{"minimum": 13.91, "maximum": 24.03, "discounted_cash": 22.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 12-25 TARGETS", "code_information": [{"code": "87633", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 416.78, "discounted_cash": 669.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 3-5 TARGETS", "code_information": [{"code": "87631", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 142.63, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESP VIRUS 6-11 TARGETS", "code_information": [{"code": "87632", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 218.06, "discounted_cash": 350.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 218.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIR IADNA 18 VIRAL&2 BACT", "code_information": [{"code": "115U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 442.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATOR MOTION MGMT SIMUL", "code_information": [{"code": "77293", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [{"code": "178", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8091.83, "maximum": 8091.83, "discounted_cash": 11016.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8091.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [{"code": "177", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9242.18, "maximum": 9242.18, "discounted_cash": 18939.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9242.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC", "code_information": [{"code": "179", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7459.78, "maximum": 7459.78, "discounted_cash": 8521.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7459.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [{"code": "181", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5444.36, "maximum": 5444.36, "discounted_cash": 12293.3, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5444.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [{"code": "180", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8910.79, "maximum": 8910.79, "discounted_cash": 19406.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8910.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY NEOPLASMS WITHOUT CC/MCC", "code_information": [{"code": "182", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4843.05, "maximum": 4843.05, "discounted_cash": 8473.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4843.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [{"code": "204", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3487.34, "maximum": 3487.34, "discounted_cash": 9187.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3487.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCTIAL", "code_information": [{"code": "86756", "type": "CPT"}, {"code": "3440101117", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.89, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 25.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYNCYTIAL AG IF", "code_information": [{"code": "87280", "type": "CPT"}], "standard_charges": [{"minimum": 13.42, "maximum": 24.03, "discounted_cash": 21.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [{"code": "208", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11491.86, "maximum": 11491.86, "discounted_cash": 30186.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11491.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [{"code": "207", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33735.94, "maximum": 33735.94, "discounted_cash": 77124.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33735.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORATIVE FOUNDATION", "code_information": [{"code": "D2949", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESTORE ADVANCE SURE", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100104205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 26250.0, "maximum": 36375.0, "gross_charge": 37500.0, "discounted_cash": 56250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31875.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26250.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36375.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26250.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31875.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORE SENSOR", "code_information": [{"code": "3100102269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41900.0, "discounted_cash": 62850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORE SENSOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100103724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 22365.0, "maximum": 30991.5, "gross_charge": 31950.0, "discounted_cash": 47925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 27157.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 23962.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 22365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 30991.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 22365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 23962.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 27157.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 25560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORE SENSOR", "code_information": [{"code": "C1820", "type": "HCPCS"}, {"code": "3100103725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 30730.0, "maximum": 42583.0, "gross_charge": 43900.0, "discounted_cash": 65850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42583.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 35120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESTORIGIN 1 SQ CM", "code_information": [{"code": "Q4191", "type": "HCPCS"}], "standard_charges": [{"minimum": 1537.0, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1537.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RESTORIGIN, 1 CC", "code_information": [{"code": "Q4192", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETAIN CROWN PORC TO TITANIU", "code_information": [{"code": "D6753", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETAIN CROWN RESIN W HI NBLE", "code_information": [{"code": "D6720", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETAIN METAL FPD BASE ALLOYS", "code_information": [{"code": "D6121", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETAIN METAL FPD NOBLE ALLOY", "code_information": [{"code": "D6122", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETAIN METAL FPD TITANIUM", "code_information": [{"code": "D6123", "type": "HCPCS"}], "standard_charges": [{"minimum": 2181.39, "maximum": 2181.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2181.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETAINER CROWN 3/4 TITANIUM", "code_information": [{"code": "D6784", "type": "HCPCS"}], "standard_charges": [{"minimum": 937.17, "maximum": 937.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 937.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETEPLASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2993", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 4447.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RETICULATED PLATELET ASSAY", "code_information": [{"code": "85055", "type": "CPT"}], "standard_charges": [{"minimum": 35.74, "maximum": 59.63, "discounted_cash": 57.42, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [{"code": "815", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4999.22, "maximum": 4999.22, "discounted_cash": 11099.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4999.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [{"code": "814", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11627.74, "maximum": 11627.74, "discounted_cash": 23759.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11627.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC", "code_information": [{"code": "816", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4241.12, "maximum": 4241.12, "discounted_cash": 7929.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4241.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETICYTE/HGB CONCENTRATE", "code_information": [{"code": "85046", "type": "CPT"}], "standard_charges": [{"minimum": 5.57, "maximum": 20.92, "discounted_cash": 8.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETR BONE FLAP TO FIX SKULL", "code_information": [{"code": "62148", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETRACTION SYSTEM DE", "code_information": [{"code": "3100101557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1219.68, "discounted_cash": 1829.52, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR", "code_information": [{"code": "3100104690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 365.0, "discounted_cash": 547.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR", "code_information": [{"code": "3100104691", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 637.0, "discounted_cash": 955.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR CHEEK", "code_information": [{"code": "3100104710", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR LONESTAR", "code_information": [{"code": "3100101558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.0, "discounted_cash": 367.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR RADIALUX*5", "code_information": [{"code": "3100203369", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SHEATH TEN", "code_information": [{"code": "3100104137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1090.0, "discounted_cash": 1635.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SYSTEM ALE", "code_information": [{"code": "3100101559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR SYSTEM MON", "code_information": [{"code": "3100101560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR VAG CERV", "code_information": [{"code": "3100101561", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL ANTERIOR", "code_information": [{"code": "D3346", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL MOLAR", "code_information": [{"code": "D3348", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETREAT ROOT CANAL PREMOLAR", "code_information": [{"code": "D3347", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETRIEVAL OF OOCYTE", "code_information": [{"code": "58970", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETRIEVER", "code_information": [{"code": "3100101562", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVER", "code_information": [{"code": "3100103229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRIEVING HOOK CRAW", "code_information": [{"code": "3100101563", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 366.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RETROBUTTON", "code_information": [{"code": "3100101564", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETROBUTTON", "code_information": [{"code": "3100103230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETROGRADE EJACULATION ANAL", "code_information": [{"code": "89331", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 31.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RETROGRADE FILLING", "code_information": [{"code": "D3430", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REUTER BOBBIN", "code_information": [{"code": "3100101565", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REV ARTIFIC DISC ADDL", "code_information": [{"code": "98T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV GLENO W/RET 32X6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1912.96, "maximum": 2650.81, "gross_charge": 2732.8, "discounted_cash": 4099.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2322.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2049.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1912.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2650.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1912.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2049.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2322.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2186.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV RPLCM ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22861", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV RPLCM RTHRP 1NTRSPC LMBR", "code_information": [{"code": "22862", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV SHOULD HUM&GLEN", "code_information": [{"code": "23474", "type": "CPT"}, {"code": "3340102314", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4165.0, "maximum": 14671.65, "gross_charge": 5950.0, "discounted_cash": 8925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5057.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4165.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5771.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4165.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5057.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4760.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV GEN", "code_information": [{"code": "271T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "discounted_cash": 5208.11, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV LEAD", "code_information": [{"code": "270T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "discounted_cash": 5208.11, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV TOTAL", "code_information": [{"code": "269T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"minimum": 8198.68, "maximum": 8198.68, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-STENT", "code_information": [{"code": "C9765", "type": "HCPCS"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-STENT TIB/PER", "code_information": [{"code": "C9773", "type": "HCPCS"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP TIBI/PERONE", "code_information": [{"code": "C9772", "type": "HCPCS"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVASCULARIZATION PENIS", "code_information": [{"code": "37788", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVEFENACIN INH NON-COM 1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7677", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERS SPACER 36+6*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERS SPACER 36+9*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERS SPACER 42+6*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERS SPACER 42+9*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVERS SUT CUP 36*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVIS FALLOPIAN TUBE", "code_information": [{"code": "58740", "type": "CPT"}, {"code": "3480102120", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1853.6, "maximum": 4828.25, "gross_charge": 2648.0, "discounted_cash": 3972.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2250.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1986.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1853.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2568.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1853.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1986.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2250.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2118.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVIS NEUROSTIM ELEC", "code_information": [{"code": "63663", "type": "CPT"}, {"code": "3430102288", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 6978.94, "maximum": 17924.63, "gross_charge": 18479.0, "discounted_cash": 10468.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15707.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7216.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13859.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12935.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17924.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12935.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7188.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13859.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8304.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15707.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14783.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6978.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7118.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8198.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4404.17, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ADDITIONAL LEG TENDON", "code_information": [{"code": "27692", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE AQUEOUS SHUNT EYE", "code_information": [{"code": "66185", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 6993.18, "maximum": 6993.18, "discounted_cash": 18975.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6993.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EXTERNAL EAR", "code_information": [{"code": "69300", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4566.59, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EXTRA SPINE S", "code_information": [{"code": "22216", "type": "CPT"}, {"code": "3480101489", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 620.9, "maximum": 7959.27, "gross_charge": 887.0, "discounted_cash": 1330.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 753.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 665.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 620.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 860.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 620.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 665.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 753.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 709.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE", "code_information": [{"code": "65091", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67311", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2904.07, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67314", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE W/SUTURE", "code_information": [{"code": "67334", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S)", "code_information": [{"code": "67318", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S) ADD-ON", "code_information": [{"code": "67320", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKET IMPLANT", "code_information": [{"code": "67560", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21260", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21261", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21263", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21267", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKETS", "code_information": [{"code": "21268", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYE WITH IMPLANT", "code_information": [{"code": "65093", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67830", "type": "CPT"}, {"code": "3340102485", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2185.41, "gross_charge": 2253.0, "discounted_cash": 1549.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1915.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1068.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1689.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1577.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2185.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1053.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1577.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1064.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1689.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1033.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1229.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1915.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1033.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1802.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1033.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1053.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67835", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID DEFECT", "code_information": [{"code": "67909", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68330", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1524.13, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68362", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT", "code_information": [{"code": "26535", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26135", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE FINGER JOINT EACH", "code_information": [{"code": "26140", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HAND/FINGER TENDON", "code_information": [{"code": "26390", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JNT REPLA", "code_information": [{"code": "27134", "type": "CPT"}, {"code": "3480101670", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3351.6, "maximum": 14671.65, "gross_charge": 4788.0, "discounted_cash": 7182.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JNT REPLA", "code_information": [{"code": "27137", "type": "CPT"}, {"code": "3480101671", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2578.8, "maximum": 14671.65, "gross_charge": 3684.0, "discounted_cash": 5526.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3131.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2763.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2578.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3573.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2578.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2763.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3131.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2947.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE HIP JNT REPLA", "code_information": [{"code": "27138", "type": "CPT"}, {"code": "3480101672", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2679.6, "maximum": 14671.65, "gross_charge": 3828.0, "discounted_cash": 5742.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3253.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2871.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2679.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3713.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2679.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2871.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3253.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3062.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP", "code_information": [{"code": "27437", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNEECAP WITH", "code_information": [{"code": "27438", "type": "CPT"}, {"code": "3480103078", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 15981.88, "gross_charge": 16236.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13800.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12177.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11365.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15748.92, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11365.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12177.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13800.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12988.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE JOINT", "code_information": [{"code": "26530", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE KNUCKLE WITH IMPLANT", "code_information": [{"code": "26531", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LOWER LEG TENDON", "code_information": [{"code": "27690", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE LUMB ARTIF DISC ADDL", "code_information": [{"code": "165T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33820", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33822", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MAJOR VESSEL", "code_information": [{"code": "33824", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69641", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69642", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69643", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69644", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69645", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69646", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69660", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69661", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR BONE", "code_information": [{"code": "69662", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65125", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3980.08, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OCULAR IMPLANT", "code_information": [{"code": "65150", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 3980.08, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE OVARIAN TUBE(S)", "code_information": [{"code": "58752", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25315", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PALSY HAND TENDON(S)", "code_information": [{"code": "25316", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54328", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54336", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25365", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS & ULNA", "code_information": [{"code": "25375", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RADIUS OR ULNA", "code_information": [{"code": "25370", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24370", "type": "CPT"}], "standard_charges": [{"minimum": 14671.65, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE RECONST ELBOW JOINT", "code_information": [{"code": "24371", "type": "CPT"}], "standard_charges": [{"minimum": 14671.65, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPERMATIC CORD VEINS", "code_information": [{"code": "55535", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1927.74, "discounted_cash": 11580.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS THRC", "code_information": [{"code": "63251", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43860", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE STOMACH-BOWEL FUSION", "code_information": [{"code": "43865", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TEAR DUCT OPENING", "code_information": [{"code": "68705", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THIGH MUSCLES/TENDONS", "code_information": [{"code": "27400", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26490", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE THUMB TENDON", "code_information": [{"code": "26496", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67312", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE TWO EYE MUSCLES", "code_information": [{"code": "67316", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2904.07, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2904.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 1767.1, "maximum": 1767.1, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 1", "code_information": [{"code": "53400", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URETHRA STAGE 2", "code_information": [{"code": "53405", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6427.58, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE URINE FLOW", "code_information": [{"code": "50830", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT OPEN ABD", "code_information": [{"code": "57296", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VAG GRAFT VIA VAGINA", "code_information": [{"code": "57295", "type": "CPT"}], "standard_charges": [{"minimum": 2564.54, "maximum": 2564.54, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2564.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE VENTRICLE MUSCLE", "code_information": [{"code": "33416", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST JOINT", "code_information": [{"code": "25332", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE WRIST/FOREARM TENDON", "code_information": [{"code": "25280", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68320", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68325", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68326", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68328", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68335", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1998.05, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/IMPLANT FINGER JOINT", "code_information": [{"code": "26536", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEURO", "code_information": [{"code": "64595", "type": "CPT"}, {"code": "3480102179", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 9085.99, "gross_charge": 9367.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7961.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7025.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6556.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9085.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6556.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7025.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7961.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7493.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROE", "code_information": [{"code": "64585", "type": "CPT"}, {"code": "3480103202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 9409.0, "gross_charge": 9700.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8245.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7275.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6790.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9409.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6790.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7275.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8245.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7760.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROE", "code_information": [{"code": "64585", "type": "CPT"}, {"code": "3480103276", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 11235.51, "gross_charge": 11583.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9845.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8687.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8108.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11235.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8108.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8687.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9845.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9266.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROELECTRODE", "code_information": [{"code": "61880", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5677.76, "discounted_cash": 5208.11, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEURORECEIVER", "code_information": [{"code": "61888", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 5677.76, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE NEUROS", "code_information": [{"code": "64585", "type": "CPT"}, {"code": "3480102177", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6340.89, "gross_charge": 6537.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5556.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4902.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4575.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6340.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4575.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4902.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5556.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5229.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPL VAGUS N ELTRD", "code_information": [{"code": "64569", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "discounted_cash": 20850.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/REPLACE KNEE JOINT", "code_information": [{"code": "27487", "type": "CPT"}], "standard_charges": [{"minimum": 14671.65, "maximum": 14671.65, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/RMV PN/GASTR", "code_information": [{"code": "64595", "type": "CPT"}, {"code": "3480103204", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 9406.09, "gross_charge": 9697.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8242.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7272.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6787.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9406.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6787.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7272.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8242.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7757.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISE/RMV PN/GASTR", "code_information": [{"code": "64595", "type": "CPT"}, {"code": "3480103278", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 11231.63, "gross_charge": 11579.0, "discounted_cash": 5208.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9842.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3590.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8684.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8105.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11231.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8105.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3576.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8684.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4131.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9842.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9263.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3472.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3541.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION EYELID", "code_information": [{"code": "67961", "type": "CPT"}, {"code": "3410100715", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION GASTROPLASTY", "code_information": [{"code": "43848", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION KIT*3560031", "code_information": [{"code": "3100209635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 1777.5, "setting": "both", "billing_class": "facility"}]}, {"description": "REVISION OF AMPUTATION", "code_information": [{"code": "24935", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ANKLE JOINT", "code_information": [{"code": "27700", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5311.52, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5311.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF AORTIC VALVE", "code_information": [{"code": "92986", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF AQUEOUS SHUNT", "code_information": [{"code": "66184", "type": "CPT"}], "standard_charges": [{"minimum": 1367.49, "maximum": 1367.49, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER & BOWEL", "code_information": [{"code": "51960", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF BLADDER/URETHRA", "code_information": [{"code": "51800", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CALF TENDON", "code_information": [{"code": "27687", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57700", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "57720", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3553.77, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CERVIX", "code_information": [{"code": "59325", "type": "CPT"}], "standard_charges": [{"minimum": 2385.2, "maximum": 2385.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37140", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37145", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37160", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CIRCULATION", "code_information": [{"code": "37180", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23480", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLLAR BONE", "code_information": [{"code": "23485", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 12563.69, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12563.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44340", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2458.18, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44345", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF COLOSTOMY", "code_information": [{"code": "44346", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 708.89, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65760", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CORNEA", "code_information": [{"code": "65765", "type": "CPT"}], "standard_charges": [{"minimum": 708.89, "maximum": 708.89, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF CRANIAL NERVE", "code_information": [{"code": "64716", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF DIAPHRAGM", "code_information": [{"code": "39545", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ELBOW JOINT", "code_information": [{"code": "24470", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21280", "type": "CPT"}, {"code": "3480103064", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "21282", "type": "CPT"}, {"code": "3340102419", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4134.14, "gross_charge": 4262.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4134.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3409.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3980.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67880", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67882", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67950", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF EYELID", "code_information": [{"code": "67966", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1998.05, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FEMUR EPIPHYSIS", "code_information": [{"code": "27185", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FINGER", "code_information": [{"code": "26499", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT", "code_information": [{"code": "28116", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT AND ANKLE", "code_information": [{"code": "28262", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT BONES", "code_information": [{"code": "28737", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7559.22, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT FASCIA", "code_information": [{"code": "28250", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28238", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF FOOT TENDON", "code_information": [{"code": "28261", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART VEINS", "code_information": [{"code": "33645", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", "code_information": [{"code": "27147", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONES", "code_information": [{"code": "27156", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [{"code": "467", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20869.93, "maximum": 20869.93, "discounted_cash": 38923.02, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20869.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [{"code": "466", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21315.68, "maximum": 21315.68, "discounted_cash": 57906.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21315.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC", "code_information": [{"code": "468", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16978.03, "maximum": 16978.03, "discounted_cash": 29804.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16978.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP TENDON", "code_information": [{"code": "27097", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE KIDNEY", "code_information": [{"code": "50540", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24400", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24420", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOM", "code_information": [{"code": "44314", "type": "CPT"}, {"code": "3480101961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1750.7, "maximum": 2458.18, "gross_charge": 2501.0, "discounted_cash": 3751.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2125.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1875.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1750.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2425.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1750.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1875.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2125.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2000.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44312", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2458.18, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66761", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF IRIS", "code_information": [{"code": "66762", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21295", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3105.66, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF JAW MUSCLE/BONE", "code_information": [{"code": "21296", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50400", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KIDNEY/URETER", "code_information": [{"code": "50405", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27440", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27441", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27442", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27443", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF KNEE JOINT", "code_information": [{"code": "27445", "type": "CPT"}], "standard_charges": [{"minimum": 14671.65, "maximum": 14671.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LEG VEIN", "code_information": [{"code": "37780", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3185.31, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER EY", "code_information": [{"code": "15820", "type": "CPT"}, {"code": "3410100686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5126.45, "gross_charge": 5285.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5126.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LOWER LEG", "code_information": [{"code": "27715", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUM SPIN", "code_information": [{"code": "22214", "type": "CPT"}, {"code": "3480101488", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2567.6, "maximum": 5178.02, "gross_charge": 3668.0, "discounted_cash": 5502.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3117.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2751.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2567.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3557.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2567.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2751.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3117.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2934.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF LUNG", "code_information": [{"code": "32940", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37650", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2718.95, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MAJOR VEIN", "code_information": [{"code": "37660", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21700", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5178.02, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21720", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2470.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5178.02, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE/RIB", "code_information": [{"code": "21705", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30120", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30435", "type": "CPT"}, {"code": "3480103056", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 12101.72, "gross_charge": 12476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12101.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8733.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10604.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9980.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30460", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF NOSE", "code_information": [{"code": "30462", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PELVIS", "code_information": [{"code": "27158", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54300", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54304", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54420", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54430", "type": "CPT"}], "standard_charges": [{"minimum": 2109.3, "maximum": 2109.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54435", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42892", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PHARYNGEAL WALLS", "code_information": [{"code": "42894", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY ARTERY", "code_information": [{"code": "33788", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "33474", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF PULMONARY VALVE", "code_information": [{"code": "92990", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25350", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF RADIUS", "code_information": [{"code": "25355", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55175", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4233.32, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SCROTUM", "code_information": [{"code": "55180", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2109.3, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF SPINAL SHUNT", "code_information": [{"code": "63744", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 8235.17, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8235.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF T-SPINE", "code_information": [{"code": "22212", "type": "CPT"}, {"code": "3480101487", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3063.2, "maximum": 5178.02, "gross_charge": 4376.0, "discounted_cash": 6564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3719.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3063.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4244.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3063.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3719.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3500.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TESTIS", "code_information": [{"code": "54660", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2109.3, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF THIGH MUSCLES", "code_information": [{"code": "27430", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOE", "code_information": [{"code": "28312", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOTAL KN", "code_information": [{"code": "27486", "type": "CPT"}, {"code": "3480101705", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2468.2, "maximum": 14671.65, "gross_charge": 3526.0, "discounted_cash": 5289.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2997.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2644.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2468.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3420.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2468.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2644.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2997.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2820.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TOTAL SH", "code_information": [{"code": "23473", "type": "CPT"}, {"code": "3340102391", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 13430.15, "maximum": 33040.14, "gross_charge": 34062.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28952.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 25546.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23843.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 33040.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23843.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 25546.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28952.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27249.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRACHEOS", "code_information": [{"code": "31830", "type": "CPT"}, {"code": "3480101874", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33468", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF ULNA", "code_information": [{"code": "25360", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER EY", "code_information": [{"code": "15822", "type": "CPT"}, {"code": "3410100687", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6151.74, "gross_charge": 6342.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6151.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5073.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "53460", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETHRA", "code_information": [{"code": "57220", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4354.77, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF URINARY TRACT", "code_information": [{"code": "51820", "type": "CPT"}], "standard_charges": [{"minimum": 4758.39, "maximum": 4758.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4758.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF UTERUS", "code_information": [{"code": "58540", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25450", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OF WRIST JOINT", "code_information": [{"code": "25455", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION OPN ELB2SHL", "code_information": [{"code": "24310", "type": "CPT"}, {"code": "3480101562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION ORBITOFACIAL BONES", "code_information": [{"code": "21275", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION SUBVALVULAR TISSUE", "code_information": [{"code": "33415", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION TIPS", "code_information": [{"code": "37183", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL ISDNS PTN", "code_information": [{"code": "588T", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 5208.11, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVISION/REMOVAL OF KNEECAP", "code_information": [{"code": "27424", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVITA, PER SQ CM", "code_information": [{"code": "Q4180", "type": "HCPCS"}], "standard_charges": [{"minimum": 372.66, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVITALON 1 SQUARE CM", "code_information": [{"code": "Q4157", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVIVE LOCKING CAP*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 690.9, "maximum": 957.39, "gross_charge": 987.0, "discounted_cash": 1480.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 957.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST AUTOG VN GRF", "code_information": [{"code": "35884", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ FEM ANAST NONAUTOG GRF", "code_information": [{"code": "35883", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ INCL RPLCMT NST", "code_information": [{"code": "63664", "type": "CPT"}, {"code": "3480101687", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 10779.3, "maximum": 30305.84, "gross_charge": 15399.0, "discounted_cash": 20850.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13089.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14373.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11549.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10779.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14937.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14178.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10779.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14317.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11549.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13900.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16541.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13089.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13900.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13900.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14178.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ PRIOR HYPSPAD REPAIR", "code_information": [{"code": "54352", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVJ/RPR OPRATIVE WO", "code_information": [{"code": "66250", "type": "CPT"}, {"code": "3480102202", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3834.41, "gross_charge": 3953.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3360.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2964.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2767.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3834.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2767.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2964.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3360.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3162.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REVOLUTION FLEX NOZ*", "code_information": [{"code": "3100205280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.56, "discounted_cash": 69.84, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOLVE FAT PROCESS", "code_information": [{"code": "3100104123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOLVE SYSTEM", "code_information": [{"code": "3100103940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVOSHIELD+ AMNIO, PER SQ CM", "code_information": [{"code": "Q4289", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "REVSC OPN/PRQ TIB/PERO STENT", "code_information": [{"code": "37234", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REZUM KIT*D2201-003", "code_information": [{"code": "3100203251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RF ABLTJ NRV NRVTG S", "code_information": [{"code": "64625", "type": "CPT"}, {"code": "3480103305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1970.24, "maximum": 5836.49, "gross_charge": 6017.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5114.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4512.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4211.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5836.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4211.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4512.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5114.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4813.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RF PROBE*FG0043", "code_information": [{"code": "3100207601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11492.0, "discounted_cash": 17238.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RF PROBE*RLV0015", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "3100209157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 8044.4, "maximum": 11147.24, "gross_charge": 11492.0, "discounted_cash": 17238.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9768.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8044.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11147.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8044.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8619.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9768.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9193.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG FULL-DOSE IM", "code_information": [{"code": "90384", "type": "CPT"}], "standard_charges": [{"minimum": 148.52, "maximum": 148.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 148.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RH IG IV", "code_information": [{"code": "90386", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RH IG MINIDOSE IM", "code_information": [{"code": "90385", "type": "CPT"}], "standard_charges": [{"minimum": 37.58, "maximum": 37.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP NEXT GNRJ SEQ", "code_information": [{"code": "222U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHD&RHCE GNTYP RHD1-10&RHCE5", "code_information": [{"code": "198U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 454.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR QU", "code_information": [{"code": "86431", "type": "CPT"}, {"code": "3440101088", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 5.67, "maximum": 60.14, "gross_charge": 62.0, "discounted_cash": 9.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 60.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 43.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 46.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 52.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 49.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHEUMATOID FACTOR TEST QUAL", "code_information": [{"code": "86430", "type": "CPT"}], "standard_charges": [{"minimum": 6.14, "maximum": 30.26, "discounted_cash": 9.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHINAER*CAT840", "code_information": [{"code": "3100206993", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RHINOPLASTY, PRIMARY", "code_information": [{"code": "30410", "type": "CPT"}, {"code": "3480101830", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY, PRIMARY", "code_information": [{"code": "30420", "type": "CPT"}, {"code": "3480101831", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY, SECONDA", "code_information": [{"code": "30430", "type": "CPT"}, {"code": "3480101832", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7111.29, "gross_charge": 6299.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHINOPLASTY, SECONDA", "code_information": [{"code": "30450", "type": "CPT"}, {"code": "3480101833", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHO D IMMUNE GLOBULIN 50 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2788", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.88, "maximum": 21.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHO D IMMUNE GLOBULIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2790", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.98, "maximum": 79.98, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 79.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHO(D) IMMUNE GLOBULIN H, SD", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2792", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.64, "maximum": 30.64, "discounted_cash": 52.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHOPHYLAC INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2791", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.8, "maximum": 4.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG REPORT", "code_information": [{"code": "93042", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG TRACING", "code_information": [{"code": "93041", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHYTHM ECG WITH REPORT", "code_information": [{"code": "93040", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RHYTIDECTOMY NECK W/", "code_information": [{"code": "15825", "type": "CPT"}, {"code": "3480103005", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 5126.45, "gross_charge": 5285.0, "discounted_cash": 5491.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3785.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5126.45, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3699.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3770.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3963.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4356.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4492.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIA TUBE ASSEMBLY", "code_information": [{"code": "3100101566", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1416.0, "discounted_cash": 2124.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RIA TUBE ASSEMBLY", "code_information": [{"code": "3100103231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RIB CARTILAGE GRAFT", "code_information": [{"code": "21230", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIBOFLAVIN 5'PHOS OPTH<=3ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2787", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RICHETTSIA AB", "code_information": [{"code": "86757", "type": "CPT"}, {"code": "3440101118", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 19.35, "maximum": 167.81, "gross_charge": 173.0, "discounted_cash": 31.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 167.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 24.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 20.72, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIFAMPIN", "code_information": [{"code": "3400300031", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 91.6, "discounted_cash": 137.4, "setting": "both", "billing_class": "facility"}]}, {"description": "RIGHT HEART CATH", "code_information": [{"code": "93451", "type": "CPT"}], "standard_charges": [{"minimum": 2998.86, "maximum": 2998.86, "discounted_cash": 4987.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2998.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIGHT VENTRICULAR RECORDING", "code_information": [{"code": "93603", "type": "CPT"}], "standard_charges": [{"minimum": 7666.91, "maximum": 7666.91, "discounted_cash": 1821.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7666.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIGID LINER SHELL TL", "code_information": [{"code": "3100103923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5035.0, "discounted_cash": 7552.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RIGIFLEX BALLOON 30M", "code_information": [{"code": "3100203576", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 2781.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RILONACEPT INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2793", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.94, "maximum": 17.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RING MALYUGIN", "code_information": [{"code": "3100102387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RING TENSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RINGERS LACTATE INFUSION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7120", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 2.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RINGJECT 12/10*375US", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RIO IRRIGATION TUBE*", "code_information": [{"code": "3100205152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 518.0, "discounted_cash": 777.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RIV3 VACCINE NO PRESERV IM", "code_information": [{"code": "90673", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIV4 VACC RECOMBINANT DNA IM", "code_information": [{"code": "90682", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 73.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 73.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RIVAROXABAN", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300249", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 23.1, "discounted_cash": 34.65, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "RLCJ PULSE GEN ONLY ISDSS", "code_information": [{"code": "681T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC ESP<100", "code_information": [{"code": "69727", "type": "CPT"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69726", "type": "CPT"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BOTH", "code_information": [{"code": "519T", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 50357.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL ARTIFIC DISC ADDL CRVCL", "code_information": [{"code": "95T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL CAR MODULJ TRANVNS ELT", "code_information": [{"code": "413T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL CARDIAC MODULJ PLS GEN", "code_information": [{"code": "412T", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL DEEP RX DELIVERY DEVICE", "code_information": [{"code": "20701", "type": "CPT"}], "standard_charges": [{"minimum": 490.39, "maximum": 490.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL DISC ARTHROPL C", "code_information": [{"code": "22864", "type": "CPT"}, {"code": "3480101528", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4070.5, "maximum": 7959.27, "gross_charge": 5815.0, "discounted_cash": 8722.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4942.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4361.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4070.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5640.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4070.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4361.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4942.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4652.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL ESOPHGL SPHNCTR DEV", "code_information": [{"code": "43285", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL FB UPPER ARM/ELBW SUBQ", "code_information": [{"code": "24200", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2542.29, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "discounted_cash": 10196.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL I-ARTIC RX DELIVERY DEV", "code_information": [{"code": "20705", "type": "CPT"}], "standard_charges": [{"minimum": 490.39, "maximum": 490.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY DEVICE", "code_information": [{"code": "20703", "type": "CPT"}], "standard_charges": [{"minimum": 490.39, "maximum": 490.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 490.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL LENS MAT ASP TE", "code_information": [{"code": "66840", "type": "CPT"}, {"code": "3410100692", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 3834.41, "gross_charge": 3953.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3360.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2964.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2767.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3834.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2767.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2964.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3360.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3162.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL LENS MAT EXTRAC", "code_information": [{"code": "66940", "type": "CPT"}, {"code": "3410100697", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 3004.2, "gross_charge": 2320.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1972.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1624.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2250.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1624.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1972.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1856.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL LENS MAT IN-CAP", "code_information": [{"code": "66930", "type": "CPT"}, {"code": "3410100696", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7113.98, "gross_charge": 7334.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7113.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5867.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL LENS MAT INTRAC", "code_information": [{"code": "66920", "type": "CPT"}, {"code": "3410100695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7113.98, "gross_charge": 7334.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7113.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5867.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL LENS MAT PHACOF", "code_information": [{"code": "66850", "type": "CPT"}, {"code": "3410100693", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7113.98, "gross_charge": 7334.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7113.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5867.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL LENS MAT PRSPLA", "code_information": [{"code": "66852", "type": "CPT"}, {"code": "3410100694", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7113.98, "gross_charge": 7334.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7113.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5133.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5500.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6233.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5867.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ LEFT HEART VAD", "code_information": [{"code": "33992", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PERQ RIGHT HEART VAD", "code_information": [{"code": "33997", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PG WCS LV BATTERY ONLY", "code_information": [{"code": "518T", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SEC MEMB CORN-S", "code_information": [{"code": "66830", "type": "CPT"}, {"code": "3410100691", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2829.81, "gross_charge": 2320.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1972.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1624.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2250.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1624.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1972.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1856.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SINUS TARSI IMPLANT", "code_information": [{"code": "510T", "type": "CPT"}], "standard_charges": [{"minimum": 3498.15, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 6010.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33286", "type": "CPT"}], "standard_charges": [{"minimum": 910.92, "maximum": 910.92, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 910.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TIS XPNDR WO INSJ IMPLT", "code_information": [{"code": "11971", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1551.72, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TONGS/HALO ANTHR INDIV", "code_information": [{"code": "20665", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 453.46, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 453.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL TOT ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22865", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RIMPLTJ ANT SGM IMPLT", "code_information": [{"code": "661T", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RINSJ SINUS TARSI IMPLT", "code_information": [{"code": "511T", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 36079.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RN CARE TRAIN/EDU IN HH", "code_information": [{"code": "G0495", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", "code_information": [{"code": "G0339", "type": "HCPCS"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROBOTIC SURGICAL SYSTEM", "code_information": [{"code": "S2900", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBT LIN-RADSURG FRACTX 2-5", "code_information": [{"code": "G0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROCKER RING*7107-036", "code_information": [{"code": "3100209139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3006.9, "discounted_cash": 4510.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROCURONIUM BROMIDE", "code_information": [{"code": "3400300228", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 23.9, "discounted_cash": 35.85, "setting": "both", "billing_class": "facility"}]}, {"description": "ROCURONIUM BROMIDE", "code_information": [{"code": "3400300310", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.9, "discounted_cash": 31.35, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1480.5, "maximum": 2051.55, "gross_charge": 2115.0, "discounted_cash": 3172.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2051.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 548.1, "maximum": 759.51, "gross_charge": 783.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 759.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 626.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 688.8, "maximum": 954.48, "gross_charge": 984.0, "discounted_cash": 1476.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 836.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 738.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 688.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 954.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 688.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 738.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 836.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 787.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 11.0X250MM*394.8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.0, "maximum": 870.23, "gross_charge": 897.15, "discounted_cash": 1345.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 762.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 672.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 762.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 717.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 11.0X350MM*39486", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 548.1, "maximum": 759.51, "gross_charge": 783.0, "discounted_cash": 1174.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 759.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 548.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 587.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 665.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 626.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 250MM*MM1-165250", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 646.8, "maximum": 896.28, "gross_charge": 924.0, "discounted_cash": 1386.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 896.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 260MM*7571260", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 100*18210-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 36750.0, "maximum": 50925.0, "gross_charge": 52500.0, "discounted_cash": 78750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44625.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36750.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50925.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36750.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44625.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 42000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 100*LT40-P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 200*360021", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 850.5, "maximum": 1178.55, "gross_charge": 1215.0, "discounted_cash": 1822.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 972.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 240*18200-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 25*18210-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 25*3603725", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 531.3, "maximum": 736.23, "gross_charge": 759.0, "discounted_cash": 1138.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 645.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 569.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 531.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 736.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 531.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 569.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 645.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 607.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 30*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 30*3603730", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 35*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 40*3603740", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 45*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 50*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 50*3603750", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 55*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 60*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 60*3603760", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 70*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 70*3603770", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 80*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 80*3603780", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 80*LT40-P0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 90*18210-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5 X 90*G775389", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 876.75, "maximum": 1214.92, "gross_charge": 1252.5, "discounted_cash": 1878.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1064.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 939.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 876.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1214.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 876.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 939.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1064.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1002.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5MM*18240-35", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 3.5X80MM OASYS*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.89, "maximum": 369.84, "gross_charge": 381.28, "discounted_cash": 571.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 324.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 369.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 324.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 305.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 300MM*1797-62-30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 35MM W/LINE*1797", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 35MM*641003035", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 400MM*04.633.294", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 621.6, "maximum": 861.36, "gross_charge": 888.0, "discounted_cash": 1332.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 754.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 666.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 861.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 621.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 666.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 754.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 710.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 100*12-110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 100*15280-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 100*155320", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 565.95, "maximum": 784.24, "gross_charge": 808.5, "discounted_cash": 1212.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 784.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 110*12-111", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 110*15280-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 110*155320", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 565.95, "maximum": 784.24, "gross_charge": 808.5, "discounted_cash": 1212.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 784.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 120*12-112", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 436.8, "maximum": 605.28, "gross_charge": 624.0, "discounted_cash": 936.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 605.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 120*15280-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 120*155320", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 565.95, "maximum": 784.24, "gross_charge": 808.5, "discounted_cash": 1212.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 784.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 120MM*1555", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 727.65, "maximum": 1008.31, "gross_charge": 1039.5, "discounted_cash": 1559.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 883.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 779.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 727.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1008.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 727.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 779.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 883.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 831.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 130*15280-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 130*654000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 150*1001-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 150*654000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 250*MD1-61", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 609.0, "maximum": 843.9, "gross_charge": 870.0, "discounted_cash": 1305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 30*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 35*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 733.32, "gross_charge": 756.0, "discounted_cash": 1134.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 733.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 35*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 35*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 40*12-1040", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 40*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 40*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 733.32, "gross_charge": 756.0, "discounted_cash": 1134.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 733.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 40*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 40*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209196", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 400*15250-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 45*12-1045", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 45*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 45*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 45*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 45*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 450*MD1-51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 609.0, "maximum": 843.9, "gross_charge": 870.0, "discounted_cash": 1305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 50*12-1050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 50*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 50*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 50*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 646.8, "maximum": 896.28, "gross_charge": 924.0, "discounted_cash": 1386.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 896.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 500*155320", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 55*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 55*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 55*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 60*1070755", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 60*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 60*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 565.95, "maximum": 784.24, "gross_charge": 808.5, "discounted_cash": 1212.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 784.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 565.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 687.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 60*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 60*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 65*1070755", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 65*12-1065", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 65*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 65*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 65*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 70*12-1070", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 436.8, "maximum": 605.28, "gross_charge": 624.0, "discounted_cash": 936.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 605.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 70*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 70*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 70*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 733.32, "gross_charge": 756.0, "discounted_cash": 1134.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 733.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 70*6510030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1292.88, "maximum": 1791.57, "gross_charge": 1846.98, "discounted_cash": 2770.47, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1569.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1385.23, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1292.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1791.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1292.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1385.23, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1569.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1477.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 70*MM1-145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 75*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 80*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 80*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 90*12-1090", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 90*15280-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 90*1553201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X 90*MM1-155", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 646.8, "maximum": 896.28, "gross_charge": 924.0, "discounted_cash": 1386.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 896.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 646.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 785.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X105*4550-10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X35*4550-035", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X45*4550-45", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X55*4550-055", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X60*4550-060", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X65*4550-065", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X70*4550-070", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1333.5, "maximum": 1847.85, "gross_charge": 1905.0, "discounted_cash": 2857.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1847.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1524.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X80*12-1080", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X80*4550-080", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X90*4550-090", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5 X95*4550-095", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5X110MM*48001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5X120 STRAIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5X500*48027-55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 5.5X600*48027-55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 500MM*1555200500", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1524.88, "maximum": 2113.04, "gross_charge": 2178.4, "discounted_cash": 3267.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1851.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1633.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1524.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2113.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1524.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1633.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1851.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1742.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 50MM*1020-65-050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 100*41-210", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 436.8, "maximum": 605.28, "gross_charge": 624.0, "discounted_cash": 936.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 605.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 100MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 110MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 120MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 130MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 140MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 150MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203952", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 300*15202-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 40MM*48233", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 480MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 500*15200-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 500*15202-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 50MM*48233", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 600MM*4823", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 60MM*48233", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 70MM*48233", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 80MM*48233", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 90*41-2090", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 436.8, "maximum": 605.28, "gross_charge": 624.0, "discounted_cash": 936.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 605.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 530.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 499.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X 90MM*48233", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.0 X450*MD1-516", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 698.4, "gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6.5 X40*4550-040", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 60 X 400*15250-6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 60MM PREBENT*046", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1520.96, "maximum": 2107.61, "gross_charge": 2172.8, "discounted_cash": 3259.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1846.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1520.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2107.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1520.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1846.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1738.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 60MM W/LINE*1797", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X35MM*48238035", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X40MM*48238040", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X45MM*48238045", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X50MM*48238050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X50MM*48239050", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X60MM*48239060", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X70MM*48238070", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X760MM*48239070", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X870MM*48238080", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD 6X90MM*48238090", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.93, "maximum": 473.82, "gross_charge": 488.48, "discounted_cash": 732.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 415.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD AESCULAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALLOY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALPHATEC CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALPHATEC CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALPHATEC CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.4, "maximum": 457.84, "gross_charge": 472.0, "discounted_cash": 708.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 457.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 377.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALPHATEC SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALPHATEC STRAIGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ALPHATEC STRAIGH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ARSENAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ARSENAL 5.5x130*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ARSENAL 5.5x30*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ARSENAL 5.5x500*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ARSENAL 5.5x65*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ATTACH LG*AR-896", "code_information": [{"code": "3100208457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1181.25, "discounted_cash": 1771.88, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CARBON 100*AR-89", "code_information": [{"code": "3100208459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 532.35, "discounted_cash": 798.53, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CARBON 300*AR-89", "code_information": [{"code": "3100208460", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.5, "discounted_cash": 897.75, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CARBON 400*AR-89", "code_information": [{"code": "3100208461", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD CARBON FIBER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 602.0, "maximum": 834.2, "gross_charge": 860.0, "discounted_cash": 1290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 731.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 645.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 602.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 834.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 602.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 645.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 731.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 688.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1213.8, "maximum": 1681.98, "gross_charge": 1734.0, "discounted_cash": 2601.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1473.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1300.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1213.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1681.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1213.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1300.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1473.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1387.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CERVICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD COBALT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD COCR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1360.8, "maximum": 1885.68, "gross_charge": 1944.0, "discounted_cash": 2916.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1652.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1458.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1360.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1885.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1360.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1458.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1652.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1555.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD COCR 110MM*14755", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD COCR 60MM*147550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 727.65, "maximum": 1008.31, "gross_charge": 1039.5, "discounted_cash": 1559.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 883.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 779.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 727.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1008.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 727.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 779.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 883.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 831.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD COCR 80MM*147550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CONN 5.5 X 6.35*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CONN ALPHATEC SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CONNECTOR 5.5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CROSSLINK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUR 3.5 X 200*36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUR 5.5 X 125*04", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUR 5.5X 125*111", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUR 5.5X45*101-6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURV 30MM*155550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURV 60MM*155550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 680.4, "maximum": 942.84, "gross_charge": 972.0, "discounted_cash": 1458.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 942.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 777.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURV 80MM*155550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURV 90MM*155550", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 680.4, "maximum": 942.84, "gross_charge": 972.0, "discounted_cash": 1458.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 942.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 729.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 826.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 777.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 110", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 35*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 55*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 60*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 65*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 70*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 75*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 80*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 85*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5 X 90*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5X105*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5X55MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 497.7, "maximum": 689.67, "gross_charge": 711.0, "discounted_cash": 1066.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 604.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 533.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 497.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 689.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 497.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 533.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 604.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 568.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5X60MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 5.5X70MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 80MM*124.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 753.9, "maximum": 1044.69, "gross_charge": 1077.0, "discounted_cash": 1615.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 915.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 807.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 753.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1044.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 753.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 807.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 915.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 861.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED 90MM*124.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 753.9, "maximum": 1044.69, "gross_charge": 1077.0, "discounted_cash": 1615.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 915.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 807.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 753.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1044.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 753.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 807.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 915.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 861.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 371.7, "maximum": 515.07, "gross_charge": 531.0, "discounted_cash": 796.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 515.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 424.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CURVED TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 861.0, "maximum": 1193.1, "gross_charge": 1230.0, "discounted_cash": 1845.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1045.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 922.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 861.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1193.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 861.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 922.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1045.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUSTOM SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUSTOM SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.2, "maximum": 471.42, "gross_charge": 486.0, "discounted_cash": 729.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD CUSTOM SPINE SEC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101577", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD DEPUY INLINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2848.3, "maximum": 3946.93, "gross_charge": 4069.0, "discounted_cash": 6103.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3458.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3051.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2848.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3946.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2848.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3051.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3458.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3255.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD DEPUY SPINAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD DEPUY SPINAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD DEPUY SPINAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD DUPEY SPINAL 5.5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD EVERE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD EVEREST 5.5X500*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD GLOBUS MEDICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 499.8, "maximum": 692.58, "gross_charge": 714.0, "discounted_cash": 1071.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 692.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD GLOBUS MEDICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 491.79, "gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD GLOBUS MEDICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 684.6, "maximum": 948.66, "gross_charge": 978.0, "discounted_cash": 1467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 831.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 684.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 948.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 684.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 831.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 782.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD INNOVASIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD INNOVASIS LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD LENS SCOPE SEALS", "code_information": [{"code": "3100203077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD LORD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.4, "maximum": 2349.34, "gross_charge": 2422.0, "discounted_cash": 3633.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2349.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC 5.5X50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 936.6, "maximum": 1297.86, "gross_charge": 1338.0, "discounted_cash": 2007.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1297.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1070.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC ANTARE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 961.8, "maximum": 1332.78, "gross_charge": 1374.0, "discounted_cash": 2061.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1167.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1030.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 961.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1332.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 961.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1030.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1167.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1099.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC SOFAMO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 936.6, "maximum": 1297.86, "gross_charge": 1338.0, "discounted_cash": 2007.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1297.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 936.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1003.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1137.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1070.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC SOFAMO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC SOFAMO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 693.0, "maximum": 960.3, "gross_charge": 990.0, "discounted_cash": 1485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 742.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 960.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 742.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 841.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC SOFAMO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 745.5, "maximum": 1033.05, "gross_charge": 1065.0, "discounted_cash": 1597.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 905.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 798.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 745.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1033.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 745.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 798.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 905.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 852.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC SOFAMO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MEDTRONIC SOFAMO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MESA 5.5 X 375*8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2497.49, "maximum": 3460.81, "gross_charge": 3567.85, "discounted_cash": 5351.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3032.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2497.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3460.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2497.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2675.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3032.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2854.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD METRONIC XENON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4092.9, "maximum": 5671.59, "gross_charge": 5847.0, "discounted_cash": 8770.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4969.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4385.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4092.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5671.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4092.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4385.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4969.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4677.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MIS 5.5X100*1523", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD MIS 5.5X40*15230", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE BALL DU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1208.2, "maximum": 1674.22, "gross_charge": 1726.0, "discounted_cash": 2589.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1467.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1294.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1208.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1674.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1208.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1294.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1467.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE BALL DU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2251.2, "maximum": 3119.52, "gross_charge": 3216.0, "discounted_cash": 4824.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2733.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2412.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2251.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3119.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2251.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2412.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2733.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2572.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE BALL DU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3000.9, "maximum": 4158.39, "gross_charge": 4287.0, "discounted_cash": 6430.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3643.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3215.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3000.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4158.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3000.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3215.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3643.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE COBALT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1586.2, "maximum": 2198.02, "gross_charge": 2266.0, "discounted_cash": 3399.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1926.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1699.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1586.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2198.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1586.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1699.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1926.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1812.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2251.2, "maximum": 3119.52, "gross_charge": 3216.0, "discounted_cash": 4824.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2733.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2412.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2251.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3119.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2251.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2412.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2733.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2572.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE CURVED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 902.3, "maximum": 1250.33, "gross_charge": 1289.0, "discounted_cash": 1933.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 966.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 902.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1250.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 902.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 966.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1095.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1031.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD NUVASIVE PRCEPT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2163.7, "maximum": 2998.27, "gross_charge": 3091.0, "discounted_cash": 4636.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2627.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2318.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2163.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2998.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2163.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2318.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2627.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2472.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD OCCIPITAL*75025", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD REAM 3.0X950MM *", "code_information": [{"code": "3100205071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD REAM WITH BALL T", "code_information": [{"code": "3100101592", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.1, "discounted_cash": 727.65, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD REAM WITH BALL T", "code_information": [{"code": "3100103251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD RELINE OPEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD RETRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 325.5, "maximum": 451.05, "gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 451.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 325.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 395.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD S&N", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SOFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 569.1, "maximum": 788.61, "gross_charge": 813.0, "discounted_cash": 1219.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 691.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 609.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 569.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 788.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 569.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 609.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 691.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 650.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SPINE DUAL BALL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2100.7, "maximum": 2910.97, "gross_charge": 3001.0, "discounted_cash": 4501.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2550.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2250.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2100.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2910.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2100.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2250.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2550.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2400.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 3.5 X 120*182", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 3.5 X 45*1820", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 3.5 X 90*1820", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 3.5 X 90*1820", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 3.5X80*LT40-S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 4.0 X 120*182", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST 4.0 X 90*1820", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD ST*18200-40-240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STGHT 5.5X100MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STGHT 5.5X120MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGH 5.5X120*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X45*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X60*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X60M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X70*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X75*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 490.0, "maximum": 679.0, "gross_charge": 700.0, "discounted_cash": 1050.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 595.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 490.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 679.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 490.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 595.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X75*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X80*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT 5.5X95*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRAIGHT5.5X110*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 989.1, "maximum": 1370.61, "gross_charge": 1413.0, "discounted_cash": 2119.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1370.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 989.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1059.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1201.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1130.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2177.7, "maximum": 3017.67, "gross_charge": 3111.0, "discounted_cash": 4666.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2644.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2333.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2177.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3017.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2177.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2333.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2644.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2488.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER MAX RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 847.7, "maximum": 1174.67, "gross_charge": 1211.0, "discounted_cash": 1816.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 908.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 847.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1174.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 847.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 908.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1029.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 968.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER MAX RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1059.1, "maximum": 1467.61, "gross_charge": 1513.0, "discounted_cash": 2269.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1286.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1134.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1059.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1467.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1059.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1134.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1286.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1210.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 535.5, "maximum": 742.05, "gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 742.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 650.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER POST ORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 639.8, "maximum": 886.58, "gross_charge": 914.0, "discounted_cash": 1371.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 776.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 639.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 886.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 639.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 685.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 776.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 731.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER POST ORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 809.9, "maximum": 1122.29, "gross_charge": 1157.0, "discounted_cash": 1735.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 983.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 867.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 809.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1122.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 809.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 867.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 983.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 925.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER POST ORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 922.6, "maximum": 1278.46, "gross_charge": 1318.0, "discounted_cash": 1977.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1120.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 988.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 922.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1278.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 922.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 988.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1120.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1054.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 809.9, "maximum": 1122.29, "gross_charge": 1157.0, "discounted_cash": 1735.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 983.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 867.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 809.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1122.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 809.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 867.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 983.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 925.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 466.2, "maximum": 646.02, "gross_charge": 666.0, "discounted_cash": 999.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 566.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 499.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 466.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 646.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 466.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 499.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 566.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 532.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER RAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER VITALLIU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2419.2, "maximum": 3352.32, "gross_charge": 3456.0, "discounted_cash": 5184.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2937.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2592.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2419.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3352.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2419.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2592.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2937.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2764.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER VITALLIU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1626.1, "maximum": 2253.31, "gross_charge": 2323.0, "discounted_cash": 3484.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1974.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1742.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1626.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2253.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1626.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1742.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1974.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1858.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER VITALLIU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2641.8, "maximum": 3660.78, "gross_charge": 3774.0, "discounted_cash": 5661.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3207.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2830.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2641.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3660.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2641.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2830.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3207.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3019.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER XIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER XIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 791.0, "maximum": 1096.1, "gross_charge": 1130.0, "discounted_cash": 1695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1096.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 791.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 847.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 960.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD STRYKER XIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1215.2, "maximum": 1683.92, "gross_charge": 1736.0, "discounted_cash": 2604.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1475.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1215.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1683.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1215.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1302.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1475.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1388.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 812.7, "maximum": 1126.17, "gross_charge": 1161.0, "discounted_cash": 1741.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 986.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 870.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 812.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1126.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 812.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 870.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 986.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 928.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1211.7, "maximum": 1679.07, "gross_charge": 1731.0, "discounted_cash": 2596.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1471.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1298.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1211.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1679.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1211.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1298.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1471.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1384.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1983.8, "maximum": 2748.98, "gross_charge": 2834.0, "discounted_cash": 4251.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2748.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1983.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2125.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2408.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2267.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 510.3, "maximum": 707.13, "gross_charge": 729.0, "discounted_cash": 1093.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 707.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 583.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TEMPLATE 150MM*6", "code_information": [{"code": "3100203939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.0, "discounted_cash": 864.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TEMPLATE*0371062", "code_information": [{"code": "3100208219", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 2308.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TEMPLATE*4856001", "code_information": [{"code": "3100208566", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 886.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TEMPLATE*4856001", "code_information": [{"code": "3100208617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 591.0, "discounted_cash": 886.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROD TI 3.5X120*1020-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TI ALLOY 5.5X600", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TITANIUM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 434.7, "maximum": 602.37, "gross_charge": 621.0, "discounted_cash": 931.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 602.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 496.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TO ROD ANGLED*29", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203157", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TO ROD OPEN*2901", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TO ROD OPEN*2901", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD TRANSITION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2907.1, "maximum": 4028.41, "gross_charge": 4153.0, "discounted_cash": 6229.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3530.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3114.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2907.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4028.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2907.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3114.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3530.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3322.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD VITALLIUM 3.5X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD VITALLIUM 3.5X24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 575.4, "maximum": 797.34, "gross_charge": 822.0, "discounted_cash": 1233.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 698.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 616.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 575.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 797.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 575.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 616.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 698.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 657.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD VITALLIUM 3.5X80", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X120*76", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X240*76", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X300*76", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X35*760", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X45*760", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206160", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X55*760", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X75*760", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD YUKON 4.0X80*760", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 415.8, "maximum": 576.18, "gross_charge": 594.0, "discounted_cash": 891.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 576.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 445.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 504.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD Z 5.5X 11.4*1542", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1519.0, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 3255.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD Z 5.5X 300*15424", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROD Z 5.5X13.5*15421", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1519.0, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 3255.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROLAPITANT, ORAL, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8670", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.63, "maximum": 1.63, "discounted_cash": 2.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROLLER BALL*RB-245M-", "code_information": [{"code": "3100203041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 382.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROMIPLOSTIM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2796", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.38, "maximum": 96.38, "discounted_cash": 154.26, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 96.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROOT AMPUTATION", "code_information": [{"code": "D3450", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROOT SURGERY EA ADD ROOT", "code_information": [{"code": "D3426", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROOT SURGERY MOLAR", "code_information": [{"code": "D3425", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROOT SURGERY PREMOLAR", "code_information": [{"code": "D3421", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2795", "type": "HCPCS"}, {"code": "3400300278", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 25.35, "gross_charge": 26.14, "discounted_cash": 39.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2795", "type": "HCPCS"}, {"code": "3400300279", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 59.17, "gross_charge": 61.0, "discounted_cash": 91.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 59.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2795", "type": "HCPCS"}, {"code": "3400300280", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 42.38, "gross_charge": 43.7, "discounted_cash": 65.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.59, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 42.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 37.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2795", "type": "HCPCS"}, {"code": "3400300281", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 47.04, "gross_charge": 48.5, "discounted_cash": 72.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 41.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 47.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 41.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROPIVACAINE HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2795", "type": "HCPCS"}, {"code": "3400300282", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.07, "maximum": 34.24, "gross_charge": 35.3, "discounted_cash": 52.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 34.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTATION NOTCH 2MM*2", "code_information": [{"code": "3100208108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTATION NOTCH 3MM*2", "code_information": [{"code": "3100208488", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTATION NOTCH 4MM*2", "code_information": [{"code": "3100208196", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTAVIRUS AB", "code_information": [{"code": "86759", "type": "CPT"}, {"code": "3440101119", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 18.23, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 29.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 20.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.52, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROUT FOOT CARE PER VISIT", "code_information": [{"code": "S0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 226.95, "maximum": 226.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ROUTER D STRYKER", "code_information": [{"code": "3100101605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 519.0, "discounted_cash": 778.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 1 AREA 1 D IMG", "code_information": [{"code": "78800", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 2+AREA 1+D IMG", "code_information": [{"code": "78801", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 1 AREA", "code_information": [{"code": "78803", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2394.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 1 D IMG", "code_information": [{"code": "78802", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 2+D IMG", "code_information": [{"code": "78804", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 2173.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 683.97, "maximum": 683.97, "discounted_cash": 380.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 683.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC COMPLETE PICC L", "code_information": [{"code": "36584", "type": "CPT"}, {"code": "3340100567", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3517.22, "gross_charge": 3626.0, "discounted_cash": 2451.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3082.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2719.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2538.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3517.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2538.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1683.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2719.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1944.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3082.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2900.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1634.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1666.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1735.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 932.72, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 13981.9, "maximum": 13981.9, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13981.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPLCMT OI IMPLT SKL PRQ ESP", "code_information": [{"code": "69717", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR 1ST FEM HERNIA A", "code_information": [{"code": "49553", "type": "CPT"}, {"code": "3480101999", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3530.38, "maximum": 8246.94, "gross_charge": 8502.0, "discounted_cash": 5295.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3650.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8246.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5951.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3636.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6376.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4201.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7226.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6801.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3530.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3600.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR BLEPHAROPTOSIS L", "code_information": [{"code": "67903", "type": "CPT"}, {"code": "3480102210", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1998.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA NTRANASL", "code_information": [{"code": "30540", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4850.06, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4850.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M 7.6-12.5 CM", "code_information": [{"code": "12015", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M >30.0 CM", "code_information": [{"code": "12018", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 12.6-20.0 CM", "code_information": [{"code": "12016", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR FE/E/EN/L/M 20.1-30.0 CM", "code_information": [{"code": "12017", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP SIMPLE", "code_information": [{"code": "54340", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERN PREMIE BLOCKED", "code_information": [{"code": "49492", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY BLOCKED", "code_information": [{"code": "49496", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "discounted_cash": 5295.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 426.56, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH<HALF VER HEIGHT", "code_information": [{"code": "40652", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 426.56, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/IMPLT", "code_information": [{"code": "30468", "type": "CPT"}], "standard_charges": [{"minimum": 4566.59, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR PUL ART UNIFOCAL W/O CPB", "code_information": [{"code": "33925", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR RET DTCH 1/> SES", "code_information": [{"code": "67105", "type": "CPT"}, {"code": "3410100698", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1394.86, "gross_charge": 1438.0, "discounted_cash": 889.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1222.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 613.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1078.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1006.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1394.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 605.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1006.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 610.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1078.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 593.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 705.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1222.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 593.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1150.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 593.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 605.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR RET DTCH INJ AIR", "code_information": [{"code": "67110", "type": "CPT"}, {"code": "3410100713", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4895.59, "gross_charge": 5047.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4289.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3532.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4895.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3532.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4289.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR RET DTCH SCLER B", "code_information": [{"code": "67107", "type": "CPT"}, {"code": "3410100711", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR RET DTCH W/VITRE", "code_information": [{"code": "67108", "type": "CPT"}, {"code": "3410100712", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR RET DTCH1/>SES C", "code_information": [{"code": "67101", "type": "CPT"}, {"code": "3410100709", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 7184.53, "gross_charge": 5047.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4289.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3532.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4895.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3532.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4289.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK12.6-20.0CM", "code_information": [{"code": "12005", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK20.1-30.0CM", "code_information": [{"code": "12006", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRNK >30.0 CM", "code_information": [{"code": "12007", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 402.28, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR UNBIL HERN REDUC", "code_information": [{"code": "49580", "type": "CPT"}, {"code": "3340102367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8826.03, "gross_charge": 9099.0, "discounted_cash": 13648.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7734.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6824.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6369.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8826.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6369.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6824.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7734.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7279.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RPRDTVE MED RNA GEN PRFL 238", "code_information": [{"code": "253U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 5075.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RRP HYPSPAD COMP MOBLJ&URTP", "code_information": [{"code": "54344", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5158.0, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RS&I ARTHROGRAM HIP", "code_information": [{"code": "73525", "type": "CPT"}, {"code": "3430100785", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 1337.63, "gross_charge": 1379.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1172.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1034.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 965.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1337.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 965.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1034.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1172.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RS&I DISKOGRAPHY LUM", "code_information": [{"code": "72295", "type": "CPT"}, {"code": "3430100784", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 871.76, "maximum": 7743.51, "gross_charge": 7983.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6785.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5987.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5588.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7743.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5588.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5987.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6785.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6386.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RS&I DISKOGRPHY CER/", "code_information": [{"code": "72285", "type": "CPT"}, {"code": "3430100782", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 871.76, "maximum": 9291.63, "gross_charge": 9579.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8142.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7184.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6705.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9291.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6705.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7184.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8142.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RS&I VRTPLS/SACRP /V", "code_information": [{"code": "72291", "type": "CPT"}, {"code": "3430100783", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 162.4, "maximum": 225.04, "gross_charge": 232.0, "discounted_cash": 348.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 197.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 225.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 162.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 174.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 197.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 185.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSA LOWER EXTR EXAM", "code_information": [{"code": "350T", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSA SPINE EXAM", "code_information": [{"code": "348T", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSA UPPER EXTR EXAM", "code_information": [{"code": "349T", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSECT HIP TUM INCL FEMUR", "code_information": [{"code": "27078", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSV DNA/RNA AMP PROBE", "code_information": [{"code": "87634", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 70.2, "discounted_cash": 112.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSV MAB IM 50MG", "code_information": [{"code": "90378", "type": "CPT"}], "standard_charges": [{"minimum": 1737.51, "maximum": 1737.51, "discounted_cash": 545.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1737.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN .5ML IM", "code_information": [{"code": "90380", "type": "CPT"}], "standard_charges": [{"minimum": 495.0, "maximum": 495.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV MONOC ANTB SEASN 1 ML IM", "code_information": [{"code": "90381", "type": "CPT"}], "standard_charges": [{"minimum": 495.0, "maximum": 495.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 495.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RSV SWAB (POC)", "code_information": [{"code": "87807", "type": "CPT"}, {"code": "3440101209", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 13.1, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 21.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.03, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RSV VACC PREF BIVALENT IM", "code_information": [{"code": "90678", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RTA POLARIZE SCAN OC SCR BI", "code_information": [{"code": "469T", "type": "CPT"}], "standard_charges": [{"minimum": 89.45, "maximum": 89.45, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RUBELLA AB", "code_information": [{"code": "86762", "type": "CPT"}, {"code": "3440101120", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.39, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 23.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RUBEOLA AG IF", "code_information": [{"code": "87283", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 60.8, "discounted_cash": 97.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 60.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RUBEOLA IGG AB", "code_information": [{"code": "86765", "type": "CPT"}, {"code": "3440101121", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.88, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 20.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RUMI TIP", "code_information": [{"code": "3100101606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RUNX1 GENE TARGETED SEQ ALYS", "code_information": [{"code": "81334", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 329.51, "discounted_cash": 529.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RUSSELL VIPER VENOM", "code_information": [{"code": "85613", "type": "CPT"}, {"code": "3440101051", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 9.58, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 15.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RV1 VACC 2 DOSE LIVE ORAL", "code_information": [{"code": "90681", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 130.15, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 130.15, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RV5 VACC 3 DOSE LIVE ORAL", "code_information": [{"code": "90680", "type": "CPT"}], "standard_charges": [{"minimum": 96.4, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 96.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX ASY PRSMV 30+RX/METABLT", "code_information": [{"code": "227U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "discounted_cash": 99.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX LOCKING DEVICE*M0", "code_information": [{"code": "3100203686", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "RX METAB ADVRS TRGT SEQ ALYS", "code_information": [{"code": "29U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1192.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX METAB GEN SEQ ALYS PNL 6", "code_information": [{"code": "81418", "type": "CPT"}], "standard_charges": [{"minimum": 917.08, "maximum": 917.08, "discounted_cash": 1473.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 917.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB GENRX IA 16 GENES", "code_information": [{"code": "392U", "type": "CPT"}], "standard_charges": [{"minimum": 1336.09, "maximum": 1336.09, "discounted_cash": 2146.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1336.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RX METAB WARF TRGT SEQ ALYS", "code_information": [{"code": "30U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 215.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX MNTR 1+ORAL ONC RX&SBSTS", "code_information": [{"code": "110U", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "discounted_cash": 43.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX MNTR 14+ DRUGS & SBSTS", "code_information": [{"code": "54U", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 183.34, "discounted_cash": 239.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX MNTR 65 COM DRUGS URINE", "code_information": [{"code": "93U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "discounted_cash": 99.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX MNTR LC-MS/MS ORAL FLUID", "code_information": [{"code": "11U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "discounted_cash": 183.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX MNTR LC-MS/MS UR/BLD 31", "code_information": [{"code": "51U", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 183.34, "discounted_cash": 311.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX MNTR NZM IA 35+ORAL FLU", "code_information": [{"code": "116U", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 183.34, "discounted_cash": 396.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX TEST DEF 90+ RX/SBSTS UR", "code_information": [{"code": "82U", "type": "CPT"}], "standard_charges": [{"minimum": 183.34, "maximum": 183.34, "discounted_cash": 396.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 183.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RX TEST PRSMV UR W/DEF CONF", "code_information": [{"code": "7U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "discounted_cash": 183.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RXT BREAST APPL PLACE/REMOV", "code_information": [{"code": "C9726", "type": "HCPCS"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic Chest X-Ray", "code_information": [{"code": "324", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Radiology, Diagnostic General Classification", "code_information": [{"code": "320", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Radiotherapy, Major", "code_information": [{"code": "692.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 28861.94, "maximum": 28861.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 28861.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Radiotherapy, Minor", "code_information": [{"code": "692.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8660.38, "maximum": 8660.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8660.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Radiotherapy, Moderate", "code_information": [{"code": "692.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15640.71, "maximum": 15640.71, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15640.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Radiotherapy, Severe", "code_information": [{"code": "692.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50427.03, "maximum": 50427.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50427.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Recording Of Fetal Magnetic Heart Signal With Electronic Signal Transfer Of Data And Storage", "code_information": [{"code": "476T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Recording Of Fetal Magnetic Heart Signal With Review And Interpretation Of Report", "code_information": [{"code": "478T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Recording Of Fetal Magnetic Heart Signal With Signal Extraction, Technical Analysis, And Result", "code_information": [{"code": "477T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Recording Of Fetal Magnetic Heart Signal With Technical Analysis And Interpretation Of Report", "code_information": [{"code": "475T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Recovery Room General", "code_information": [{"code": "710", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Removal Impregnated Ovum Outside The Uterus And Entire Uterus", "code_information": [{"code": "59135", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Foreign Material In Brain Using An Endoscope", "code_information": [{"code": "62163", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Mastoid Bone With Implantation Of Cochlear Stimulating System, Accessed Through The Skin", "code_information": [{"code": "69715", "type": "CPT"}], "standard_charges": [{"minimum": 13981.9, "maximum": 13981.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13981.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Mastoid Bone With Removal And Replacement (Accessed Through The Skin) Of Cochlear Stimulating System", "code_information": [{"code": "69718", "type": "CPT"}], "standard_charges": [{"minimum": 13981.9, "maximum": 13981.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13981.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Neurostimulator Electrodes And Pulse Generator For Vagus Nerve Blocking Therapy For Obesity Using An Endoscope", "code_information": [{"code": "314T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Pulse Generator For Vagus Nerve Blocking Therapy For Treatment Of Obesity", "code_information": [{"code": "315T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Pulse Generator Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "428T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Sensing Lead Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "429T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of Both Upper Spinal Cord Tracts", "code_information": [{"code": "63196", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of Middle Spinal Cord, 2 Stages Within 14 Days", "code_information": [{"code": "63199", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of One Middle Spinal Cord Tract", "code_information": [{"code": "63195", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of One Upper Spinal Cord Tract", "code_information": [{"code": "63194", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Spine Bone With Incision Of Upper Spinal Cord, 2 Stages Within 14 Days", "code_information": [{"code": "63198", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Stimulating Lead Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "430T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Sutures Under Anesthesia By Same Surgeon", "code_information": [{"code": "15850", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Upper Spine Bone With Removal Of Ligaments, 1 Or 2 Segments", "code_information": [{"code": "63180", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Removal Of Upper Spine Bone With Removal Of Ligaments, More Than 2 Segments", "code_information": [{"code": "63182", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Renal Dialysis Access Device Procedures, Major", "code_information": [{"code": "444.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27799.58, "maximum": 27799.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27799.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Renal Dialysis Access Device Procedures, Minor", "code_information": [{"code": "444.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13968.35, "maximum": 13968.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13968.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Renal Dialysis Access Device Procedures, Moderate", "code_information": [{"code": "444.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18298.54, "maximum": 18298.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18298.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Renal Dialysis Access Device Procedures, Severe", "code_information": [{"code": "444.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53847.35, "maximum": 53847.35, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53847.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repair Of Extra Blood Flow Tract From Left Heart Chamber To Aorta", "code_information": [{"code": "33722", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repair Of Hernia Between Abdominal Muscles", "code_information": [{"code": "49590", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Hernia At Navel Patient Younger Than Age 5 Years", "code_information": [{"code": "49582", "type": "CPT"}], "standard_charges": [{"minimum": 4772.18, "maximum": 4772.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4772.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Hernia Using An Endoscope", "code_information": [{"code": "49653", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repair Of Trapped Recurrent Incisional Or Abdominal Hernia", "code_information": [{"code": "49566", "type": "CPT"}], "standard_charges": [{"minimum": 5762.31, "maximum": 5762.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5762.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repair nasal stenosis w/imp", "code_information": [{"code": "C9749", "type": "HCPCS"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Replacement Of Pulse Generator For Vagus Nerve Blocking Therapy For Treatment Of Obesity", "code_information": [{"code": "316T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Replacement Of Pulse Generator Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "431T", "type": "CPT"}], "standard_charges": [{"minimum": 30305.84, "maximum": 30305.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30305.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repositioning Of Sensing Lead Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "433T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Repositioning Of Stimulating Lead Of Neurostimulator System For Treatment Of Central Sleep Apnea", "code_information": [{"code": "432T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Diagnostic Testing (Response To Co2)", "code_information": [{"code": "94400", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Failure, Major", "code_information": [{"code": "133.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17741.09, "maximum": 17741.09, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17741.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Failure, Minor", "code_information": [{"code": "133.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6667.64, "maximum": 6667.64, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6667.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Failure, Moderate", "code_information": [{"code": "133.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10861.99, "maximum": 10861.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10861.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Failure, Severe", "code_information": [{"code": "133.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29794.88, "maximum": 29794.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29794.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Malignancy, Major", "code_information": [{"code": "136.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19141.77, "maximum": 19141.77, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19141.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Malignancy, Minor", "code_information": [{"code": "136.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8636.03, "maximum": 8636.03, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8636.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Malignancy, Moderate", "code_information": [{"code": "136.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11702.66, "maximum": 11702.66, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11702.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Malignancy, Severe", "code_information": [{"code": "136.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34451.85, "maximum": 34451.85, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34451.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Services, General", "code_information": [{"code": "410", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Respiratory Signs, Symptoms And Miscellaneous Diagnoses, Major", "code_information": [{"code": "144.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11973.05, "maximum": 11973.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11973.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Signs, Symptoms And Miscellaneous Diagnoses, Minor", "code_information": [{"code": "144.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8307.96, "maximum": 8307.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8307.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Signs, Symptoms And Miscellaneous Diagnoses, Moderate", "code_information": [{"code": "144.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8866.7, "maximum": 8866.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8866.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory Signs, Symptoms And Miscellaneous Diagnoses, Severe", "code_information": [{"code": "144.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17482.22, "maximum": 17482.22, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17482.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory System Diagnosis With Ventilator Support > 96 Hours, Major", "code_information": [{"code": "130.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 87189.42, "maximum": 87189.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 87189.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory System Diagnosis With Ventilator Support > 96 Hours, Minor", "code_information": [{"code": "130.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48600.89, "maximum": 48600.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48600.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory System Diagnosis With Ventilator Support > 96 Hours, Moderate", "code_information": [{"code": "130.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 53006.68, "maximum": 53006.68, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53006.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Respiratory System Diagnosis With Ventilator Support > 96 Hours, Severe", "code_information": [{"code": "130.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 108303.41, "maximum": 108303.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 108303.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Review And Interpretation Of External Patient-Activated Ekg Event Recordings", "code_information": [{"code": "498T", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Revision Of Attachment Of Stomach And Small Bowel", "code_information": [{"code": "43850", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Revision Of Attachment Of Stomach To Upper Small Bowel", "code_information": [{"code": "43855", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Revision Of Previous Mastoid Surgery, With Removal Of A Portion Of The Temporal Bone", "code_information": [{"code": "69605", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Revision Or Replacement Of Neurostimulator Electrodes For Vagus Nerve Blocking Therapy For Obesity Using An Endoscope", "code_information": [{"code": "313T", "type": "CPT"}], "standard_charges": [{"minimum": 5677.76, "maximum": 5677.76, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5677.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Rf magnetic-guide av fistula", "code_information": [{"code": "C9755", "type": "HCPCS"}], "standard_charges": [{"minimum": 5104.6, "maximum": 5104.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5104.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Room And Board Semiprivate (Two Beds) General", "code_information": [{"code": "120", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "S BOWEL ENDOSCOPE W/STENT", "code_information": [{"code": "44379", "type": "CPT"}], "standard_charges": [{"minimum": 2883.16, "maximum": 2883.16, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "S&I STENT/CHEST VERT ART", "code_information": [{"code": "76T", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "S-PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 572.6, "maximum": 793.46, "gross_charge": 818.0, "discounted_cash": 1227.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "S-PLATE L-SHAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 320.6, "maximum": 444.26, "gross_charge": 458.0, "discounted_cash": 687.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 389.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 343.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 320.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 444.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 320.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 343.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 389.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 366.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "S-TAK ASSY 3.0 *AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SABER ARTHREX", "code_information": [{"code": "3100101607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 354.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SABRE", "code_information": [{"code": "3100101608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SABRE", "code_information": [{"code": "3100104483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SABRE 3.5MMX7CM*AR-9", "code_information": [{"code": "3100203300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 396.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SABRE ARTHREX", "code_information": [{"code": "3100104414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SACITUZUMAB GOVITECAN-HZIY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9317", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.1, "maximum": 34.1, "discounted_cash": 54.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SACRAL NERVE STIM FL", "code_information": [{"code": "76000", "type": "CPT"}, {"code": "3270102309", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 1008.8, "gross_charge": 1040.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 884.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 728.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1008.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 728.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 884.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 832.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALEM SUMP 14 FR*88-", "code_information": [{"code": "3100203194", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.44, "discounted_cash": 99.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SALEM SUMP ANTI-REFL", "code_information": [{"code": "3100101609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SALICYLATE", "code_information": [{"code": "80196", "type": "CPT"}, {"code": "3440100827", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 46.2, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3650", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALIVA TEST, HORMONE LEVEL;", "code_information": [{"code": "S3652", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND FUNCTION EXAM", "code_information": [{"code": "78232", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND IMAGING", "code_information": [{"code": "78230", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SALIVARY GLAND PROCEDURES", "code_information": [{"code": "139", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6303.89, "maximum": 6303.89, "discounted_cash": 13260.15, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6303.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SALMONELLA AB", "code_information": [{"code": "86768", "type": "CPT"}, {"code": "3440101122", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 13.19, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 21.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARGRAMOSTIM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2820", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.46, "maximum": 59.46, "discounted_cash": 95.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 59.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 ANTB QUANTITATIVE", "code_information": [{"code": "86413", "type": "CPT"}], "standard_charges": [{"minimum": 54.0, "maximum": 68.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 54.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID-19 AMP PRB", "code_information": [{"code": "87635", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 51.31, "discounted_cash": 82.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARS-COV-2 COVID-19 ANTIBODY", "code_information": [{"code": "86769", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 42.13, "discounted_cash": 67.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARSCOV & INF VIR A&B AG IA", "code_information": [{"code": "87428", "type": "CPT"}], "standard_charges": [{"minimum": 32.49, "maximum": 41.83, "discounted_cash": 112.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARSCOV CORONAVIRUS AG IA", "code_information": [{"code": "87426", "type": "CPT"}], "standard_charges": [{"minimum": 24.03, "maximum": 35.33, "discounted_cash": 56.76, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 & INF A&B AMP PRB", "code_information": [{"code": "87636", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 142.63, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 25 MCG/.25ML IM", "code_information": [{"code": "91321", "type": "CPT"}], "standard_charges": [{"minimum": 145.92, "maximum": 145.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 145.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 3MCG TRS-SUC IM", "code_information": [{"code": "91318", "type": "CPT"}], "standard_charges": [{"minimum": 65.55, "maximum": 65.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 65.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 50 MCG/0.5ML IM", "code_information": [{"code": "91322", "type": "CPT"}], "standard_charges": [{"minimum": 145.92, "maximum": 145.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 145.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCOV2 VAC 5MCG/0.5ML IM", "code_information": [{"code": "91304", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 148.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 148.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARSCOV2&INF A&B&RSV AMP PRB", "code_information": [{"code": "87637", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 142.63, "discounted_cash": 229.14, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 142.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 10MCG TRS-SUC IM", "code_information": [{"code": "91319", "type": "CPT"}], "standard_charges": [{"minimum": 87.78, "maximum": 87.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 87.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SARSCV2 VAC 30MCG TRS-SUC IM", "code_information": [{"code": "91320", "type": "CPT"}], "standard_charges": [{"minimum": 131.1, "maximum": 131.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 131.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SAW BLADE", "code_information": [{"code": "3100104514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE ULNAR", "code_information": [{"code": "3100101610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 308.0, "discounted_cash": 462.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW BLADE ULNAR", "code_information": [{"code": "3100103263", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 587.0, "discounted_cash": 880.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SAWBLADE 40MM*7000-4", "code_information": [{"code": "3100210249", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 535.6, "discounted_cash": 803.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 1900.15, "maximum": 1900.15, "discounted_cash": 2731.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1900.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SBRT MANAGEMENT", "code_information": [{"code": "77435", "type": "CPT"}], "standard_charges": [{"minimum": 586.07, "maximum": 586.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 586.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP CARE/DAY 1", "code_information": [{"code": "99231", "type": "CPT"}, {"code": "3500102270", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP CARE/DAY 2", "code_information": [{"code": "99232", "type": "CPT"}, {"code": "3500102272", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 189.7, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 406.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP CARE/DAY 3", "code_information": [{"code": "99231", "type": "CPT"}, {"code": "3500102271", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ HOSP CARE/DAY 3", "code_information": [{"code": "99233", "type": "CPT"}, {"code": "3500102273", "type": "CDM"}, {"code": "987", "type": "RC"}], "standard_charges": [{"minimum": 273.7, "maximum": 379.27, "gross_charge": 391.0, "discounted_cash": 586.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 332.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 293.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 273.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 273.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 293.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 332.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 312.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ OBS CARE/DAY 15", "code_information": [{"code": "99224", "type": "CPT"}, {"code": "3500102268", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 105.0, "maximum": 145.5, "gross_charge": 150.0, "discounted_cash": 225.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ OBS CARE/DAY 35", "code_information": [{"code": "99226", "type": "CPT"}, {"code": "3500102269", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 275.8, "maximum": 382.18, "gross_charge": 394.0, "discounted_cash": 591.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 334.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 275.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 382.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 275.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 334.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 315.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SBSQ PSYC COLLAB CARE MGMT", "code_information": [{"code": "99493", "type": "CPT"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "discounted_cash": 244.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SBSQT PLMT DRUG ELUT OC INS", "code_information": [{"code": "445T", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC DIS P-SELECTIN WHL BLOOD", "code_information": [{"code": "122U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 845.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC DIS VCAM-1 WHOLE BLOOD", "code_information": [{"code": "121U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 818.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC GNOTYP ERMAP EXONS 4 12", "code_information": [{"code": "199U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION ADDL HR", "code_information": [{"code": "96370", "type": "CPT"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION RESET PUMP", "code_information": [{"code": "96371", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 107.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SC THER INFUSION UP TO 1 HR", "code_information": [{"code": "96369", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 328.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCALE & DEBRIDE, SINGLE IMP", "code_information": [{"code": "D6081", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCALP COOL 1ST MEAS&CALBRJ", "code_information": [{"code": "662T", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "discounted_cash": 2008.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCALP COOL PLMT MNTR RMVL", "code_information": [{"code": "663T", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCALPEL BLADE 15*323", "code_information": [{"code": "3100203302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.76, "discounted_cash": 35.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SCALPEL HANDLE", "code_information": [{"code": "3100103972", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCAN PROC CRANIAL INTRA", "code_information": [{"code": "61781", "type": "CPT"}], "standard_charges": [{"minimum": 5831.73, "maximum": 5831.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCD TUBING ASSEMBLY", "code_information": [{"code": "3100101611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCHANZ SCREW CLAMP*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1305.73, "maximum": 1809.37, "gross_charge": 1865.34, "discounted_cash": 2798.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1585.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1305.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1809.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1305.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1585.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1492.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCINTIMAMMOGRAPHY", "code_information": [{"code": "S8080", "type": "HCPCS"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCLERAL IOL PACK*SFP", "code_information": [{"code": "3100208462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 747.0, "discounted_cash": 1120.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCLERAL PATCH 7X7*S0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCLERAL REINFORCEMEN", "code_information": [{"code": "67250", "type": "CPT"}, {"code": "3480102204", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4644.36, "gross_charge": 4788.0, "discounted_cash": 3576.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2465.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4644.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3351.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2456.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2837.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4069.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3830.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2384.56, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2432.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCLERAL REINFORCEMEN", "code_information": [{"code": "67255", "type": "CPT"}, {"code": "3480102205", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4937.25, "gross_charge": 5047.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4289.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3532.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4895.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3532.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3785.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4289.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCLEROTX FLUID COLLECTION", "code_information": [{"code": "49185", "type": "CPT"}], "standard_charges": [{"minimum": 1083.58, "maximum": 1083.58, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCOLIOSIS DNA ALYS", "code_information": [{"code": "4M", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 126.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCOPE PLANTAR FASCIOTOMY", "code_information": [{"code": "29893", "type": "CPT"}], "standard_charges": [{"minimum": 3498.15, "maximum": 3498.15, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCOPE URETERO*AX93US", "code_information": [{"code": "3100207351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2203.6, "discounted_cash": 3305.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SCOPOLAMINE", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300206", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 40.1, "discounted_cash": 60.15, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "SCOPOLAMINE HYDROBRO", "code_information": [{"code": "3400300273", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.4, "discounted_cash": 21.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SCOTCHBAND ADHS", "code_information": [{"code": "3100102227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 498.0, "discounted_cash": 747.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCP FOOT/ANKLE KIT*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5569.2, "maximum": 7717.32, "gross_charge": 7956.0, "discounted_cash": 11934.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6762.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5569.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7717.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5569.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6762.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6364.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCP KNEE KIT*414.502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7416.5, "maximum": 10277.15, "gross_charge": 10595.0, "discounted_cash": 15892.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9005.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7946.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7416.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10277.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7416.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7946.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9005.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8476.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCP KNEE KIT*414.503", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7416.5, "maximum": 10277.15, "gross_charge": 10595.0, "discounted_cash": 15892.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9005.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7946.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7416.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10277.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7416.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7946.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9005.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8476.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOMATED SYS", "code_information": [{"code": "G0147", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.76, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO, AUTOSYS, RESCR", "code_information": [{"code": "G0148", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.94, "maximum": 34.27, "discounted_cash": 51.32, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,AUTOSYS AND MD", "code_information": [{"code": "G0141", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0143", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "discounted_cash": 43.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCR C/V CYTO,THINLAYER,RESCR", "code_information": [{"code": "G0144", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "discounted_cash": 70.64, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCR MAMMO BI INCL CAD", "code_information": [{"code": "77067", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCRAPER", "code_information": [{"code": "3100102228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 768.0, "discounted_cash": 1152.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCRE CORTEX SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 97.18, "maximum": 134.67, "gross_charge": 138.84, "discounted_cash": 208.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREEN C/V THIN LAYER BY MD", "code_information": [{"code": "G0124", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREEN PAP BY TECH W MD SUPV", "code_information": [{"code": "P3000", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREENING CYTOPATHOL", "code_information": [{"code": "G0145", "type": "HCPCS"}, {"code": "3440103031", "type": "CDM"}, {"code": "311", "type": "RC"}], "standard_charges": [{"minimum": 28.37, "maximum": 231.83, "gross_charge": 239.0, "discounted_cash": 42.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 203.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 179.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 167.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 231.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 167.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 179.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 203.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 191.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 28.37, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREENING OF A PATIENT", "code_information": [{"code": "D0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREENING PAP SMEAR BY PHYS", "code_information": [{"code": "P3001", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.27, "maximum": 34.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREENING PROCTOSCOPY", "code_information": [{"code": "S0601", "type": "HCPCS"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1325.1, "maximum": 1836.21, "gross_charge": 1893.0, "discounted_cash": 2839.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1609.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1325.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1325.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1419.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1609.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1514.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 562.8, "maximum": 779.88, "gross_charge": 804.0, "discounted_cash": 1206.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 683.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 603.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 779.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 562.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 603.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 683.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 643.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1435.0, "maximum": 1988.5, "gross_charge": 2050.0, "discounted_cash": 3075.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1742.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1537.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1435.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1988.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1435.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1537.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1742.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 579.6, "maximum": 803.16, "gross_charge": 828.0, "discounted_cash": 1242.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 703.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 621.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 803.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 579.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 621.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 703.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 662.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 49.7, "maximum": 68.87, "gross_charge": 71.0, "discounted_cash": 106.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 68.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 49.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 53.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 60.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 56.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 382.9, "maximum": 530.59, "gross_charge": 547.0, "discounted_cash": 820.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 464.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 410.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 530.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 382.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 410.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 464.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 437.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 215.46, "maximum": 298.56, "gross_charge": 307.8, "discounted_cash": 461.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 261.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 230.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 215.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 298.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 215.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 230.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 261.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.6, "maximum": 2151.46, "gross_charge": 2218.0, "discounted_cash": 3327.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1885.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1885.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 606.2, "maximum": 840.02, "gross_charge": 866.0, "discounted_cash": 1299.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 736.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 649.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 606.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 840.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 606.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 649.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 736.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 692.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.0 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.2X9MM BONE*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 10MM*02.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 121.8, "maximum": 168.78, "gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 13MM*02.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 5*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 6*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 7*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 8MM*02.1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 121.8, "maximum": 168.78, "gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X 9MM*02.1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X10*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.42, "maximum": 495.28, "gross_charge": 510.6, "discounted_cash": 765.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 495.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X12*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X14*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X16*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X18*02.130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 135.49, "maximum": 187.75, "gross_charge": 193.56, "discounted_cash": 290.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 187.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 154.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X5*02.130.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.42, "maximum": 495.28, "gross_charge": 510.6, "discounted_cash": 765.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 495.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X6*02.130.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.42, "maximum": 495.28, "gross_charge": 510.6, "discounted_cash": 765.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 495.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X8*02.130.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.42, "maximum": 495.28, "gross_charge": 510.6, "discounted_cash": 765.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 495.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.3 X9*02.130.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.42, "maximum": 495.28, "gross_charge": 510.6, "discounted_cash": 765.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 495.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 6*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 7*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4X6MM*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.4X7MM*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 10*00-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 12*00-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 14*00-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 16*00-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 18*00-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 4*56-159", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 207.9, "maximum": 288.09, "gross_charge": 297.0, "discounted_cash": 445.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 252.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 288.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 252.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 237.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 4.0MM*25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 7*91-150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 89.6, "maximum": 124.16, "gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 108.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 124.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 108.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 102.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X 8*00-481", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5 X11*00-481", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X11MM CORTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X11MM*25875", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X12MM LOCK*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X13MM CORTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X20MM CORTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X7MM CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 144.36, "maximum": 200.05, "gross_charge": 206.24, "discounted_cash": 309.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 175.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 154.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 144.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 200.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 144.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 154.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 175.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X8MM CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 144.36, "maximum": 200.05, "gross_charge": 206.24, "discounted_cash": 309.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 175.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 154.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 144.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 200.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 144.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 154.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 175.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.5X9MM LOCK*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 10* 330-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 7*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 7MM*331-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 8MM*331-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 9* 330-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 9*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 9*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.6 X 9MM*331-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 08*L1708", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 09*L1709", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 10*L1710", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 11*L1711", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 12*L1712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 13*L1713", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.7 X 14*L1714", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.8 X 5.0MM*25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 274.4, "maximum": 380.24, "gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 380.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.8 X 7*91-180", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 103.6, "maximum": 143.56, "gross_charge": 148.0, "discounted_cash": 222.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 143.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 118.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 1.8 X18*SPEG1.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.0 X 20MM*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 025*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 030*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 035*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 040*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 040*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 045*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5 X 100*41-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10.5X1000MM*48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 10X30MM*AR-403", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 11.0 X 30MM*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 11.5 X 035*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 11.5 X 040*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 11.5 X 045*500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 11.5 X 100*41-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 11.5 X 90*41-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 12.0 X 30MM*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 12.5X45*X07912", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 12.5X50MM*X079", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 14MM*5301-3814", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10*201.3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 113.68, "maximum": 157.52, "gross_charge": 162.4, "discounted_cash": 243.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10*41-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 10*MCLS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203134", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 11*91-56", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 187.6, "maximum": 259.96, "gross_charge": 268.0, "discounted_cash": 402.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 201.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 187.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 259.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 187.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 201.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 214.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 11*MCCS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12*201.3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 113.68, "maximum": 157.52, "gross_charge": 162.4, "discounted_cash": 243.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12*201.8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 368.14, "maximum": 510.14, "gross_charge": 525.92, "discounted_cash": 788.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 12*MCLS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14*41-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14*MCCS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 14*MCLS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16*00-48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16*201.3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 113.68, "maximum": 157.52, "gross_charge": 162.4, "discounted_cash": 243.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16*201.8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 368.14, "maximum": 510.14, "gross_charge": 525.92, "discounted_cash": 788.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16*41-20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 18*201.8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 368.14, "maximum": 510.14, "gross_charge": 525.92, "discounted_cash": 788.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 18*MCCS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 18*MCLS2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 22*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 26*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 26*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 28*HCSD-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1285.2, "maximum": 1780.92, "gross_charge": 1836.0, "discounted_cash": 2754.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1780.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1468.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 30*HCSD-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1285.2, "maximum": 1780.92, "gross_charge": 1836.0, "discounted_cash": 2754.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1780.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1468.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 32*HCSD-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1285.2, "maximum": 1780.92, "gross_charge": 1836.0, "discounted_cash": 2754.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1780.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1560.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1468.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 5.0MM*25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 167.86, "maximum": 232.6, "gross_charge": 239.8, "discounted_cash": 359.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 203.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 179.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 167.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 167.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 179.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 203.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 191.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 5.0MM*25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 371.7, "maximum": 515.07, "gross_charge": 531.0, "discounted_cash": 796.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 515.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 371.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 398.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 451.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 424.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 6*41-200", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 6*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206952", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 6MM*25-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 375.9, "maximum": 520.89, "gross_charge": 537.0, "discounted_cash": 805.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 520.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 375.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 402.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 456.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 6MM*25-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 7*25-882", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 424.2, "maximum": 587.82, "gross_charge": 606.0, "discounted_cash": 909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 587.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 7*91-560", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 187.6, "maximum": 259.96, "gross_charge": 268.0, "discounted_cash": 402.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 201.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 187.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 259.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 187.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 201.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 214.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 7.0MM*25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.2, "maximum": 422.92, "gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 422.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 8*41-200", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 9*91-560", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 187.6, "maximum": 259.96, "gross_charge": 268.0, "discounted_cash": 402.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 201.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 187.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 259.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 187.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 201.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 227.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 214.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 9*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X 9*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X7*AR-1872", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0 X8*AR-1872", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0X11MM*99-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 288.4, "maximum": 399.64, "gross_charge": 412.0, "discounted_cash": 618.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 350.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 309.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 288.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 399.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 288.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 309.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 350.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 329.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0X5MM*258720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 268.8, "maximum": 372.48, "gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 307.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0X7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 288.4, "maximum": 399.64, "gross_charge": 412.0, "discounted_cash": 618.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 350.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 309.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 288.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 399.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 288.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 309.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 350.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 329.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0X7MM*258720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 268.8, "maximum": 372.48, "gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 307.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.0X9MM*258720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205739", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 154.0, "maximum": 213.4, "gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 10*41-23", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 12*41-23", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 14*41-23", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 14*L2312", "code_information": [{"code": "3100210078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 14*L2314", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 16*L2316", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 16*UPEG-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 18*L2318", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 20*CO-T2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 306.26, "maximum": 424.39, "gross_charge": 437.52, "discounted_cash": 656.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 371.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 328.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 306.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 424.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 306.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 328.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 371.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 350.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 20*L2320", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 22*L2322", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 24*L2324", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 25*L2325", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 28*CO-N2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.7, "maximum": 291.97, "gross_charge": 301.0, "discounted_cash": 451.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 28*L2328", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 28*UPEG-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 5*25-883", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 468.3, "maximum": 648.93, "gross_charge": 669.0, "discounted_cash": 1003.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 501.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 648.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 468.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 501.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 568.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 535.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X 8*41-230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X23*L2323", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3 X26*L2326", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X12MM *TRX2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X14MM *TRX2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X18MM *TRX2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X28MM *TRX2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X30MM *TRX2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X32MM *TRX2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X5MM*25-873", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X7MM*25-873", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 268.8, "maximum": 372.48, "gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 307.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.3X7MM*25-873", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 06*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 07*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 08*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 08*NC240", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 08*TB-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 08*TB-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 09*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*NC241", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*TB-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10*TB-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 10MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12*NC241", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12*TB-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14595.0, "maximum": 20224.5, "gross_charge": 20850.0, "discounted_cash": 31275.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17722.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15637.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14595.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20224.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14595.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15637.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17722.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 12MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 14*NC241", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 14MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 15*AR891", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 16*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 16*NC241", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 16MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 18*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 18*NC241", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 18MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 20*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 20*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 20MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 22*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 22*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 22*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 22MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 24MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 26*334-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 26*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 26*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 26MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 28*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 28MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 30*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208968", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 30MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 32*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 32*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 32*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 32*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 34*201.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.16, "maximum": 198.38, "gross_charge": 204.52, "discounted_cash": 306.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 173.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 198.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 173.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 163.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 34*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 34*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 34*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 36*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 36*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 38*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 38*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 38*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 40*02.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 345.46, "maximum": 478.71, "gross_charge": 493.52, "discounted_cash": 740.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 370.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 478.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 370.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 394.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 40*201.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.16, "maximum": 198.38, "gross_charge": 204.52, "discounted_cash": 306.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 173.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 198.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 173.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 163.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 40*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 40*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206968", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 40*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 48*02.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 345.46, "maximum": 478.71, "gross_charge": 493.52, "discounted_cash": 740.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 370.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 478.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 370.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 394.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 5*14-523", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 154.0, "maximum": 213.4, "gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 50*02.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 142.18, "maximum": 197.02, "gross_charge": 203.12, "discounted_cash": 304.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 172.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 152.34, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 142.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 197.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 142.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 152.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 172.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 162.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 50*02.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 345.46, "maximum": 478.71, "gross_charge": 493.52, "discounted_cash": 740.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 370.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 478.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 345.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 370.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 419.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 394.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 6*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 7*14-523", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 154.0, "maximum": 213.4, "gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 8*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4 X 9*AR-187", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X10MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 201.6, "maximum": 279.36, "gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X10MM*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.2, "maximum": 471.42, "gross_charge": 486.0, "discounted_cash": 729.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X12*TB-24-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X14MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X14MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X22MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X24MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X26MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X28MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X30MM VAL *", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X36*AR87243", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X40*AR87244", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 231.0, "maximum": 320.1, "gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 320.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.4X8MM VAL *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 12*AR-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 14*AR-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 14MM*IC2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 550.57, "maximum": 762.94, "gross_charge": 786.54, "discounted_cash": 1179.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 668.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 589.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 762.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 589.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 668.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 629.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 16*AR-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 18*AR-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 20*AR-26", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 20*IH252", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 959.28, "maximum": 1329.28, "gross_charge": 1370.4, "discounted_cash": 2055.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1164.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1027.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 959.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1329.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 959.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1027.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1164.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1096.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 22*IH252", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 959.28, "maximum": 1329.28, "gross_charge": 1370.4, "discounted_cash": 2055.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1164.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1027.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 959.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1329.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 959.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1027.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1164.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1096.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 28MM*IC2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 550.57, "maximum": 762.94, "gross_charge": 786.54, "discounted_cash": 1179.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 668.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 589.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 762.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 550.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 589.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 668.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 629.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 30*HCSD-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1350.3, "maximum": 1871.13, "gross_charge": 1929.0, "discounted_cash": 2893.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1639.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1446.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1350.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1871.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1350.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1446.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1639.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1543.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 34*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 36*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 36*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 38*AR-87", "code_information": [{"code": "3100207023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 40*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 42*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 44*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 46*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 48*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X 50*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X10MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X14MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X16MM*414-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X18MM*414-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X19MM*414-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X20MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 653.94, "maximum": 906.17, "gross_charge": 934.2, "discounted_cash": 1401.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 794.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 700.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 653.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 906.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 653.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 700.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 794.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 747.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X22MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X24MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X26MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X28MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5 X30MM*141-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X10MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X11MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X12MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X13MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X14MM CANN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X16MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X26MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X30MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X8MM CANN*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.5X9MM CANN*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.6 X 7MM*853-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 148.4, "maximum": 205.64, "gross_charge": 212.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 205.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.6 X5MM*853-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 148.4, "maximum": 205.64, "gross_charge": 212.0, "discounted_cash": 318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 205.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 10*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 10*AR-88", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 11*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 12*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 13*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*04.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 146.77, "maximum": 203.38, "gross_charge": 209.68, "discounted_cash": 314.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 146.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 203.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 146.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 167.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.0, "maximum": 552.9, "gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 14*AR-88", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 15*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*30-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.0, "maximum": 552.9, "gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 16*AR-88", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18*30-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205577", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 18*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20*65712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.88, "maximum": 415.54, "gross_charge": 428.4, "discounted_cash": 642.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 364.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 299.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 415.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 299.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 364.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 342.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20*65712", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.88, "maximum": 415.54, "gross_charge": 428.4, "discounted_cash": 642.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 364.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 299.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 415.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 299.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 364.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 342.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.0, "maximum": 552.9, "gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 20*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 22*30-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 22*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.0, "maximum": 552.9, "gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 22*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 22*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 24MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 26*AR-18", "code_information": [{"code": "3100208999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 26*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 28*8083-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 327.04, "maximum": 453.18, "gross_charge": 467.2, "discounted_cash": 700.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 350.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 350.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 373.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 28*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 28*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 30*04.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 146.77, "maximum": 203.38, "gross_charge": 209.68, "discounted_cash": 314.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 146.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 203.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 146.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 167.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 30*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 30*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 30*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 32*202.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.84, "maximum": 414.11, "gross_charge": 426.92, "discounted_cash": 640.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 414.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 341.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 32*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 32*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 34*04.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 146.77, "maximum": 203.38, "gross_charge": 209.68, "discounted_cash": 314.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 146.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 203.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 146.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 157.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 178.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 167.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 34*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 34*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 34*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 36*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 36*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 36*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 38*04.21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.82, "maximum": 450.11, "gross_charge": 464.04, "discounted_cash": 696.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.03, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 38*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 38*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 40*202.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.84, "maximum": 414.11, "gross_charge": 426.92, "discounted_cash": 640.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 414.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 341.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 40*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 40*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 42*202.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.84, "maximum": 414.11, "gross_charge": 426.92, "discounted_cash": 640.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 414.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 341.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 42*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 42MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 44*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 44*AR-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 46*8083-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 46*8087-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 50*02.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 52*02.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 128.1, "maximum": 177.51, "gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7 X 70*65717", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 295.2, "maximum": 409.06, "gross_charge": 421.72, "discounted_cash": 632.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 358.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 316.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 295.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 409.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 295.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 316.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 358.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 337.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X10*HEX2.7-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X10*LCBS2.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X10MM T8*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 128.1, "maximum": 177.51, "gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X11MM*25-77", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 424.2, "maximum": 587.82, "gross_charge": 606.0, "discounted_cash": 909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 587.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X12*HEX2.7-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X12*LCBS2.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X12MM T8*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X13MM*25-77", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 424.2, "maximum": 587.82, "gross_charge": 606.0, "discounted_cash": 909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 587.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X14*HEX2.7-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X14*LCBS2.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X14MM ST T8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X16*HEX2.7-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X16*LCBS2.7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X18*AR-8827", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X22*AR-8827", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X34MM*02.11", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X36MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.1, "maximum": 468.51, "gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 468.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X36MM LOCK*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.72, "maximum": 504.01, "gross_charge": 519.6, "discounted_cash": 779.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X36MM ST*02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 174.58, "maximum": 241.91, "gross_charge": 249.4, "discounted_cash": 374.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 211.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 187.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 174.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 241.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 174.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 187.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 211.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 199.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X38MM ST*02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X40MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 132.3, "maximum": 183.33, "gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 183.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X40MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208539", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.1, "maximum": 468.51, "gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 468.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X42MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 132.3, "maximum": 183.33, "gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 183.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X42MM LOCK*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.72, "maximum": 504.01, "gross_charge": 519.6, "discounted_cash": 779.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X42MM ST*02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X44MM ST*02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X46MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 132.3, "maximum": 183.33, "gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 183.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X48MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 132.3, "maximum": 183.33, "gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 183.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X50MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 132.3, "maximum": 183.33, "gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 183.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X54MM LOCK*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 342.88, "maximum": 475.14, "gross_charge": 489.84, "discounted_cash": 734.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 416.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 367.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 342.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 475.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 342.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 367.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 416.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 391.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X60MM LOCK*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.0, "maximum": 552.9, "gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 274.4, "maximum": 380.24, "gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 380.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X8MM*25-677", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 408.8, "maximum": 566.48, "gross_charge": 584.0, "discounted_cash": 876.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 496.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 408.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 566.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 408.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 496.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 467.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 2.7X9MM*25-774", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 424.2, "maximum": 587.82, "gross_charge": 606.0, "discounted_cash": 909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 587.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 20MM*ARS655102", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1270.5, "maximum": 1760.55, "gross_charge": 1815.0, "discounted_cash": 2722.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1542.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1361.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1760.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1361.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1542.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1452.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3 X 20*PLSS302", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 345.93, "maximum": 479.36, "gross_charge": 494.19, "discounted_cash": 741.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 370.64, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 345.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 479.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 345.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 370.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 395.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3 X 26*PLSS302", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 345.93, "maximum": 479.36, "gross_charge": 494.19, "discounted_cash": 741.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 370.64, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 345.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 479.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 345.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 370.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 395.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 10*TB-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 16*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 16*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 18*121-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 18*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 20*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 20*L3020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 21*L3021", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 22*L3022", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 23*L3023", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 24*127-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 24*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 24*L3024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 24*S3024", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 25*L3025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 26*L3026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 26*S3026", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 28*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 28*L3028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 28*S3028", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 30*121-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 30*L3030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 34*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 38MM *AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 40*04.33", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1057.77, "maximum": 1465.76, "gross_charge": 1511.1, "discounted_cash": 2266.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1284.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1133.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1057.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1465.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1057.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1133.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1284.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1208.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 40*04.33", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 865.38, "maximum": 1199.18, "gross_charge": 1236.27, "discounted_cash": 1854.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1050.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 927.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 865.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1199.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 865.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 927.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1050.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 989.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 40*30-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 40*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 45*30-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X 50*30-03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X16*127-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X18*127-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X20*127-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X22*127-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0 X26*121-30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 819.0, "maximum": 1134.9, "gross_charge": 1170.0, "discounted_cash": 1755.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1134.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 819.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 877.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 994.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X10MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X12MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X14MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X16MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X18MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X20MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X22MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X22MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X24MM *AR89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X24MM LOC*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X24MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X26MM *AR89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X26MM LOC*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X26MM TI *A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X28MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X28MM LOC*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X30MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X34MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X36MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203497", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X36MM *AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X38MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X40MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.0X50MM*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209924", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X10 CORT*LH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207136", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X10MM CORTI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 198.8, "maximum": 275.48, "gross_charge": 284.0, "discounted_cash": 426.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 241.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 213.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 198.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 275.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 198.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 213.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 241.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 227.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X11MM CORTI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X13MM CORTI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X14MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X16MM *LHEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X16MM CORTI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X18 CORTICL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X18MM *LHEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X20MM *LHEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.2X20MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.3 X 14MM*07.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 966.0, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 2070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 10*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.9, "maximum": 346.29, "gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 346.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 10*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 11*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205537", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12*RT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.1, "maximum": 644.5, "gross_charge": 664.44, "discounted_cash": 996.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 564.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 644.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.33, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 564.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 531.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 12MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 358.4, "maximum": 496.64, "gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 496.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 409.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 13*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.96, "maximum": 545.91, "gross_charge": 562.8, "discounted_cash": 844.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*18620", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*19010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*3601-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*5301-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*5302-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*66141", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209947", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 134.4, "maximum": 186.24, "gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 186.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*7601-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.9, "maximum": 346.29, "gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 346.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14*RT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 493.5, "maximum": 683.85, "gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 599.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 528.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 683.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 528.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 599.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 14MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 358.4, "maximum": 496.64, "gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 496.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 409.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 15*CO-31", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 200.2, "maximum": 277.42, "gross_charge": 286.0, "discounted_cash": 429.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 243.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 200.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 277.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 200.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 214.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 243.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.96, "maximum": 545.91, "gross_charge": 562.8, "discounted_cash": 844.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*02.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.08, "maximum": 87.41, "gross_charge": 90.12, "discounted_cash": 135.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*04.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*5301-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*5302-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206959", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 16*RT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 362.71, "maximum": 502.61, "gross_charge": 518.16, "discounted_cash": 777.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 414.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*02.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 81.17, "maximum": 112.48, "gross_charge": 115.96, "discounted_cash": 173.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*04.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 18*DRUJ-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.2, "maximum": 422.92, "gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 422.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*02.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.08, "maximum": 87.41, "gross_charge": 90.12, "discounted_cash": 135.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*04.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*65742", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.88, "maximum": 415.54, "gross_charge": 428.4, "discounted_cash": 642.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 364.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 299.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 415.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 299.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 364.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 342.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*8114-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 20*DRUJ-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.2, "maximum": 422.92, "gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 422.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*04.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205563", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*58803", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*66142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 134.4, "maximum": 186.24, "gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 186.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*8088-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 22*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 393.96, "maximum": 545.91, "gross_charge": 562.8, "discounted_cash": 844.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 478.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 393.96, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 545.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 393.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 478.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 450.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*02.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 81.17, "maximum": 112.48, "gross_charge": 115.96, "discounted_cash": 173.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 98.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 112.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 98.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*8110-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*8114-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24*DRUJ-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.2, "maximum": 422.92, "gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 422.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 24MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*04.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*8110-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*8114-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 26MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28 SOLAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*04.20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*36035", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3185.0, "maximum": 4413.5, "gross_charge": 4550.0, "discounted_cash": 6825.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4413.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3185.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3412.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*360PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*8084-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.08, "maximum": 557.16, "gross_charge": 574.4, "discounted_cash": 861.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 488.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 430.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 557.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 430.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 488.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*8088-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*8110-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*8114-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 28MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 358.4, "maximum": 496.64, "gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 496.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 409.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 362.71, "maximum": 502.61, "gross_charge": 518.16, "discounted_cash": 777.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 414.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207244", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*48556", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*66143", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 134.4, "maximum": 186.24, "gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 186.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*8084-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.08, "maximum": 557.16, "gross_charge": 574.4, "discounted_cash": 861.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 488.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 430.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 557.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 430.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 488.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*8088-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.28, "maximum": 572.68, "gross_charge": 590.4, "discounted_cash": 885.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 572.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 442.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 501.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*8114-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*AR141", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30*AR873", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 30MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 362.71, "maximum": 502.61, "gross_charge": 518.16, "discounted_cash": 777.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 414.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*8110-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*8114-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*AR873", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 32*HCSD-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1350.3, "maximum": 1871.13, "gross_charge": 1929.0, "discounted_cash": 2893.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1639.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1446.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1350.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1871.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1350.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1446.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1639.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1543.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 34*02.12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 362.71, "maximum": 502.61, "gross_charge": 518.16, "discounted_cash": 777.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 502.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 362.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 388.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 440.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 414.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 34*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 34*CS34A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 924.92, "maximum": 1281.68, "gross_charge": 1321.32, "discounted_cash": 1981.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1123.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 990.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 924.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1281.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 924.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 990.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1123.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1057.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 35*8110-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 36*8084-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 474.07, "maximum": 656.93, "gross_charge": 677.25, "discounted_cash": 1015.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 575.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 507.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 474.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 656.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 474.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 507.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 575.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 36*8100-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 36*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 36*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 36MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 38*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 38*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 38*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 38MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 465.1, "maximum": 644.5, "gross_charge": 664.44, "discounted_cash": 996.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 564.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 465.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 644.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 465.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.33, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 564.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 531.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 38MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 40*18056", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 40*8100-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 40*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 42*58813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.4, "maximum": 457.84, "gross_charge": 472.0, "discounted_cash": 708.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 457.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 377.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 42*8084-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.08, "maximum": 557.16, "gross_charge": 574.4, "discounted_cash": 861.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 488.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 430.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 557.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 402.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 430.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 488.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 459.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 42*8100-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 496.12, "maximum": 687.48, "gross_charge": 708.75, "discounted_cash": 1063.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 602.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 496.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 687.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 496.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 602.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 42*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 42MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 44*58813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 44*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 45*18056", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 45*30-02", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 46*58813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.4, "maximum": 457.84, "gross_charge": 472.0, "discounted_cash": 708.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 457.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 377.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 46*8100-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 496.12, "maximum": 687.48, "gross_charge": 708.75, "discounted_cash": 1063.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 602.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 496.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 687.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 496.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 602.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 46*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 46MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 48*66144", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205466", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.81, "maximum": 175.72, "gross_charge": 181.16, "discounted_cash": 271.74, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.98, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 175.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.81, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 48*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 50*58813", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 50*8088-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 50*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 50MM*657", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.4, "maximum": 467.54, "gross_charge": 482.0, "discounted_cash": 723.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 52*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 52*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 54*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 54*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 55*8088-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 56*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 56*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 58*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 58*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 60*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 60*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 6MM*4855", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 70MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 75*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 80*66148", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 232.4, "maximum": 322.04, "gross_charge": 332.0, "discounted_cash": 498.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 322.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 232.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 249.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 265.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 80*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X 8MM*4855", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.19, "maximum": 310.67, "gross_charge": 320.28, "discounted_cash": 480.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X10MM*4855", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.19, "maximum": 310.67, "gross_charge": 320.28, "discounted_cash": 480.42, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X14*AR-883", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X14*DRUJ-L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X18*DRUJ-L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X22*DRUJ-L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5 X24*DRUJ-L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X 16*PANL-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.0, "maximum": 562.6, "gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 493.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 562.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 493.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X 20*PANL-3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.0, "maximum": 562.6, "gross_charge": 580.0, "discounted_cash": 870.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 493.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 562.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 406.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 435.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 493.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X10MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X10MM LOC*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X10MM*48558", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X12*1020-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1564.08, "maximum": 2167.36, "gross_charge": 2234.4, "discounted_cash": 3351.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1675.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1675.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1787.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X12*AR-8935", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X12MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 128.12, "maximum": 177.54, "gross_charge": 183.04, "discounted_cash": 274.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X12MM VERTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1324.05, "maximum": 1834.75, "gross_charge": 1891.5, "discounted_cash": 2837.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1607.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1418.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1324.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1834.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1324.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1418.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1607.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X14*1020-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1564.08, "maximum": 2167.36, "gross_charge": 2234.4, "discounted_cash": 3351.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1899.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1675.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1564.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2167.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1564.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1675.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1899.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1787.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X14*LT10-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X14MM BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X14MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 113.68, "maximum": 157.52, "gross_charge": 162.4, "discounted_cash": 243.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 138.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X16MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X16MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.42, "maximum": 39.38, "gross_charge": 40.6, "discounted_cash": 60.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X18MM BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X18MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X18MM VERTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1324.05, "maximum": 1834.75, "gross_charge": 1891.5, "discounted_cash": 2837.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1607.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1418.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1324.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1834.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1324.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1418.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1607.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X20MM BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X20MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X20MM SOLAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X22MM *02.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.08, "maximum": 87.41, "gross_charge": 90.12, "discounted_cash": 135.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X22MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X24MM BIAS*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X24MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X264MM CORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X26MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X28*LT10-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X28MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X28MM SOLAN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X30*LT10-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X32*1020-35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X34MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X36MM *02.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 119.7, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X4.75X15MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X4.75X20MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 196.0, "maximum": 271.6, "gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X4.75X25MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 196.0, "maximum": 271.6, "gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X4.75X30MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 196.0, "maximum": 271.6, "gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X45MM LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 351.4, "maximum": 486.94, "gross_charge": 502.0, "discounted_cash": 753.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 426.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 376.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 351.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 486.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 351.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 376.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 426.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 401.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X50MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X50MM LOC*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X52MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X54MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X56*AR-8835", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X56MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X58MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X60MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X70*AR-8835", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X75MM CORTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3.5X80MM CORTE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.86, "maximum": 98.2, "gross_charge": 101.24, "discounted_cash": 151.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 34MM CORTICAL*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 967.05, "maximum": 1340.05, "gross_charge": 1381.5, "discounted_cash": 2072.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1174.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1036.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 967.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1340.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 967.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1036.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1174.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1105.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 38MM CORTICAL*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 967.05, "maximum": 1340.05, "gross_charge": 1381.5, "discounted_cash": 2072.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1174.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1036.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 967.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1340.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 967.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1036.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1174.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1105.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X20MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X22MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X24MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X34MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X36MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X38MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X40MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 3X44MM QUIKFX*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 28MM*AR-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 319.2, "maximum": 442.32, "gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 442.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 319.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 342.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 387.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 30*AR-8740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 30MM*AR-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 32*AR-8740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 32MM*AR-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.6, "maximum": 550.96, "gross_charge": 568.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 34*AR-8740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 342MM*AR-5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 36*AR-8740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 36MM*AR-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 38MM*AR-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.6, "maximum": 550.96, "gross_charge": 568.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 40MM*AR-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X 58*AR-8740", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209043", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X38*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X40*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X42*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X44*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X46*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X48*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X50*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X52*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X52*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X56*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4 X60*AR-8740B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 10*RT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 10MM*31-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12*RT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 12MM*31-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 13MM*31-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 13MM*771", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14 *FT10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*26240", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*8801-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.8, "maximum": 450.08, "gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*FT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14*RT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 14MM*31-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 15*87802", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206167", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 15*87803", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 15*87807", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 15MM*31-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204647", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 15MM*771", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16 *FT10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*0221-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*19000", "code_information": [{"code": "3100207435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*27040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16*FT10-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16MM*31-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 16MM*771", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 17*87804", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 17MM*771", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18 *FT10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*0221-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*API-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 18*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 20*121-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2216.76, "maximum": 3071.79, "gross_charge": 3166.8, "discounted_cash": 4750.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2691.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3071.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2691.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2533.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 20*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 20*58934", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 20*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 22 *3604", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 22*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 22*58934", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 22*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 22*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 24*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 24*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1362.9, "maximum": 1888.59, "gross_charge": 1947.0, "discounted_cash": 2920.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1654.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1460.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1362.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1888.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1362.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1460.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1654.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1557.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 24*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 24*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 26*113-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 26*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 26*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 26*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 26*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*360PT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*58934", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 285.6, "maximum": 395.76, "gross_charge": 408.0, "discounted_cash": 612.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 395.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 346.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 28*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30*15001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30*36040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 30*AR142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32*113-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 32*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 34*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 34*8096-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 595.35, "maximum": 824.98, "gross_charge": 850.5, "discounted_cash": 1275.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 722.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 637.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 595.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 824.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 595.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 637.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 722.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 34*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 34*AR142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 35*15001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 36*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 36*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 38*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 382*8124", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 40*15001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 40*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 40*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 42*8096-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 595.35, "maximum": 824.98, "gross_charge": 850.5, "discounted_cash": 1275.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 722.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 637.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 595.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 824.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 595.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 637.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 722.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 680.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 42*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 42*AR-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 44*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 44*AR142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 46*8094-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 46*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 46*AR142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 48*04.35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 572.37, "maximum": 793.14, "gross_charge": 817.68, "discounted_cash": 1226.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 695.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 613.26, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 572.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 793.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 572.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 613.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 695.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 654.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 48*8094-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 48*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 50*8094-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 50*8124-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 628.42, "maximum": 870.81, "gross_charge": 897.75, "discounted_cash": 1346.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 628.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 673.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 763.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 718.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 50*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 50*AR142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 52*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 52*AR142", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 54*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 55*8094-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 56*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 58*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 6*485544", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 60*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 8*485544", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X 80*60748", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 235.2, "maximum": 325.92, "gross_charge": 336.0, "discounted_cash": 504.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 325.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X14*AP1-70", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X16*AP1-70", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X16*API-71", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X36*873-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0 X38*873-13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 869.4, "maximum": 1204.74, "gross_charge": 1242.0, "discounted_cash": 1863.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1204.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 869.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 931.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1055.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 993.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X12MM OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X12MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X14MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X14MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X14MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X16MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X16MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X18MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X18MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X20MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X20MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X24MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X26MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X28MM OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X28MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X30MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 368.55, "maximum": 510.7, "gross_charge": 526.5, "discounted_cash": 789.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 421.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X30MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X32MM OASY*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X32MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X34MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 368.55, "maximum": 510.7, "gross_charge": 526.5, "discounted_cash": 789.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 421.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X34MM OASY*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X34MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X36MM OASY*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X38MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X42MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 368.55, "maximum": 510.7, "gross_charge": 526.5, "discounted_cash": 789.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 421.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X42MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X42MM*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206197", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X44MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X44MM*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X46MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X48MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X48MM*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X50MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X52MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X54MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X55MM* AR87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209544", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X56MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X58MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.0X60MM TI*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 12*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 14*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 14*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 16*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 16*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 16*API-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 18*AP1-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 18*API-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 400.4, "maximum": 554.84, "gross_charge": 572.0, "discounted_cash": 858.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 554.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 400.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 486.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 457.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 40MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 46MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3 X 60MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.35 X 13MM*31", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204973", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.35 X 15MM*31", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.35X16MM VAR*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.35X20MM SOLA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.35X32MM SOLA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3X55*AR-8943", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.3X65*AR-8943", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 12 OC*3600", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 10 OC*36", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 10*18091", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 12*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 12*18091", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 528.5, "maximum": 732.35, "gross_charge": 755.0, "discounted_cash": 1132.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 641.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 566.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 528.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 732.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 528.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 566.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 641.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 12*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 14 *FT10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 14*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 14*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 14*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 14*26045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 15*87806", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206168", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 15*8WC4-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 541.8, "maximum": 750.78, "gross_charge": 774.0, "discounted_cash": 1161.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 750.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 16*1061-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 16*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 16*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 18*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 18*236-1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 18MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 18MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 20MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 20MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206204", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 22*36045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 22MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 22MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 24*36045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 24MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 24MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 26*19020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 26*36045", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 26MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 26MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 28MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 28MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204563", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 30*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207245", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 30*19020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 30/CAP*3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 470.92, "maximum": 652.56, "gross_charge": 672.75, "discounted_cash": 1009.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 652.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 538.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 30MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 30MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 32MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 32MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 34MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 34MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204862", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 35*15001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 35*41-45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 35*8WC4-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 541.8, "maximum": 750.78, "gross_charge": 774.0, "discounted_cash": 1161.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 750.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 36MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 36MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 38MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 38MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40*15001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40*41-45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 40MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 42MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 42MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 44*02.22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 44MM*661", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.72, "maximum": 199.16, "gross_charge": 205.32, "discounted_cash": 307.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 44MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 44MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 44MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 45*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 46MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 46MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 48MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 48MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 50*66175", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.72, "maximum": 199.16, "gross_charge": 205.32, "discounted_cash": 307.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 50MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 50MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 52MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 54*02.22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 54MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 55MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 55MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 55MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 56MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 58MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 6*18091-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 6*18091-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 6*360040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 60*66176", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.72, "maximum": 199.16, "gross_charge": 205.32, "discounted_cash": 307.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 60MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 60MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 65MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 429.97, "maximum": 595.82, "gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 595.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 429.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 460.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 491.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 6MM*7504", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 8 OC*360", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 80*66178", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.72, "maximum": 199.16, "gross_charge": 205.32, "discounted_cash": 307.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 174.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 8MM*7504", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 552.3, "maximum": 765.33, "gross_charge": 789.0, "discounted_cash": 1183.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 765.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 552.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 591.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 670.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 631.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X 8MM*7750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.5, "maximum": 712.95, "gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X45*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209089", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X45*41-454", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X50*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5 X55*41-455", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.50X32MM*3406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.04, "maximum": 133.08, "gross_charge": 137.2, "discounted_cash": 205.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 133.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.50X38MM*3406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.04, "maximum": 133.08, "gross_charge": 137.2, "discounted_cash": 205.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 133.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.50X42MM*3406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.04, "maximum": 133.08, "gross_charge": 137.2, "discounted_cash": 205.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 133.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.50X44MM*3406", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.04, "maximum": 133.08, "gross_charge": 137.2, "discounted_cash": 205.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 133.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 96.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 116.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 109.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X12MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X14*8801-04", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X14MM *1868", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X14MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X15/CAP*348", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 470.92, "maximum": 652.56, "gross_charge": 672.75, "discounted_cash": 1009.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 652.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 538.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X16*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 262.08, "maximum": 363.16, "gross_charge": 374.4, "discounted_cash": 561.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 318.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 262.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 363.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 262.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 318.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 299.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X16MM *1868", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X16MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 724.5, "maximum": 1003.95, "gross_charge": 1035.0, "discounted_cash": 1552.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 776.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1003.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 776.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X16MM*05-10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X20*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X20MM CERV*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X20MM OASYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X24*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X24MM OASYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1164.26, "maximum": 1613.33, "gross_charge": 1663.23, "discounted_cash": 2494.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1613.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1164.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1247.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1413.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1330.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X25MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X28*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X30MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X32*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X32MM CANN*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 724.5, "maximum": 1003.95, "gross_charge": 1035.0, "discounted_cash": 1552.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 776.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1003.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 724.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 776.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 879.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X32MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X34MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 422.1, "maximum": 584.91, "gross_charge": 603.0, "discounted_cash": 904.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 512.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 584.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 422.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 452.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 512.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 482.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X34MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X36*AR-8945", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X36*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X36MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 500.85, "maximum": 694.03, "gross_charge": 715.5, "discounted_cash": 1073.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 608.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 536.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 500.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 694.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 500.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 536.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 608.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 572.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X36MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X36MM OASYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X38MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X40*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X40MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X40MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202459", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X42MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X44*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X44MM CANN", "code_information": [{"code": "3100203311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 904.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW 4.5X44MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X46MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X47MM LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X48*AR-9562", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X48MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 515.02, "maximum": 713.67, "gross_charge": 735.75, "discounted_cash": 1103.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 625.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 515.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 713.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 515.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 625.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X48MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 500.85, "maximum": 694.03, "gross_charge": 715.5, "discounted_cash": 1073.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 608.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 536.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 500.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 694.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 500.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 536.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 608.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 572.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X50MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 500.85, "maximum": 694.03, "gross_charge": 715.5, "discounted_cash": 1073.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 608.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 536.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 500.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 694.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 500.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 536.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 608.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 572.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X50MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X54MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X55*AR-8945", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X58MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X60MM CORT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X66MM CTX S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 71.4, "maximum": 98.94, "gross_charge": 102.0, "discounted_cash": 153.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 98.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 86.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.5X72MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 515.02, "maximum": 713.67, "gross_charge": 735.75, "discounted_cash": 1103.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 625.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 515.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 713.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 515.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 625.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.6 X 20*121-5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2216.76, "maximum": 3071.79, "gross_charge": 3166.8, "discounted_cash": 4750.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2691.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3071.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2691.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2533.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4.75 X 35MM*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X16MM SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X17 VARI SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204530", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X18 FIX SELF*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X25MM LOCK*04", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X28MM SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X30MM SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 4X54MM CANN*2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209479", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 175*AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 20*46750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 25*232-2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 25*46750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 30*1257-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207944", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 372.4, "maximum": 516.04, "gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 516.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 30*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 30*46750", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 567.0, "maximum": 785.7, "gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 785.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 688.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 30*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 34*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 35*1257-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 372.4, "maximum": 516.04, "gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 516.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 36*412.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 610.65, "maximum": 846.19, "gross_charge": 872.37, "discounted_cash": 1308.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 741.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 654.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 610.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 846.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 610.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 654.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 741.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 697.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 40*1257-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 372.4, "maximum": 516.04, "gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 516.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 40*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 40*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.12, "maximum": 483.78, "gross_charge": 498.75, "discounted_cash": 748.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 423.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 483.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 423.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 44*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 45*15001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 46*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 48*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.12, "maximum": 483.78, "gross_charge": 498.75, "discounted_cash": 748.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 423.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 483.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 423.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 50*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 50*65815", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.83, "maximum": 1382.71, "gross_charge": 1425.48, "discounted_cash": 2138.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1069.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1069.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 50*66315", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2478.07, "maximum": 3433.9, "gross_charge": 3540.11, "discounted_cash": 5310.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3009.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2655.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2478.07, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3433.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2478.07, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2655.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3009.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2832.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 55*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 55*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 60*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 60*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 65*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 70*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 85*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X 90*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X34*DWJ334", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X38*DWJ338", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X42*DWJ342", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0 X46*DWJ346", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X18MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 207.2, "maximum": 287.12, "gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X22MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 207.2, "maximum": 287.12, "gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X25*132-20-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X26MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 207.2, "maximum": 287.12, "gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X26MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 502.06, "maximum": 695.72, "gross_charge": 717.24, "discounted_cash": 1075.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 502.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 502.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X28MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 502.06, "maximum": 695.72, "gross_charge": 717.24, "discounted_cash": 1075.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 502.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 502.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X32MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.19, "maximum": 460.33, "gross_charge": 474.57, "discounted_cash": 711.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 460.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 379.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X35MM*54840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X36MM *04.0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.19, "maximum": 460.33, "gross_charge": 474.57, "discounted_cash": 711.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 460.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 379.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X38MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 188.38, "maximum": 261.04, "gross_charge": 269.12, "discounted_cash": 403.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 201.84, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 188.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 261.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 188.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 201.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 215.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X42MM*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.0X55MM LOCK*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 382.72, "maximum": 530.34, "gross_charge": 546.75, "discounted_cash": 820.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 464.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 410.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 382.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 530.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 382.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 410.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 464.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 437.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 20*AX552", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 25*79655", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 25*AX552", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 25MM*230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 25MM*G36", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208085", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 30*19000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207086", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1421.7, "maximum": 1970.07, "gross_charge": 2031.0, "discounted_cash": 3046.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1970.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1421.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1523.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 30*AX530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 30MM*230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 35MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 40*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 40*41-55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 40*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2821.0, "maximum": 3909.1, "gross_charge": 4030.0, "discounted_cash": 6045.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3909.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 40*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 40MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 45*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 45*41-55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 45*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 45*75445", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1615.04, "maximum": 2237.98, "gross_charge": 2307.2, "discounted_cash": 3460.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2237.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1615.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1730.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1961.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1845.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 45MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*15025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*41-55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2821.0, "maximum": 3909.1, "gross_charge": 4030.0, "discounted_cash": 6045.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3909.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 50MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 55*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 55*41-55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 55MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 60*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X 60MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X40*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X45*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5 X45*E5111-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1690.5, "maximum": 2342.55, "gross_charge": 2415.0, "discounted_cash": 3622.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1811.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1690.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2342.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1690.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1811.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2052.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1932.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5MMX50MM*548", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X12MM MU*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202497", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X25MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X25MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X25MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X30MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X30MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X35MM LP IS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X40MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X40MM LP IS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X45MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X45MM MULT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X50MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.5X55MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.O X 36*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.O X 38*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.O X 50*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.O X 55*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.O X 75*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5.O X 80*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1047.37, "maximum": 1451.36, "gross_charge": 1496.25, "discounted_cash": 2244.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1451.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1047.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1122.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1271.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1197.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X30*232-20-50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X35MM FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203180", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X37.5 FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X40MM FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203181", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X42MM FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X45MM FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X60MM LCK T2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202967", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X70MM LCK T2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202968", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X75MM LCK T2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X80MM FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 5X85MM FT LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6 X 30MM*X076-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0 X 50*04.63", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0 X 75MM*608", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 160.6, "maximum": 222.55, "gross_charge": 229.44, "discounted_cash": 344.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 195.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 172.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 160.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 222.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 160.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 172.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 195.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 183.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0 X20MM*AR-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X40M LP PT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X45M LP PT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X45MM MATR*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X50M LP PT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X55M LP PT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207824", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X60M LP PT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X65M LP PT*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1558.2, "maximum": 2159.22, "gross_charge": 2226.0, "discounted_cash": 3339.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2159.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1558.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1669.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1892.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1780.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.0X72MM LCK S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209103", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.19, "maximum": 460.33, "gross_charge": 474.57, "discounted_cash": 711.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 460.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 379.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.4X45*01.0371", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5285.28, "maximum": 7323.88, "gross_charge": 7550.4, "discounted_cash": 11325.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6417.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5662.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5285.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7323.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5285.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5662.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6417.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6040.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 25MM*230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 30MM*010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 30MM*230", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 35*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 35*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*13-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*41-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210071", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*465-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*54850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2821.0, "maximum": 3909.1, "gross_charge": 4030.0, "discounted_cash": 6045.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3909.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 40MM*010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*13-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*41-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*465-4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1333.5, "maximum": 1847.85, "gross_charge": 1905.0, "discounted_cash": 2857.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1847.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1524.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*5119.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*54850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1344.79, "maximum": 1863.5, "gross_charge": 1921.14, "discounted_cash": 2881.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1632.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1440.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1344.79, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1863.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1344.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1440.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1632.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1536.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 45*E3565", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*108L-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1249.5, "maximum": 1731.45, "gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1731.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*13-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*41-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*465-5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1333.5, "maximum": 1847.85, "gross_charge": 1905.0, "discounted_cash": 2857.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1847.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1524.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*5119.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2821.0, "maximum": 3909.1, "gross_charge": 4030.0, "discounted_cash": 6045.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3909.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206774", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 50*E3565", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*108L-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1249.5, "maximum": 1731.45, "gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1731.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1517.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*13-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*41-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209193", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*465-5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1244.6, "maximum": 1724.66, "gross_charge": 1778.0, "discounted_cash": 2667.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1511.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1244.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1724.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1244.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1511.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 55*E3565", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 60*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 60*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 60*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 60*34306", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 107.8, "maximum": 149.38, "gross_charge": 154.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 149.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 60*41-65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209194", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 60MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 65*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 70*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 70*208.4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.39, "maximum": 865.23, "gross_charge": 891.99, "discounted_cash": 1337.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 668.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 713.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 75MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 75MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 80MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X 80MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X40*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X40*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X45*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X50*115400", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X50*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X50*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X50*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5 X55*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5MMX45M*5484", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X15MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X20MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X25*00-6250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X25MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X30MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X30MM BONE*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.0, "maximum": 698.4, "gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X35MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X35MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X35MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X35MM CENTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X40*15025-0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X40MM *1153", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X40MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X40MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45*AR-8665", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.33, "maximum": 466.06, "gross_charge": 480.48, "discounted_cash": 720.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 466.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45MM CENTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45MM GAP P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.04, "maximum": 530.78, "gross_charge": 547.2, "discounted_cash": 820.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 410.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 530.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 410.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 437.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X45MM REVER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2169.44, "maximum": 3006.22, "gross_charge": 3099.2, "discounted_cash": 4648.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2634.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2324.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2169.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3006.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2169.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2324.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2634.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2479.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X50*5484004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X50*AR-8665", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X50MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X50MM *7030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X50MM GAP P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 337.26, "maximum": 467.34, "gross_charge": 481.8, "discounted_cash": 722.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 409.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 361.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 337.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 467.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 337.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 361.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 409.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 385.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X55*AR-8665", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X55MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X55MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X55MM FULL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 91.33, "maximum": 126.56, "gross_charge": 130.48, "discounted_cash": 195.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X55MM POL*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X60MM *4823", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X60MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X60MM FULL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 91.33, "maximum": 126.56, "gross_charge": 130.48, "discounted_cash": 195.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X60MM LP IS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X65MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X70MM CANC*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X80MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 544.95, "maximum": 755.14, "gross_charge": 778.5, "discounted_cash": 1167.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 661.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 583.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 544.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 755.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 544.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 583.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 661.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 622.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X85MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 644.17, "maximum": 892.64, "gross_charge": 920.25, "discounted_cash": 1380.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 782.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 690.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 644.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 892.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 644.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 690.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 782.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 736.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X90*AR-8665", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X90MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 644.17, "maximum": 892.64, "gross_charge": 920.25, "discounted_cash": 1380.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 782.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 690.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 644.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 892.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 644.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 690.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 782.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 736.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X95*AR-8665", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.5X95MM CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203253", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 544.95, "maximum": 755.14, "gross_charge": 778.5, "discounted_cash": 1167.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 661.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 583.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 544.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 755.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 544.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 583.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 661.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 622.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 50*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 50*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 55*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 60*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 65*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 70MM*AR8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 75*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7 X 85*AR-89", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X 60*AR-896", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X100MM*AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X40MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X45MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X55MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X70MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X75MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X80MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X85MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X90MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 6.7X95MM CA*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 100*AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 105*AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 110*AR-8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 20MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 30MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 40*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 45*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 50*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 55*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 60*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 65*65856", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1488.36, "maximum": 2062.45, "gross_charge": 2126.24, "discounted_cash": 3189.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1807.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1594.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1488.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2062.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1488.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1594.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1807.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1700.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 65*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 70*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 75*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 80*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 85*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 90*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.0 X 95*AR-87", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1532.47, "maximum": 2123.57, "gross_charge": 2189.25, "discounted_cash": 3283.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2123.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1532.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1860.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.3 X 16*408.9", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 620.78, "maximum": 860.22, "gross_charge": 886.83, "discounted_cash": 1330.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 753.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 665.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 620.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 860.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 620.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 665.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 753.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 709.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 100*41-7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 165*04.3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 953.71, "maximum": 1321.57, "gross_charge": 1362.45, "discounted_cash": 2043.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1158.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1021.83, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 953.71, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1321.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 953.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1021.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1158.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1089.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 35*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 35*41-75", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 40*13-75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 40*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 40*41-75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 40*54850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 40*55840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 40*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*41-75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*54850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2640.82, "maximum": 3659.42, "gross_charge": 3772.6, "discounted_cash": 5658.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3206.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2829.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2640.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3659.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2640.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2829.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3206.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3018.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 45*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 50*15025", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 50*15704", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 50*41-75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 50*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2640.82, "maximum": 3659.42, "gross_charge": 3772.6, "discounted_cash": 5658.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3206.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2829.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2640.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3659.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2640.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2829.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3206.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3018.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 50*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 55*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 55*15025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 55*15025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 55*41-75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 55*55720", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2640.82, "maximum": 3659.42, "gross_charge": 3772.6, "discounted_cash": 5658.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3206.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2829.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2640.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3659.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2640.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2829.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3206.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3018.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 55*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 60*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 60*15025", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X 60*41-75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X35*558500", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X40*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X45*15025-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X50*13-755", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X70*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2406.04, "maximum": 3334.08, "gross_charge": 3437.2, "discounted_cash": 5155.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2921.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2577.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2406.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3334.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2406.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2577.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2921.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2749.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X80*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5 X90*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5X40*4823175", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5X50MM LEGA*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1134.0, "maximum": 1571.4, "gross_charge": 1620.0, "discounted_cash": 2430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1571.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5X50MM POLYA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1663.2, "maximum": 2304.72, "gross_charge": 2376.0, "discounted_cash": 3564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2019.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1782.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2304.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1782.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2019.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1900.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5X50MM*54840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5X55MM POLYA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 7.5X55MM*54840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.0 X 20MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.0 X 30MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.0X50MM*17971", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.0X60MM*17971", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 80*485-80-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1333.5, "maximum": 1847.85, "gross_charge": 1905.0, "discounted_cash": 2857.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1847.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1333.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1428.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1619.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1524.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 100*1507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 40*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 40*41-85", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 40*55850", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 45*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206549", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 45*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 45*41-85", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 45*5119.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 50*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 50*15704", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 50*41-85", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 50*5119.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 55*15014", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 55*41-85", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 60*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 60*41-85", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 70*25840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 80*15074", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 80*25840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 80*48238", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X 90*48238", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X60*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X70*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X80*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X90*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5 X90*256300", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5MMX100MM*48", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X35MM POLYA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X40*15025-0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X45*15025-0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X50*15025-0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X50MM LP IS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X50MM*54840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208127", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X55*15025-0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X60MM LP IS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X60MM LP IS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X70MM POLYA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8.5X80MM ILIAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 8X28MM BIO-*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.0 X 20MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.0 X 30MM*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204252", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5 X 100*1507", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5 X 100*41-9", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5 X 50*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5 X 50*41-95", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 789.6, "maximum": 1094.16, "gross_charge": 1128.0, "discounted_cash": 1692.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1094.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 958.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 902.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5 X 55*15004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5 X 90*41-95", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5X 035*5004-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5X 040*5004-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4908.54, "maximum": 6801.83, "gross_charge": 7012.2, "discounted_cash": 10518.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6801.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4908.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5259.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5960.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5609.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5X100MM POLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5X50MM POLY*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5X50MM*54840", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW 9.5X80MM POLY*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ACUTRAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 208.6, "maximum": 289.06, "gross_charge": 298.0, "discounted_cash": 447.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 253.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 223.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 208.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 289.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 208.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 223.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 253.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 238.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ACUTRAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103268", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ACUTRAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ACUTRAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1176.0, "maximum": 1629.6, "gross_charge": 1680.0, "discounted_cash": 2520.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1344.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AESCULAP", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "3100103869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AESCULAP", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "3100103871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 497.0, "maximum": 688.7, "gross_charge": 710.0, "discounted_cash": 1065.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 603.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 532.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 497.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 688.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 497.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 532.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 603.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ANCHOR-C SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1325.1, "maximum": 1836.21, "gross_charge": 1893.0, "discounted_cash": 2839.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1609.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1325.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1836.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1325.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1419.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1609.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1514.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARCADIUS", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "3100102413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARMADA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2671.2, "maximum": 3701.52, "gross_charge": 3816.0, "discounted_cash": 5724.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3243.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2862.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2671.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3701.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2671.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2862.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3243.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3052.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSEN 8.5X80*4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSEN 9.5X60*4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSEN 9.5X60*4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 4.0X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 4.5X35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 4.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 4.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 5.5X35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 5.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 5.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 5.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 5.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 5.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 6.5X35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 6.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 6.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 6.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 6.5X55*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 6.5X60*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X40*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X55*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X55*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X60*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X70*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X80*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 7.5X90*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 681.8, "maximum": 944.78, "gross_charge": 974.0, "discounted_cash": 1461.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 827.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 730.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 681.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 944.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 681.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 730.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 827.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 779.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X55*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X55*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X60*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X80*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 8.5X90*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 9.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 9.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 9.5X45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 9.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 9.5X70*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARSENA 9.5X80*", "code_information": [{"code": "3100203272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENA10.5X40*", "code_information": [{"code": "3100203547", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW ARSENA10.5X50*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ARTHREX BI-COR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ASPIDA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 672.0, "maximum": 931.2, "gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 931.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ASSEMBLY*ARS65", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209467", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1683.64, "maximum": 2333.04, "gross_charge": 2405.2, "discounted_cash": 3607.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2044.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1803.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1683.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2333.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1683.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1803.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2044.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTO DRV OSTEO", "code_information": [{"code": "3100103995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AUTODRIVE OSTE", "code_information": [{"code": "3100103843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 218.0, "discounted_cash": 327.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 600.6, "maximum": 832.26, "gross_charge": 858.0, "discounted_cash": 1287.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 729.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 643.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 600.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 832.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 600.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 643.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 729.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 686.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX 2.0X14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX 2.0X18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX 2.0X20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 540.54, "maximum": 749.03, "gross_charge": 772.2, "discounted_cash": 1158.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 656.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 579.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 540.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 749.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 540.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 579.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 656.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 617.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX 2.0X20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX 2.0X21", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 667.02, "maximum": 924.3, "gross_charge": 952.89, "discounted_cash": 1429.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 924.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 667.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 714.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 809.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 762.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AUTOFIX 2.0X24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.35, "maximum": 764.02, "gross_charge": 787.65, "discounted_cash": 1181.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 764.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW AVIATOR SELF T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 933.8, "maximum": 1293.98, "gross_charge": 1334.0, "discounted_cash": 2001.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1133.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1000.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 933.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1293.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 933.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1000.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1133.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1067.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIASED ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIASED ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1855.7, "maximum": 2571.47, "gross_charge": 2651.0, "discounted_cash": 3976.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2253.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1988.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1855.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2571.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1855.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1988.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2253.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2120.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIASED ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIASED ANGLE S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1896.3, "maximum": 2627.73, "gross_charge": 2709.0, "discounted_cash": 4063.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2302.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2031.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2627.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2031.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2302.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2167.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIO-COMP INTER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIO-COMP TENOD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 661.5, "maximum": 916.65, "gross_charge": 945.0, "discounted_cash": 1417.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 916.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 708.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 803.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIO-COMP TENOD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIO-COMPRESSIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BIO-INTER THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.6, "maximum": 550.96, "gross_charge": 568.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BLOCKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BLOCKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BN 6.5X20 ST*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 361.2, "maximum": 500.52, "gross_charge": 516.0, "discounted_cash": 774.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 500.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 361.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 387.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 438.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BN 6.5X35 ST*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 314.3, "maximum": 435.53, "gross_charge": 449.0, "discounted_cash": 673.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 381.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 314.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 435.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 314.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 381.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 359.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 289.8, "maximum": 401.58, "gross_charge": 414.0, "discounted_cash": 621.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 351.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 310.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 401.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 289.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 310.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 351.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 331.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 303.1, "maximum": 420.01, "gross_charge": 433.0, "discounted_cash": 649.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 420.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 346.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5XMM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE 6.5XMM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1121.4, "maximum": 1553.94, "gross_charge": 1602.0, "discounted_cash": 2403.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1361.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1201.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1121.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1553.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1121.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1201.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1361.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1281.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 264.6, "maximum": 366.66, "gross_charge": 378.0, "discounted_cash": 567.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 366.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 264.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 302.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 275.8, "maximum": 382.18, "gross_charge": 394.0, "discounted_cash": 591.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 334.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 275.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 382.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 275.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 295.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 334.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 315.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 311.5, "maximum": 431.65, "gross_charge": 445.0, "discounted_cash": 667.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 378.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 333.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 311.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 431.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 311.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 333.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 378.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 356.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 318.5, "maximum": 441.35, "gross_charge": 455.0, "discounted_cash": 682.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 386.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 318.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 441.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 318.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 386.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103281", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 58.8, "maximum": 81.48, "gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 81.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 71.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 39.59, "maximum": 54.86, "gross_charge": 56.56, "discounted_cash": 84.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 42.42, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 54.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 39.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 42.42, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 48.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 45.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.0, "maximum": 87.3, "gross_charge": 90.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 107.8, "maximum": 149.38, "gross_charge": 154.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 149.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 116.2, "maximum": 161.02, "gross_charge": 166.0, "discounted_cash": 249.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 124.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 132.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 91.0, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 195.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 49.0, "maximum": 67.9, "gross_charge": 70.0, "discounted_cash": 105.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 52.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 67.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 49.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 52.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 59.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANC THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 46.2, "maximum": 64.02, "gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 64.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 46.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 56.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 52.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 310.8, "maximum": 430.68, "gross_charge": 444.0, "discounted_cash": 666.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 377.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 333.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 310.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 430.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 310.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 333.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 377.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 355.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CROSS FIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 303.1, "maximum": 420.01, "gross_charge": 433.0, "discounted_cash": 649.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 420.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 346.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE CROSS FIT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103286", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 60.9, "maximum": 84.39, "gross_charge": 87.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 73.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 60.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 60.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 73.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 69.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE FIXED ANG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 812.7, "maximum": 1126.17, "gross_charge": 1161.0, "discounted_cash": 1741.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 986.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 870.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 812.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1126.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 812.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 870.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 986.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 928.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE FIXED ANG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103287", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 690.9, "maximum": 957.39, "gross_charge": 987.0, "discounted_cash": 1480.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 957.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 303.1, "maximum": 420.01, "gross_charge": 433.0, "discounted_cash": 649.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 420.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 346.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 431.2, "maximum": 597.52, "gross_charge": 616.0, "discounted_cash": 924.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 431.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 597.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 431.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 462.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 492.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 287.7, "maximum": 398.67, "gross_charge": 411.0, "discounted_cash": 616.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 308.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 287.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 398.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 287.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 308.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 349.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 328.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103289", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 291.2, "maximum": 403.52, "gross_charge": 416.0, "discounted_cash": 624.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 403.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 312.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 353.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 349.3, "maximum": 484.03, "gross_charge": 499.0, "discounted_cash": 748.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 424.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 374.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 349.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 484.03, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 349.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 374.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 424.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 399.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.7, "maximum": 563.57, "gross_charge": 581.0, "discounted_cash": 871.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 493.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 406.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 563.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 406.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 493.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE LOCK RSP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 207.2, "maximum": 287.12, "gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE MINI ACUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1131.9, "maximum": 1568.49, "gross_charge": 1617.0, "discounted_cash": 2425.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1374.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1212.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1131.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1131.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1212.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1374.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1293.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE MINI ACUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1176.0, "maximum": 1629.6, "gross_charge": 1680.0, "discounted_cash": 2520.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1629.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1428.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1344.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE REMOVER*I", "code_information": [{"code": "3100208107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW BONE SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 161.7, "maximum": 224.07, "gross_charge": 231.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 116.9, "maximum": 161.99, "gross_charge": 167.0, "discounted_cash": 250.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 125.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 125.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 133.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BONE SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 229.6, "maximum": 318.16, "gross_charge": 328.0, "discounted_cash": 492.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 278.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 318.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 246.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 278.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 262.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BRIGADE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101638", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1881.6, "maximum": 2607.36, "gross_charge": 2688.0, "discounted_cash": 4032.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2284.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2607.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1881.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2284.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2150.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW BRIGADE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1891.4, "maximum": 2620.94, "gross_charge": 2702.0, "discounted_cash": 4053.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2296.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2026.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1891.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2620.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1891.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2026.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2296.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2161.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 327.6, "maximum": 453.96, "gross_charge": 468.0, "discounted_cash": 702.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103350", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 283.5, "maximum": 392.85, "gross_charge": 405.0, "discounted_cash": 607.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 303.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 392.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 283.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 303.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 324.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 284.2, "maximum": 393.82, "gross_charge": 406.0, "discounted_cash": 609.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 345.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 304.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 284.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 393.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 284.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 304.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 345.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 290.5, "maximum": 402.55, "gross_charge": 415.0, "discounted_cash": 622.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 311.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 402.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 290.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 311.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 352.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 332.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.7, "maximum": 505.37, "gross_charge": 521.0, "discounted_cash": 781.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 505.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 193.9, "maximum": 268.69, "gross_charge": 277.0, "discounted_cash": 415.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 235.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 207.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 193.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 268.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 193.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 207.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 235.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 221.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 161.7, "maximum": 224.07, "gross_charge": 231.0, "discounted_cash": 346.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.7, "maximum": 233.77, "gross_charge": 241.0, "discounted_cash": 361.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 233.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 183.4, "maximum": 254.14, "gross_charge": 262.0, "discounted_cash": 393.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 254.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 209.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 197.4, "maximum": 273.54, "gross_charge": 282.0, "discounted_cash": 423.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 273.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 197.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 211.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 239.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 225.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 206.5, "maximum": 286.15, "gross_charge": 295.0, "discounted_cash": 442.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 250.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 206.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 206.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 250.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 212.1, "maximum": 293.91, "gross_charge": 303.0, "discounted_cash": 454.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 227.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 212.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 293.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 212.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 227.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 242.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 217.0, "maximum": 300.7, "gross_charge": 310.0, "discounted_cash": 465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 263.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 232.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 217.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 300.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 217.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 232.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 263.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 221.2, "maximum": 306.52, "gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 306.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW C-PIN SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 227.5, "maximum": 315.25, "gross_charge": 325.0, "discounted_cash": 487.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 276.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 227.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 315.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 227.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 276.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CADDY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CAGE LG*AR-930", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6040.12, "maximum": 8369.88, "gross_charge": 8628.75, "discounted_cash": 12943.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7334.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6471.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6040.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8369.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6040.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6471.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7334.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6903.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CAGE LG*AR-930", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6040.12, "maximum": 8369.88, "gross_charge": 8628.75, "discounted_cash": 12943.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7334.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6471.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6040.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8369.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6040.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6471.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7334.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6903.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CAGE SM*AR-930", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8053.5, "maximum": 11159.85, "gross_charge": 11505.0, "discounted_cash": 17257.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9779.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8628.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8053.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11159.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8053.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8628.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9779.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9204.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 86.1, "maximum": 119.31, "gross_charge": 123.0, "discounted_cash": 184.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 119.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 86.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 92.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 104.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 98.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 91.0, "maximum": 126.1, "gross_charge": 130.0, "discounted_cash": 195.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 126.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 91.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 97.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 110.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 104.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.8, "maximum": 159.08, "gross_charge": 164.0, "discounted_cash": 246.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 123.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 159.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 123.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 131.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC 6.5X20MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC LOCK THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1059.1, "maximum": 1467.61, "gross_charge": 1513.0, "discounted_cash": 2269.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1286.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1134.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1059.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1467.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1059.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1134.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1286.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1210.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC LOCK THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103298", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 953.4, "maximum": 1321.14, "gross_charge": 1362.0, "discounted_cash": 2043.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1157.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1021.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 953.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1321.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 953.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1021.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1157.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1089.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103299", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.2, "maximum": 345.32, "gross_charge": 356.0, "discounted_cash": 534.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 302.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 345.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 302.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 284.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC POLY SNYT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101643", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC POLY SNYT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC SELF DRIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 501.9, "maximum": 695.49, "gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANC SPIKED WA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "310010646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 285.0, "discounted_cash": 427.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101646", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 502.6, "maximum": 696.46, "gross_charge": 718.0, "discounted_cash": 1077.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 610.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 538.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 502.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 696.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 502.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 538.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 610.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 574.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103303", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 451.5, "maximum": 625.65, "gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 625.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 974.85, "gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 441.0, "maximum": 611.1, "gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 611.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN 3.0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 502.6, "maximum": 696.46, "gross_charge": 718.0, "discounted_cash": 1077.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 610.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 538.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 502.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 696.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 502.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 538.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 610.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 574.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN 6.5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 974.85, "gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN 8.0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 974.85, "gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ARTHREX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ARTHREX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ASNIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 974.85, "gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ASNIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ASNIS III", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 451.5, "maximum": 625.65, "gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 625.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ASNIS PAR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 441.0, "maximum": 611.1, "gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 611.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 504.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 315.7, "maximum": 437.47, "gross_charge": 451.0, "discounted_cash": 676.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 383.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 338.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 315.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 437.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 315.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 338.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 383.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 360.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.9, "maximum": 365.69, "gross_charge": 377.0, "discounted_cash": 565.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 320.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 365.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 320.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 301.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LONG THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 352.8, "maximum": 488.88, "gross_charge": 504.0, "discounted_cash": 756.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 488.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 352.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 428.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 403.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LOW PRO P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LOW PRO P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN LOW PRO P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN NUVASIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1374.8, "maximum": 1905.08, "gross_charge": 1964.0, "discounted_cash": 2946.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1669.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1473.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1905.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1473.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1669.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1571.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN ORTHOPEDI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.8, "maximum": 663.48, "gross_charge": 684.0, "discounted_cash": 1026.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 513.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 513.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN PART THRE", "code_information": [{"code": "3100104489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 824.0, "discounted_cash": 1236.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW CANN PART THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 703.5, "maximum": 974.85, "gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 974.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 703.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 753.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 854.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 804.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN PART THRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.1, "maximum": 662.51, "gross_charge": 683.0, "discounted_cash": 1024.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 662.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 546.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN QUICK CON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1386.0, "maximum": 1920.6, "gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1920.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1485.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1683.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1584.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHANK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1374.8, "maximum": 1905.08, "gross_charge": 1964.0, "discounted_cash": 2946.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1669.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1473.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1905.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1473.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1669.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1571.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101647", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 365.73, "maximum": 506.8, "gross_charge": 522.48, "discounted_cash": 783.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 444.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 391.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 365.73, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 506.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 365.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 391.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 444.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 417.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 370.3, "maximum": 513.13, "gross_charge": 529.0, "discounted_cash": 793.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 449.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 370.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 513.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 370.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 449.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 423.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT TH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 493.5, "maximum": 683.85, "gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 599.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 528.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 683.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 528.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 599.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT THR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.82, "maximum": 504.15, "gross_charge": 519.75, "discounted_cash": 779.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN SHORT THR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 367.5, "maximum": 509.25, "gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 509.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 367.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 393.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 451.5, "maximum": 625.65, "gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 625.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 450.8, "maximum": 624.68, "gross_charge": 644.0, "discounted_cash": 966.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 547.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 450.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 624.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 450.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 547.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 515.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 410.9, "maximum": 569.39, "gross_charge": 587.0, "discounted_cash": 880.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 498.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 440.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 410.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 569.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 410.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 440.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 498.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 469.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 425.6, "maximum": 589.76, "gross_charge": 608.0, "discounted_cash": 912.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 516.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 589.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 516.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 486.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 434.7, "maximum": 602.37, "gross_charge": 621.0, "discounted_cash": 931.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 602.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 434.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 465.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 527.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 496.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.1, "maximum": 662.51, "gross_charge": 683.0, "discounted_cash": 1024.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 662.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 580.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 546.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103323", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 539.0, "maximum": 746.9, "gross_charge": 770.0, "discounted_cash": 1155.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 654.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 539.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 746.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 539.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 654.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 554.4, "maximum": 768.24, "gross_charge": 792.0, "discounted_cash": 1188.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 673.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 594.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 554.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 768.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 554.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 594.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 673.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 633.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN THREAD HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 618.8, "maximum": 857.48, "gross_charge": 884.0, "discounted_cash": 1326.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 751.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 857.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 751.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN W SHEATH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.1, "maximum": 468.51, "gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 468.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CANN3.0X42*AR-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 20MM*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1336.65, "maximum": 1852.21, "gross_charge": 1909.5, "discounted_cash": 2864.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1852.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1527.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 25MM*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1336.65, "maximum": 1852.21, "gross_charge": 1909.5, "discounted_cash": 2864.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1852.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1527.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 25MM*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1336.65, "maximum": 1852.21, "gross_charge": 1909.5, "discounted_cash": 2864.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1852.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1527.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 30MM*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1336.65, "maximum": 1852.21, "gross_charge": 1909.5, "discounted_cash": 2864.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1852.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1527.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 35MM*A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1336.65, "maximum": 1852.21, "gross_charge": 1909.5, "discounted_cash": 2864.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1852.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1336.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1432.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1623.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1527.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 6.0X25", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 6.0X30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 6.0X35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL 6X30*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2664.48, "maximum": 3692.2, "gross_charge": 3806.4, "discounted_cash": 5709.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3235.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2854.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2664.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3692.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2664.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2854.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3235.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3045.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CENTRAL UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 380.8, "maximum": 527.68, "gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 527.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CERVICAL SELF-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CLSD 8.5 X 60*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202902", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CLSD 8.5 X 90*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1484.87, "maximum": 2057.61, "gross_charge": 2121.25, "discounted_cash": 3181.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1803.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1590.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1484.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2057.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1484.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1590.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1803.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1697.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CMAS ILIAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101671", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3410.4, "maximum": 4725.84, "gross_charge": 4872.0, "discounted_cash": 7308.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4141.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3654.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3410.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4725.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3410.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3654.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4141.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3897.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CNCBN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101672", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 315.7, "maximum": 437.47, "gross_charge": 451.0, "discounted_cash": 676.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 383.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 338.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 315.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 437.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 315.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 338.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 383.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 360.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CNCBN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.7, "maximum": 447.17, "gross_charge": 461.0, "discounted_cash": 691.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 447.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CNTRL 6.5X15M*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 380.8, "maximum": 527.68, "gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 527.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CNTRL 6X 25MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 380.8, "maximum": 527.68, "gross_charge": 544.0, "discounted_cash": 816.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 527.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 462.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 435.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CNTRL UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103930", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X12MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X14MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X16MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X18MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X24MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X34MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X40*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205988", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 771.75, "maximum": 1069.42, "gross_charge": 1102.5, "discounted_cash": 1653.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1069.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 771.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 826.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X42*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X44*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208113", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X46*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X48*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMP 3.5X50*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 735.0, "maximum": 1018.5, "gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1018.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 735.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION DE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101673", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 130.9, "maximum": 181.39, "gross_charge": 187.0, "discounted_cash": 280.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW COMPRESSION*18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 482.49, "maximum": 668.6, "gross_charge": 689.28, "discounted_cash": 1033.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 585.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 516.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 482.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 668.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 482.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 516.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 585.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 551.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CONDYLE FASTEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101674", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 382.2, "maximum": 529.62, "gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 382.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 529.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 382.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 464.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 436.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CONICAL COVER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 388.5, "maximum": 538.35, "gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 538.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORT Z NAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 528.5, "maximum": 732.35, "gross_charge": 755.0, "discounted_cash": 1132.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 641.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 566.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 528.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 732.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 528.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 566.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 641.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORT Z NAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103325", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 510.3, "maximum": 707.13, "gross_charge": 729.0, "discounted_cash": 1093.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 707.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 510.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 546.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 619.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 583.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 274.4, "maximum": 380.24, "gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 380.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 333.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 501.9, "maximum": 695.49, "gross_charge": 717.0, "discounted_cash": 1075.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 695.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 501.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 537.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 609.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 573.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 73.5, "maximum": 101.85, "gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 101.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 73.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 89.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5X13M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 1.5X14M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 126.0, "maximum": 174.6, "gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 174.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 135.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X12M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X16M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X18M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X20M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X24M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X28M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 323.4, "maximum": 448.14, "gross_charge": 462.0, "discounted_cash": 693.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 448.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 323.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 392.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X30M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X32M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X34M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX 2.4X38M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 308.0, "maximum": 426.8, "gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 426.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 330.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 374.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 352.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 121.8, "maximum": 168.78, "gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 168.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 121.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 130.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 147.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 139.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 52.05, "maximum": 72.12, "gross_charge": 74.36, "discounted_cash": 111.54, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 55.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 52.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 72.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 52.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 55.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 89.6, "maximum": 124.16, "gross_charge": 128.0, "discounted_cash": 192.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 108.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 124.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 108.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 102.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 96.6, "maximum": 133.86, "gross_charge": 138.0, "discounted_cash": 207.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 133.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 96.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 103.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 117.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 110.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 100.8, "maximum": 139.68, "gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 139.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 106.4, "maximum": 147.44, "gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 147.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.7, "maximum": 156.17, "gross_charge": 161.0, "discounted_cash": 241.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 156.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 97.18, "maximum": 134.67, "gross_charge": 138.84, "discounted_cash": 208.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 97.18, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 134.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 97.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 104.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 118.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 111.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 116.9, "maximum": 161.99, "gross_charge": 167.0, "discounted_cash": 250.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 141.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 125.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 116.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 161.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 116.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 125.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 141.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 133.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 170.8, "maximum": 236.68, "gross_charge": 244.0, "discounted_cash": 366.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 207.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 183.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 170.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 236.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 170.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 183.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 207.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 195.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 180.6, "maximum": 250.26, "gross_charge": 258.0, "discounted_cash": 387.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 219.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 193.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 180.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 250.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 180.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 193.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 219.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 190.4, "maximum": 263.84, "gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 263.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103339", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.1, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 154.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 82.74, "maximum": 114.65, "gross_charge": 118.2, "discounted_cash": 177.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 143.16, "maximum": 198.38, "gross_charge": 204.52, "discounted_cash": 306.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 173.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 143.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 198.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 143.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.39, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 173.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 163.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 124.6, "maximum": 172.66, "gross_charge": 178.0, "discounted_cash": 267.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 133.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 124.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 172.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 124.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 133.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 151.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 142.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 122.5, "maximum": 169.75, "gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 169.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 105.7, "maximum": 146.47, "gross_charge": 151.0, "discounted_cash": 226.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 146.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 113.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 128.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 99.4, "maximum": 137.74, "gross_charge": 142.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 137.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 82.74, "maximum": 114.65, "gross_charge": 118.2, "discounted_cash": 177.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 52.33, "maximum": 72.51, "gross_charge": 74.76, "discounted_cash": 112.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 63.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 72.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 63.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 52.33, "maximum": 72.51, "gross_charge": 74.76, "discounted_cash": 112.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 63.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 72.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 52.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 56.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 63.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 59.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTEX SELF TA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 156.1, "maximum": 216.31, "gross_charge": 223.0, "discounted_cash": 334.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 189.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 167.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 156.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 216.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 156.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 167.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 189.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 178.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 104.3, "maximum": 144.53, "gross_charge": 149.0, "discounted_cash": 223.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 144.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 104.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 111.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 126.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 119.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 221.2, "maximum": 306.52, "gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 306.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 201.6, "maximum": 279.36, "gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 72.8, "maximum": 100.88, "gross_charge": 104.0, "discounted_cash": 156.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 100.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 78.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 88.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOW P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL LOW P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 551.25, "maximum": 763.87, "gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 763.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 590.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL MEDTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1640.8, "maximum": 2273.68, "gross_charge": 2344.0, "discounted_cash": 3516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1992.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1758.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1640.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2273.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1640.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1758.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1992.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1875.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL MEDTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2768.5, "maximum": 3836.35, "gross_charge": 3955.0, "discounted_cash": 5932.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3361.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2966.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2768.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3836.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2768.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2966.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3361.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CORTICAL THREA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101684", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW CRT LP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 132.3, "maximum": 183.33, "gross_charge": 189.0, "discounted_cash": 283.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 183.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 132.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 141.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 160.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 151.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW DEPTH GAUGE", "code_information": [{"code": "3100101689", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2053.0, "discounted_cash": 3079.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW DYNESYS COATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101690", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3367.0, "maximum": 4665.7, "gross_charge": 4810.0, "discounted_cash": 7215.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4665.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3367.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3607.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4088.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3848.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EMERGENCY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 183.4, "maximum": 254.14, "gross_charge": 262.0, "discounted_cash": 393.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 254.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 183.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 196.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 222.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 209.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EMERGENCY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 303.1, "maximum": 420.01, "gross_charge": 433.0, "discounted_cash": 649.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 420.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 346.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVER 8.5X100*2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVERES 8.5X90*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVERES 9.5X80*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 4.5X30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203552", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 4.5X35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203553", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 4.5X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 4.5X45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 5.5X35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 5.5X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 385.87, "maximum": 534.71, "gross_charge": 551.25, "discounted_cash": 826.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 534.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 413.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 468.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 5.5X45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 6.5X30", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 7.5X35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 7.5X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 7.5X45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 7.5X50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202535", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 7.5X55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X45", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X60", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X70", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 8.5X80", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EVEREST 9.5X40", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EXCELLA II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EXCELLA II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1438.5, "maximum": 1993.35, "gross_charge": 2055.0, "discounted_cash": 3082.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1746.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1541.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1438.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1993.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1438.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1541.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1746.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1644.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EXCELLA II", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EXTRACT 5MM*AR", "code_information": [{"code": "3100210178", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1968.75, "discounted_cash": 2953.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW EXTRACTION CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 305.55, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EXTRACTION CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103266", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 222.6, "maximum": 308.46, "gross_charge": 318.0, "discounted_cash": 477.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 270.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 238.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 222.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 308.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 222.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 238.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 270.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 254.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW EXTRACTION CO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 684.6, "maximum": 948.66, "gross_charge": 978.0, "discounted_cash": 1467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 831.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 684.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 948.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 684.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 831.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 782.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FACET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2769.9, "maximum": 3838.29, "gross_charge": 3957.0, "discounted_cash": 5935.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3363.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2967.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2769.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3838.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2769.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2967.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3363.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3165.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FASTAK CORKSCR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FEM OXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102229", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3642.1, "maximum": 5046.91, "gross_charge": 5203.0, "discounted_cash": 7804.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4422.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3902.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3642.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5046.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3642.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3902.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4422.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4162.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FEM OXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3896.9, "maximum": 5399.99, "gross_charge": 5567.0, "discounted_cash": 8350.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4731.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4175.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3896.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5399.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3896.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4175.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4731.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4453.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FEMALE 2.5*425", "code_information": [{"code": "3100204055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 630.0, "discounted_cash": 945.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW FEMORAL NECK*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.94, "maximum": 1048.9, "gross_charge": 1081.35, "discounted_cash": 1622.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 919.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 811.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1048.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 811.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 919.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 865.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIX 4 X 14*722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 523.6, "maximum": 725.56, "gross_charge": 748.0, "discounted_cash": 1122.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 635.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 725.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 635.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 598.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101696", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF DRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 863.8, "maximum": 1196.98, "gross_charge": 1234.0, "discounted_cash": 1851.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1048.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 925.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 863.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1196.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 863.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 925.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1048.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 987.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF DRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103366", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF DRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 763.0, "maximum": 1057.3, "gross_charge": 1090.0, "discounted_cash": 1635.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 926.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 817.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1057.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 817.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 926.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 872.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF DRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103368", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 893.2, "maximum": 1237.72, "gross_charge": 1276.0, "discounted_cash": 1914.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1084.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 957.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 893.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1237.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 893.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 957.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1084.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF DRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 961.8, "maximum": 1332.78, "gross_charge": 1374.0, "discounted_cash": 2061.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1167.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1030.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 961.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1332.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 961.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1030.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1167.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1099.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 582.4, "maximum": 807.04, "gross_charge": 832.0, "discounted_cash": 1248.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 624.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 582.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 807.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 582.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 624.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 665.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103370", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 523.6, "maximum": 725.56, "gross_charge": 748.0, "discounted_cash": 1122.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 635.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 725.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 635.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 598.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 744.8, "maximum": 1032.08, "gross_charge": 1064.0, "discounted_cash": 1596.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1032.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 851.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FIXED SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103373", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FUSION 2.0X18*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW FUSION 2.4X24M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205198", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW GAP PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 359.8, "maximum": 498.58, "gross_charge": 514.0, "discounted_cash": 771.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 436.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 385.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 359.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 498.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 359.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 385.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 436.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 411.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW GLENOSPHERE*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW GUIDE SLV NEST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLES 6.5X100*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLES 6.5X100*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLESS 6.5X10*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLESS 6.5X65*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLESS 6.5X70*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLESS 6.5X80*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLESS 6.5X80*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLESS 6.5X90*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLS THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 790.3, "maximum": 1095.13, "gross_charge": 1129.0, "discounted_cash": 1693.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 959.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 846.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 790.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1095.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 790.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 846.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 959.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 903.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HDLS THREAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.6, "maximum": 1191.16, "gross_charge": 1228.0, "discounted_cash": 1842.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1043.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1043.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEAD CANN EXPA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101703", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEAD POLYAXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADED 33MM*59", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 201.6, "maximum": 279.36, "gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADED 48MM*59", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADED KNEE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 231.0, "maximum": 320.1, "gross_charge": 330.0, "discounted_cash": 495.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 320.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 231.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 280.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADED KNEE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 252.0, "maximum": 349.2, "gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 349.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 306.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLE 2.5X18M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLE 2.5X20M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLE 2.5X22M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLE 3.5X26M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 945.0, "maximum": 1309.5, "gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1309.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1012.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 6.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 727.65, "maximum": 1008.31, "gross_charge": 1039.5, "discounted_cash": 1559.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 883.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 779.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 727.65, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1008.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 727.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 779.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 883.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 831.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 6.5X5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 833.72, "maximum": 1155.29, "gross_charge": 1191.03, "discounted_cash": 1786.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1012.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 893.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 833.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1155.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 833.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 893.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1012.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 952.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 6.5X6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 6.5X8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEADLESS 6.5X9", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 859.95, "maximum": 1191.64, "gross_charge": 1228.5, "discounted_cash": 1842.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1191.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 859.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 921.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1044.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 982.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW HEX HD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 609.0, "maximum": 843.9, "gross_charge": 870.0, "discounted_cash": 1305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 843.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 609.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 739.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ILIAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1754.2, "maximum": 2430.82, "gross_charge": 2506.0, "discounted_cash": 3759.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2430.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1754.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1879.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2130.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2004.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW INSERTERS T8 S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ISSYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW ISSYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW JONES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1761.9, "maximum": 2441.49, "gross_charge": 2517.0, "discounted_cash": 3775.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2139.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1887.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1761.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2441.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1761.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1887.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2139.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2013.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW KLS MARTIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 198.8, "maximum": 275.48, "gross_charge": 284.0, "discounted_cash": 426.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 241.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 213.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 198.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 275.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 198.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 213.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 241.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 227.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW KLS MARTIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 154.0, "maximum": 213.4, "gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 213.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 154.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 187.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 1.5X10*EXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 1.5X11*EXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208332", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 1.5X12*EXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 1.5X13*EXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 1.5X15*EXI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 1.5X6*EXIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 3.2-14*LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 3.2-16*LAG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 3.2X22MM*L", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG 3.2X4MM*LA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG DHS/DCS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 844.2, "maximum": 1169.82, "gross_charge": 1206.0, "discounted_cash": 1809.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1025.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 904.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 844.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1169.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 844.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 904.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1025.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 964.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LAG DHS/DCS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1400.0, "maximum": 1940.0, "gross_charge": 2000.0, "discounted_cash": 3000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1700.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1940.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1700.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LCKNG 2.0 X 9*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LCKNG 2.0 X10*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LCKNG 2.0 X18*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LEGA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LEGACY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2915.5, "maximum": 4040.05, "gross_charge": 4165.0, "discounted_cash": 6247.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3540.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2915.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4040.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2915.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3540.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3332.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LEGACY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2759.4, "maximum": 3823.74, "gross_charge": 3942.0, "discounted_cash": 5913.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3350.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2956.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2759.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3823.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2759.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2956.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3350.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LK LP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X46MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X48MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 176.4, "maximum": 244.44, "gross_charge": 252.0, "discounted_cash": 378.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 176.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 189.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 214.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205317", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X52MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X54MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X56MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X58M*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205321", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LO-PRO3.5X60MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.0, "maximum": 232.8, "gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 232.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOC 3.5X16MM*C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203938", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOC COR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.2, "maximum": 345.32, "gross_charge": 356.0, "discounted_cash": 534.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 302.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 345.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 302.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 284.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 296.8, "maximum": 411.28, "gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 360.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 318.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 411.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 296.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 318.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 360.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 339.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102334", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.7, "maximum": 505.37, "gross_charge": 521.0, "discounted_cash": 781.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 505.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 406.7, "maximum": 563.57, "gross_charge": 581.0, "discounted_cash": 871.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 493.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 406.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 563.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 406.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 435.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 493.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 464.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 436.1, "maximum": 604.31, "gross_charge": 623.0, "discounted_cash": 934.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 529.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 467.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 436.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 604.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 436.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 467.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 529.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 498.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 454.3, "maximum": 629.53, "gross_charge": 649.0, "discounted_cash": 973.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 551.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 486.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 454.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 629.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 454.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 486.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 551.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 519.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 464.8, "maximum": 644.08, "gross_charge": 664.0, "discounted_cash": 996.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 564.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 498.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 464.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 644.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 464.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 498.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 564.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 531.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 479.5, "maximum": 664.45, "gross_charge": 685.0, "discounted_cash": 1027.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 664.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 380.1, "maximum": 526.71, "gross_charge": 543.0, "discounted_cash": 814.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 461.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 407.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 380.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 526.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 380.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 407.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 461.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 434.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104381", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 339.5, "maximum": 470.45, "gross_charge": 485.0, "discounted_cash": 727.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 412.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 363.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 470.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 363.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 412.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.84, "maximum": 414.11, "gross_charge": 426.92, "discounted_cash": 640.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 414.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 341.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 327.6, "maximum": 453.96, "gross_charge": 468.0, "discounted_cash": 702.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.72, "maximum": 504.01, "gross_charge": 519.6, "discounted_cash": 779.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 1.5X11MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 1.5X9MM*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 215.46, "maximum": 298.56, "gross_charge": 307.8, "discounted_cash": 461.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 261.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 230.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 215.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 298.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 215.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 230.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 261.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X10MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X18MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208269", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X20MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X20MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 563.47, "maximum": 780.81, "gross_charge": 804.96, "discounted_cash": 1207.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 684.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 603.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 780.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 603.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 684.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 643.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X22MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 350.0, "maximum": 485.0, "gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 485.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 350.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 425.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X24MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 563.47, "maximum": 780.81, "gross_charge": 804.96, "discounted_cash": 1207.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 684.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 603.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 780.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 603.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 684.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 643.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.4X28MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 563.47, "maximum": 780.81, "gross_charge": 804.96, "discounted_cash": 1207.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 684.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 603.72, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 780.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 563.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 603.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 684.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 643.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.5X14M*P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.5X20M*P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.5X40M*P", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.7 X 12*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 427.32, "maximum": 592.15, "gross_charge": 610.47, "discounted_cash": 915.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 427.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 592.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 427.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 488.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.7 X 12*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209949", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 615.3, "maximum": 852.63, "gross_charge": 879.0, "discounted_cash": 1318.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 747.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 659.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 615.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 852.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 615.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 659.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 747.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 703.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.7 X 14*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 427.32, "maximum": 592.15, "gross_charge": 610.47, "discounted_cash": 915.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 427.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 592.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 427.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 488.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.7 X 14*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209950", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 615.3, "maximum": 852.63, "gross_charge": 879.0, "discounted_cash": 1318.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 747.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 659.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 615.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 852.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 615.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 659.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 747.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 703.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.7 X 24*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 427.32, "maximum": 592.15, "gross_charge": 610.47, "discounted_cash": 915.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 427.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 592.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 427.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 457.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 518.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 488.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 2.7X12MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 760.2, "maximum": 1053.42, "gross_charge": 1086.0, "discounted_cash": 1629.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 923.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 814.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 760.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1053.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 760.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 814.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 923.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 25MM*04.8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 3 X 16*PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.33, "maximum": 698.86, "gross_charge": 720.48, "discounted_cash": 1080.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 3 X 18*PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.33, "maximum": 698.86, "gross_charge": 720.48, "discounted_cash": 1080.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 3 X 20*PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202941", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.33, "maximum": 698.86, "gross_charge": 720.48, "discounted_cash": 1080.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 3 X 22*PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.33, "maximum": 698.86, "gross_charge": 720.48, "discounted_cash": 1080.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 3 X 24*PL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 504.33, "maximum": 698.86, "gross_charge": 720.48, "discounted_cash": 1080.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 698.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 504.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 540.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 612.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 576.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 4 PTS SYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 546.7, "maximum": 757.57, "gross_charge": 781.0, "discounted_cash": 1171.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 663.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 585.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 757.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 546.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 585.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 663.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 624.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 4.5X36MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 268.8, "maximum": 372.48, "gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 307.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 4.5X42MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 268.8, "maximum": 372.48, "gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 307.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X 38*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X 65*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X 70*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X 75*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X 80*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X 85*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X40*6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.0 X44*6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204907", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 478.69, "maximum": 663.33, "gross_charge": 683.85, "discounted_cash": 1025.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 663.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 478.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 512.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 581.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X16*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X20*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X24*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X28*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204808", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X32*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X36*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X40*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X44*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 262.08, "maximum": 363.16, "gross_charge": 374.4, "discounted_cash": 561.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 318.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 262.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 363.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 262.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 280.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 318.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 299.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5.5X48*AR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.12, "maximum": 311.95, "gross_charge": 321.6, "discounted_cash": 482.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 311.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 225.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 241.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 273.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5X32*1896", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5X50*1896", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5X70*1896", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK 5X75*1896", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK FINE TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 837.9, "maximum": 1161.09, "gross_charge": 1197.0, "discounted_cash": 1795.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1017.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1161.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1017.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 957.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK FINE TIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 479.5, "maximum": 664.45, "gross_charge": 685.0, "discounted_cash": 1027.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 664.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 479.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 513.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 582.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 548.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 347.2, "maximum": 481.12, "gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 347.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 481.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 347.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 372.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 421.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.1, "maximum": 468.51, "gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 468.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 142.8, "maximum": 197.88, "gross_charge": 204.0, "discounted_cash": 306.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 173.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 197.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 153.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 173.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 338.1, "maximum": 468.51, "gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 468.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 338.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 362.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 410.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.0, "maximum": 412.94, "gross_charge": 425.72, "discounted_cash": 638.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 361.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 319.29, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 412.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 319.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 361.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 340.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103390", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.7, "maximum": 466.57, "gross_charge": 481.0, "discounted_cash": 721.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 466.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 347.9, "maximum": 482.09, "gross_charge": 497.0, "discounted_cash": 745.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 422.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 372.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 347.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 482.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 347.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 372.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 422.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.84, "maximum": 414.11, "gross_charge": 426.92, "discounted_cash": 640.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 414.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 320.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 341.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103394", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.46, "maximum": 434.36, "gross_charge": 447.8, "discounted_cash": 671.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 335.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 335.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.6, "maximum": 550.96, "gross_charge": 568.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 414.4, "maximum": 574.24, "gross_charge": 592.0, "discounted_cash": 888.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 503.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 414.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 574.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 414.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 503.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 473.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 321.3, "maximum": 445.23, "gross_charge": 459.0, "discounted_cash": 688.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 390.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 390.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 367.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.19, "maximum": 460.33, "gross_charge": 474.57, "discounted_cash": 711.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 460.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 355.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 403.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 379.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 430.5, "maximum": 596.55, "gross_charge": 615.0, "discounted_cash": 922.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 461.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 430.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 596.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 430.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 461.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 522.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 492.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK ST", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SYNFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 837.9, "maximum": 1161.09, "gross_charge": 1197.0, "discounted_cash": 1795.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1017.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1161.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1017.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 957.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.7, "maximum": 728.47, "gross_charge": 751.0, "discounted_cash": 1126.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 638.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 563.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 728.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 563.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 638.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK TRANSCONN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 413.7, "maximum": 573.27, "gross_charge": 591.0, "discounted_cash": 886.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 502.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 443.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 413.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 573.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 413.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 443.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 502.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 472.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 268.8, "maximum": 372.48, "gross_charge": 384.0, "discounted_cash": 576.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 372.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 326.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 307.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 416.5, "maximum": 577.15, "gross_charge": 595.0, "discounted_cash": 892.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 505.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 416.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 577.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 416.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 446.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 505.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 363.72, "maximum": 504.01, "gross_charge": 519.6, "discounted_cash": 779.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 363.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 389.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 441.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 415.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK VAR ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.6, "maximum": 550.96, "gross_charge": 568.0, "discounted_cash": 852.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 454.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCK2.4X20MM*6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 760.2, "maximum": 1053.42, "gross_charge": 1086.0, "discounted_cash": 1629.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 923.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 814.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 760.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1053.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 760.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 814.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 923.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 336.0, "maximum": 465.6, "gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 321.3, "maximum": 445.23, "gross_charge": 459.0, "discounted_cash": 688.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 390.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 390.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 367.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 15M*55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2.4X22", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 760.2, "maximum": 1053.42, "gross_charge": 1086.0, "discounted_cash": 1629.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 923.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 814.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 760.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1053.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 760.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 814.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 923.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 868.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 20M*55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 20MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 25M*55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2X11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205397", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2X16MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2X8MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 2X9MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X12", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X16", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 3.2X18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING 30M*55", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 263.2, "maximum": 364.72, "gross_charge": 376.0, "discounted_cash": 564.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 364.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 263.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 282.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 319.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOCKING CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 249.9, "maximum": 346.29, "gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 346.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 303.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOW PRO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 294.0, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOW PRO LONG T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LOW PRO SHORT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LP ISSYS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW LPLT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101727", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MALIBU POLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2275.0, "maximum": 3152.5, "gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3152.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2275.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2437.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2762.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MALLEOLAR HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101729", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 103.6, "maximum": 143.56, "gross_charge": 148.0, "discounted_cash": 222.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 143.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 103.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 111.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 125.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 118.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MATRIX BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MATRIX BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MEDIAL*7601-04", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 4.5 X 30*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 4.5 X 35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 5.5 X 30*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 5.5 X 35*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 5.5 X 40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 5.5X30*62", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 5.5X35*62", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 5.5X40*62", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MESA 6.5 X 45*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1746.36, "maximum": 2419.95, "gross_charge": 2494.8, "discounted_cash": 3742.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1746.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1871.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2120.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1995.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MICRO 1.5X11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 246.4, "maximum": 341.44, "gross_charge": 352.0, "discounted_cash": 528.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 299.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 246.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 341.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 246.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 264.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 299.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 281.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 190.4, "maximum": 263.84, "gross_charge": 272.0, "discounted_cash": 408.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 263.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 190.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 231.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 217.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MMF SELF DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101731", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 377.3, "maximum": 522.83, "gross_charge": 539.0, "discounted_cash": 808.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 458.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 404.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 377.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 522.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 377.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 404.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 458.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 431.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MMF SELF DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MNTR DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2102.1, "maximum": 2912.91, "gross_charge": 3003.0, "discounted_cash": 4504.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2552.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2102.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2912.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2102.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2252.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2552.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2402.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MP SELF DRILL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101732", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 227.5, "maximum": 315.25, "gross_charge": 325.0, "discounted_cash": 487.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 276.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 227.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 315.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 227.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 276.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MULT ARTHREX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102335", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MULTI AXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2915.5, "maximum": 4040.05, "gross_charge": 4165.0, "discounted_cash": 6247.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3540.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2915.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4040.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2915.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3123.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3540.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3332.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MULTI AXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1519.0, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 3255.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW MULTI AXIAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103404", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NLC 3.5X9MM*PA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 243.6, "maximum": 337.56, "gross_charge": 348.0, "discounted_cash": 522.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 337.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 243.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 295.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101734", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 236.6, "maximum": 327.86, "gross_charge": 338.0, "discounted_cash": 507.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 287.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 327.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 287.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 270.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 277.2, "maximum": 384.12, "gross_charge": 396.0, "discounted_cash": 594.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 384.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 336.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 316.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 296.8, "maximum": 411.28, "gross_charge": 424.0, "discounted_cash": 636.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 360.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 318.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 411.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 296.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 318.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 360.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 339.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.0, "maximum": 552.9, "gross_charge": 570.0, "discounted_cash": 855.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 552.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 427.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 484.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 456.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NON-LOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103966", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 207.2, "maximum": 287.12, "gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 287.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 207.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 251.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONBIASED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1939.7, "maximum": 2687.87, "gross_charge": 2771.0, "discounted_cash": 4156.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2355.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2078.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1939.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2687.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1939.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2078.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2355.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2216.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.3X10", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206691", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 218.4, "maximum": 302.64, "gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 302.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 249.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.3X20", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206929", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.3X9*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206692", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 218.4, "maximum": 302.64, "gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 302.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 249.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.5X13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206398", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.5X13", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206399", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 218.4, "maximum": 302.64, "gross_charge": 312.0, "discounted_cash": 468.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 302.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 249.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.5X18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 254.8, "maximum": 353.08, "gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 353.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 254.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 309.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 291.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW NONLOCK 1.5X18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 204.12, "maximum": 282.85, "gross_charge": 291.6, "discounted_cash": 437.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 218.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 204.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 282.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 204.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 218.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 233.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW OCCIPITOCERV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1939.7, "maximum": 2687.87, "gross_charge": 2771.0, "discounted_cash": 4156.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2355.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2078.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1939.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2687.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1939.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2078.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2355.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2216.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW OMINIMAX 7MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW OPEN ILIAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101737", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1801.1, "maximum": 2495.81, "gross_charge": 2573.0, "discounted_cash": 3859.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2187.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1929.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1801.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2495.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1801.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1929.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2187.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2058.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW OPTIC 14MM*07.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW OSTEOMED", "code_information": [{"code": "3100103852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 309.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW PEEK VENTD TEN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIFPHERAL*50", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210061", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X20*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X24*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 247.82, "maximum": 343.41, "gross_charge": 354.04, "discounted_cash": 531.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 343.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 283.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X28*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 247.82, "maximum": 343.41, "gross_charge": 354.04, "discounted_cash": 531.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 343.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 283.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X32*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 326.64, "maximum": 452.64, "gross_charge": 466.64, "discounted_cash": 699.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 396.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 349.98, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 326.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 452.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 326.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 349.98, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 396.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 373.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X36*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PERIPH 4.5X44*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204965", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 247.82, "maximum": 343.41, "gross_charge": 354.04, "discounted_cash": 531.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 343.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 247.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 265.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 300.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 283.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PLATE HOOK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 235.2, "maximum": 325.92, "gross_charge": 336.0, "discounted_cash": 504.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 325.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 285.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CANC STRY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2202.2, "maximum": 3051.62, "gross_charge": 3146.0, "discounted_cash": 4719.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2674.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2359.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3051.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2359.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2674.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2516.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2997.4, "maximum": 4153.54, "gross_charge": 4282.0, "discounted_cash": 6423.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3639.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3211.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2997.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4153.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2997.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3211.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3639.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2997.4, "maximum": 4153.54, "gross_charge": 4282.0, "discounted_cash": 6423.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3639.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3211.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2997.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4153.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2997.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3211.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3639.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3017.0, "maximum": 4180.7, "gross_charge": 4310.0, "discounted_cash": 6465.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3663.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3232.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3017.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4180.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3017.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3232.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3663.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY CLOSED HE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3036.6, "maximum": 4207.86, "gross_charge": 4338.0, "discounted_cash": 6507.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3687.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3253.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3036.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4207.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3036.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3253.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3687.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1801.1, "maximum": 2495.81, "gross_charge": 2573.0, "discounted_cash": 3859.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2187.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1929.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1801.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2495.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1801.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1929.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2187.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2058.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2775.5, "maximum": 3846.05, "gross_charge": 3965.0, "discounted_cash": 5947.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3370.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2973.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2775.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3846.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2775.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2973.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3370.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3172.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY NUVASIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2548.0, "maximum": 3530.8, "gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3530.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2548.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3094.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY NUVASIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3743.6, "maximum": 5187.56, "gross_charge": 5348.0, "discounted_cash": 8022.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4545.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4011.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3743.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5187.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3743.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4011.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4545.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4278.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY NUVASIVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2515.8, "maximum": 3486.18, "gross_charge": 3594.0, "discounted_cash": 5391.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3054.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2695.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2515.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3486.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2515.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2695.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3054.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2875.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY SNYTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY SNYTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103421", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2039.1, "maximum": 2825.61, "gross_charge": 2913.0, "discounted_cash": 4369.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2476.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2184.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2039.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2825.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2039.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2184.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2476.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2330.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW POLY STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2282.7, "maximum": 3163.17, "gross_charge": 3261.0, "discounted_cash": 4891.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2771.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2445.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2282.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3163.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2282.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2445.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2771.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2608.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PPS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1374.8, "maximum": 1905.08, "gross_charge": 1964.0, "discounted_cash": 2946.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1669.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1473.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1905.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1374.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1473.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1669.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1571.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PT 4.0 X 38*G3", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW PYRMI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1121.4, "maximum": 1553.94, "gross_charge": 1602.0, "discounted_cash": 2403.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1361.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1201.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1121.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1553.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1121.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1201.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1361.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1281.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW QUICKFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 529.2, "maximum": 733.32, "gross_charge": 756.0, "discounted_cash": 1134.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 733.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 567.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 642.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW QUICKFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 330.75, "maximum": 458.32, "gross_charge": 472.5, "discounted_cash": 708.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 330.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 354.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 401.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW RADIENT FACET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101752", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2307.9, "maximum": 3198.09, "gross_charge": 3297.0, "discounted_cash": 4945.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2802.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2472.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2307.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3198.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2307.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2472.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2802.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2637.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW RADIUS FIX SCH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101753", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5189.1, "maximum": 7190.61, "gross_charge": 7413.0, "discounted_cash": 11119.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6301.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5559.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5189.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7190.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5189.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5559.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6301.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5930.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW REDUCTION*4826", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW REGENT 4.0X16*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW RETAINED PLATE", "code_information": [{"code": "D7292", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SCREW REVERE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101754", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1536.5, "maximum": 2129.15, "gross_charge": 2195.0, "discounted_cash": 3292.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1865.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1646.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1536.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2129.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1536.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1646.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1865.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW REVOLVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1592.5, "maximum": 2206.75, "gross_charge": 2275.0, "discounted_cash": 3412.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1933.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1706.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1592.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2206.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1592.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1706.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1933.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW REVOLVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2957.5, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SAFETY OSTEOME", "code_information": [{"code": "3100103844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 233.0, "discounted_cash": 349.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCHANZ 4 X 120", "code_information": [{"code": "3100204323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCHANZ 4 X 80*", "code_information": [{"code": "3100204326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCHANZ 4 X 80*", "code_information": [{"code": "3100204483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCHANZ 4 X120*", "code_information": [{"code": "3100204484", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW SCHANZ BOLT*03", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 693.5, "maximum": 960.99, "gross_charge": 990.72, "discounted_cash": 1486.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 842.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 743.04, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 693.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 960.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 693.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 743.04, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 842.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 792.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SECURIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF 3.5X12MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF 3.5X14MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 458.32, "maximum": 635.1, "gross_charge": 654.75, "discounted_cash": 982.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 556.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 491.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 635.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 491.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 556.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF 3.5X16MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 458.32, "maximum": 635.1, "gross_charge": 654.75, "discounted_cash": 982.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 556.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 491.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 635.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 491.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 556.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF 3.5X18MM*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 458.32, "maximum": 635.1, "gross_charge": 654.75, "discounted_cash": 982.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 556.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 491.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 635.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 458.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 491.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 556.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF DRILL ZEP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 850.5, "maximum": 1178.55, "gross_charge": 1215.0, "discounted_cash": 1822.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 972.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF DRILL ZEP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1024.8, "maximum": 1420.08, "gross_charge": 1464.0, "discounted_cash": 2196.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1420.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1024.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1098.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1244.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101758", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 114.52, "maximum": 158.69, "gross_charge": 163.6, "discounted_cash": 245.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 158.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 114.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 122.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 139.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 130.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 122.5, "maximum": 169.75, "gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 169.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 168.7, "maximum": 233.77, "gross_charge": 241.0, "discounted_cash": 361.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 233.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 180.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 204.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 192.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 198.1, "maximum": 274.51, "gross_charge": 283.0, "discounted_cash": 424.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 240.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 212.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 198.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 274.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 198.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 212.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 240.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 226.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104165", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP THREA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 618.8, "maximum": 857.48, "gross_charge": 884.0, "discounted_cash": 1326.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 751.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 857.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 751.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP THREA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 723.1, "maximum": 1002.01, "gross_charge": 1033.0, "discounted_cash": 1549.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1002.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 826.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF TAP ZEPHI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 741.3, "maximum": 1027.23, "gross_charge": 1059.0, "discounted_cash": 1588.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1027.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 741.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 794.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 900.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 847.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SELF-DR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 398.3, "maximum": 551.93, "gross_charge": 569.0, "discounted_cash": 853.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 483.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 398.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 551.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 398.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 426.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 483.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 455.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SEMI CON", "code_information": [{"code": "C1773", "type": "HCPCS"}, {"code": "3100104172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 196.0, "maximum": 271.6, "gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 305.2, "maximum": 422.92, "gross_charge": 436.0, "discounted_cash": 654.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 422.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 305.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 370.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 348.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET *4530020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET ALPHATEC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET BREAK OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101763", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET BREAK OFF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 394.8, "maximum": 547.08, "gross_charge": 564.0, "discounted_cash": 846.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 479.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 423.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 394.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 394.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 423.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 479.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 451.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET CMAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101764", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET DEPUY", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET DYNESYS PE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET G4 INTERNA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 615.3, "maximum": 852.63, "gross_charge": 879.0, "discounted_cash": 1318.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 747.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 659.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 615.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 852.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 615.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 659.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 747.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 703.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET LOCKING CA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET MEDTRONIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 344.4, "maximum": 477.24, "gross_charge": 492.0, "discounted_cash": 738.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 418.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 369.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 477.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 369.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 418.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET MEDTRONIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET SPINAL TI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2557.1, "maximum": 3543.41, "gross_charge": 3653.0, "discounted_cash": 5479.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3105.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2739.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2557.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3543.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2557.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2739.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3105.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2922.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET SPINE DEPU", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 459.2, "maximum": 636.32, "gross_charge": 656.0, "discounted_cash": 984.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 557.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 492.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 459.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 636.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 459.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 492.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 557.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 524.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 469.7, "maximum": 650.87, "gross_charge": 671.0, "discounted_cash": 1006.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 570.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 503.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 469.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 650.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 469.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 503.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 570.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 536.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET ZIMMER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7070.7, "maximum": 9797.97, "gross_charge": 10101.0, "discounted_cash": 15151.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8585.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7575.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7070.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9797.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7070.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7575.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8585.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8080.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SET*5540130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT 5 X 25*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203186", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.83, "maximum": 531.88, "gross_charge": 548.34, "discounted_cash": 822.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 466.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT 5 X 40*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203356", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 403.03, "maximum": 558.48, "gross_charge": 575.76, "discounted_cash": 863.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 489.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 431.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 403.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 558.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 403.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 431.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 489.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 460.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT 5 X 45*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 403.03, "maximum": 558.48, "gross_charge": 575.76, "discounted_cash": 863.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 489.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 431.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 403.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 558.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 403.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 431.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 489.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 460.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT 5 X 50*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 403.03, "maximum": 558.48, "gross_charge": 575.76, "discounted_cash": 863.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 489.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 431.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 403.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 558.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 403.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 431.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 489.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 460.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 55.3, "maximum": 76.63, "gross_charge": 79.0, "discounted_cash": 118.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 67.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 59.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 76.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 59.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 67.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 63.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 60.2, "maximum": 83.42, "gross_charge": 86.0, "discounted_cash": 129.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 73.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 64.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 83.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 64.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 73.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 68.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 60.9, "maximum": 84.39, "gross_charge": 87.0, "discounted_cash": 130.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 73.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 60.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 84.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 60.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 65.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 73.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 69.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SHAFT HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.0, "maximum": 87.3, "gross_charge": 90.0, "discounted_cash": 135.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 87.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SILEX 7X35MM*X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SIZER GLENOID", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SMOOTH 3.5X30*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SMOOTH 3.5X33*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SMOOTH SHANK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLANAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 4.5X45*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 5.5X30*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 5.5X35*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 5.5X45*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 5.5X50*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 5.5X55*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 6.5X35*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 6.5X40*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 6.5X60*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100208006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 7.5X40*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 7.5X45*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 7.5X50*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 7.5X55*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 8.5X40*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SOLER 8.5X60*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100210226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SS CANN LOW PR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101777", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101778", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1896.3, "maximum": 2627.73, "gross_charge": 2709.0, "discounted_cash": 4063.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2302.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2031.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2627.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1896.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2031.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2302.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2167.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 303.1, "maximum": 420.01, "gross_charge": 433.0, "discounted_cash": 649.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 420.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 303.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 324.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 368.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 346.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103949", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1196.3, "maximum": 1657.73, "gross_charge": 1709.0, "discounted_cash": 2563.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1452.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1281.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1196.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1657.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1196.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1281.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1452.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1367.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SYNFIX 25MM*04", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102423", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 424.2, "maximum": 587.82, "gross_charge": 606.0, "discounted_cash": 909.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 587.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 454.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102424", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 576.1, "maximum": 798.31, "gross_charge": 823.0, "discounted_cash": 1234.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 699.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 617.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 576.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 798.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 576.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 617.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 699.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 658.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104179", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 373.8, "maximum": 517.98, "gross_charge": 534.0, "discounted_cash": 801.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 453.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 400.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 373.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 517.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 373.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 400.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 453.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 427.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 372.4, "maximum": 516.04, "gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 516.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 317.1, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103441", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 329.7, "maximum": 456.87, "gross_charge": 471.0, "discounted_cash": 706.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 400.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 353.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 329.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 456.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 329.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 353.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 400.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 376.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103442", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1084.3, "maximum": 1502.53, "gross_charge": 1549.0, "discounted_cash": 2323.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1316.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1161.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1084.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1502.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1084.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1161.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1316.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1239.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW THREAD CANN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 618.8, "maximum": 857.48, "gross_charge": 884.0, "discounted_cash": 1326.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 751.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 857.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 618.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 751.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW THREAD HEX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TI CDH M8 MAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101781", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2768.5, "maximum": 3836.35, "gross_charge": 3955.0, "discounted_cash": 5932.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3361.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2966.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2768.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3836.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2768.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2966.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3361.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3164.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TI SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TI ZODIAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TI ZODIAC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TITANIUM BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 107.8, "maximum": 149.38, "gross_charge": 154.0, "discounted_cash": 231.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 149.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 107.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 115.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TORNIER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.6, "maximum": 2597.66, "gross_charge": 2678.0, "discounted_cash": 4017.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2276.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2276.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TORQUE BOLT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1274.7, "maximum": 1766.37, "gross_charge": 1821.0, "discounted_cash": 2731.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1547.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1365.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1274.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1766.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1274.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1365.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1547.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1456.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TORX 14MM*506-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TORX 18MM*506-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TORX 26MM*506-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TORX 30MM*506-", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TRIFIN 12X55*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TRIFIN 12X55*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TULIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1895.6, "maximum": 2626.76, "gross_charge": 2708.0, "discounted_cash": 4062.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2301.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2031.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1895.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2626.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1895.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2031.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2301.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TULIP ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1740.2, "maximum": 2411.42, "gross_charge": 2486.0, "discounted_cash": 3729.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2113.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1864.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1740.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2411.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1740.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1864.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2113.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1988.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW TUNNEL NOTCHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.0, "maximum": 1513.2, "gross_charge": 1560.0, "discounted_cash": 2340.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1513.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW UNICO 2.8X14*U", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202577", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.12, "maximum": 550.3, "gross_charge": 567.32, "discounted_cash": 850.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 425.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 425.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 453.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202271", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 357.0, "maximum": 494.7, "gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 494.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 382.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 433.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 1.5X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 397.12, "maximum": 550.3, "gross_charge": 567.32, "discounted_cash": 850.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 482.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 425.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 397.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 550.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 397.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 425.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 482.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 453.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 2.0X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 2.0X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 2.0X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 2.0X1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN 8MM*0", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 369.6, "maximum": 512.16, "gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 512.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 369.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 448.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 422.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VA-LCKIN*02130", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 157.5, "maximum": 218.25, "gross_charge": 225.0, "discounted_cash": 337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 218.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VACANG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VAR 4 X 14*722", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VAR 4.0 X 14*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VAR 4.0 X 16*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VAR 4.0 X 18*1", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VAR 4.5 X 14*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VAR ANGLE*1116", "code_information": [{"code": "3100208042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 639.9, "discounted_cash": 959.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREW VARI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 523.6, "maximum": 725.56, "gross_charge": 748.0, "discounted_cash": 1122.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 635.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 725.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 523.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 561.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 635.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 598.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 690.9, "maximum": 957.39, "gross_charge": 987.0, "discounted_cash": 1480.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 957.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 690.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 740.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 838.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 789.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE ANGLE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103446", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 812.7, "maximum": 1126.17, "gross_charge": 1161.0, "discounted_cash": 1741.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 986.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 870.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 812.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1126.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 812.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 870.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 986.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 928.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 863.8, "maximum": 1196.98, "gross_charge": 1234.0, "discounted_cash": 1851.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1048.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 925.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 863.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1196.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 863.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 925.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1048.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 987.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101791", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 582.4, "maximum": 807.04, "gross_charge": 832.0, "discounted_cash": 1248.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 624.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 582.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 807.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 582.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 624.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 707.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 665.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103447", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 763.0, "maximum": 1057.3, "gross_charge": 1090.0, "discounted_cash": 1635.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 926.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 817.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1057.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 763.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 817.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 926.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 872.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 961.8, "maximum": 1332.78, "gross_charge": 1374.0, "discounted_cash": 2061.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1167.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1030.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 961.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1332.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 961.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1030.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1167.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1099.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1092.7, "maximum": 1514.17, "gross_charge": 1561.0, "discounted_cash": 2341.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1514.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1092.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1170.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1326.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1248.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 744.8, "maximum": 1032.08, "gross_charge": 1064.0, "discounted_cash": 1596.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1032.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 851.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 364.0, "maximum": 504.4, "gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 504.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 390.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 442.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103452", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 937.3, "maximum": 1298.83, "gross_charge": 1339.0, "discounted_cash": 2008.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1138.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1004.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 937.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1298.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 937.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1004.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1138.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1071.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 960.4, "maximum": 1330.84, "gross_charge": 1372.0, "discounted_cash": 2058.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1166.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 960.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1330.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 960.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1166.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1097.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VARIABLE SELF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW VERTEX MAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2633.4, "maximum": 3649.14, "gross_charge": 3762.0, "discounted_cash": 5643.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3197.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2821.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2633.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3649.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2633.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2821.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3197.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3009.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW XENON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 682.5, "maximum": 945.75, "gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 682.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 731.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 828.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 780.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW XENON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW XIA STRYKER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 744.8, "maximum": 1032.08, "gross_charge": 1064.0, "discounted_cash": 1596.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1032.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 744.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 904.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 851.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X10*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203905", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X12*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X16*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X22*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204675", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X24*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203693", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X24*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X24*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X26*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203694", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X28*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 3.5X30*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204220", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 4.0X26*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 4.0X28*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 4.0X30*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 4.0X32*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW YUKON 4.0X34*7", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203906", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW/CAP 4.5 X17*34", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 470.92, "maximum": 652.56, "gross_charge": 672.75, "discounted_cash": 1009.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 652.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 538.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREW/CAP 4.5 X35*34", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 470.92, "maximum": 652.56, "gross_charge": 672.75, "discounted_cash": 1009.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 652.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 470.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 504.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 571.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 538.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SCREWDRIVER", "code_information": [{"code": "3100101795", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 879.0, "discounted_cash": 1318.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER 6in1", "code_information": [{"code": "3100102339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER BLADE*25", "code_information": [{"code": "3100208325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 801.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER CANN 3.0", "code_information": [{"code": "3100203063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 728.28, "discounted_cash": 1092.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER CANN*901", "code_information": [{"code": "3100203066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1042.23, "discounted_cash": 1563.35, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER FOR ACCE", "code_information": [{"code": "3100101796", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCREWDRIVER TIP*DVTX", "code_information": [{"code": "3100207214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SCROTAL EXPLORATION", "code_information": [{"code": "55110", "type": "CPT"}, {"code": "3480102074", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEAL SILICONE GR", "code_information": [{"code": "3100101797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEALANT REPAIR PER TOOTH", "code_information": [{"code": "D1353", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.64, "maximum": 63.64, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 63.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEALANT, PULMONARY, LIQUID", "code_information": [{"code": "C2615", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEAM GUARD", "code_information": [{"code": "3100101798", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 535.0, "discounted_cash": 802.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEC ART THROMBECTOMY ADD-ON", "code_information": [{"code": "37186", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEC CLSR SURG WND/DEHSN XTN", "code_information": [{"code": "13160", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SECOND STAGE IMPLANT SURGERY", "code_information": [{"code": "D6011", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SECUR RING SNAP*SRNG", "code_information": [{"code": "3100204000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEDATION (NON-IV)", "code_information": [{"code": "D9248", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEDATIVE HYPNOTICS", "code_information": [{"code": "80368", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEDIMNTATN RATE RBC", "code_information": [{"code": "85651", "type": "CPT"}, {"code": "3440101052", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 4.27, "maximum": 32.01, "gross_charge": 33.0, "discounted_cash": 6.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 28.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 32.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 24.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 28.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEDIMNTATN RATE RBC", "code_information": [{"code": "85652", "type": "CPT"}, {"code": "3440101053", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 2.7, "maximum": 26.19, "gross_charge": 27.0, "discounted_cash": 4.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEEK CARIES INDICATO", "code_information": [{"code": "3100101799", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEEK CARIES INDICATO", "code_information": [{"code": "3100103456", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEEK REFILL", "code_information": [{"code": "3100101800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SEEKER FRONTAL OSTRU", "code_information": [{"code": "3100104091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 943.0, "discounted_cash": 1414.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEG ACET AND ETH ESTR YEARLY", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7294", "type": "HCPCS"}], "standard_charges": [{"minimum": 2243.52, "maximum": 2243.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2243.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEGMENTAL COMPONENT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2796.79, "maximum": 3875.55, "gross_charge": 3995.42, "discounted_cash": 5993.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3396.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2996.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2796.79, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3875.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2796.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2996.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3396.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3196.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEGMENTAL COMPONENT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2999.36, "maximum": 4156.25, "gross_charge": 4284.8, "discounted_cash": 6427.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3642.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2999.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4156.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2999.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3642.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3427.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEGMENTAL COMPONENT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2999.36, "maximum": 4156.25, "gross_charge": 4284.8, "discounted_cash": 6427.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3642.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2999.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4156.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2999.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3642.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3427.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEGMENTECTOMY", "code_information": [{"code": "32484", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITH MCC", "code_information": [{"code": "100", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6294.67, "maximum": 6294.67, "discounted_cash": 22133.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6294.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEIZURES WITHOUT MCC", "code_information": [{"code": "101", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3316.41, "maximum": 3316.41, "discounted_cash": 10155.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3316.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SELECT PICTURE AUDIOMETRY", "code_information": [{"code": "92583", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELF CARE MNGMENT TRAINING", "code_information": [{"code": "97535", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELF-MEAS BP 2 READG BID 30D", "code_information": [{"code": "99474", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELF-MEAS BP PT EDUCAJ/TRAIN", "code_information": [{"code": "99473", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC & TRAIN 1 PT", "code_information": [{"code": "98960", "type": "CPT"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC/TRAIN 2-4 PT", "code_information": [{"code": "98961", "type": "CPT"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SELF-MGMT EDUC/TRAIN 5-8 PT", "code_information": [{"code": "98962", "type": "CPT"}], "standard_charges": [{"minimum": 69.87, "maximum": 69.87, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 69.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL STRICT CRITERIA", "code_information": [{"code": "89322", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 24.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMEN ANAL VOL/COUNT/MOT", "code_information": [{"code": "89320", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 19.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS", "code_information": [{"code": "89321", "type": "CPT"}, {"code": "3440103021", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.91, "maximum": 102.82, "gross_charge": 106.0, "discounted_cash": 19.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 90.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 102.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 74.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 79.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 90.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 84.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS", "code_information": [{"code": "G0027", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 10.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/COUNT", "code_information": [{"code": "89310", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 13.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMEN ANALYSIS W/HUHNER", "code_information": [{"code": "89300", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 15.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMI PRECISION ABUTMENT", "code_information": [{"code": "D6191", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMI PRECISION ATTACHMENT", "code_information": [{"code": "D6192", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEMITENDINOSUS DBL S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3549.0, "maximum": 4917.9, "gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4917.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSING LEAD V INSPI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210087", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6142.5, "maximum": 8511.75, "gross_charge": 8775.0, "discounted_cash": 13162.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8511.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSING LEAD*4340", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100206293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6142.5, "maximum": 8511.75, "gross_charge": 8775.0, "discounted_cash": 13162.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8511.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6581.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7458.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SENSOR", "code_information": [{"code": "3100101801", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR", "code_information": [{"code": "3100103457", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR", "code_information": [{"code": "3100103458", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 93.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR 02", "code_information": [{"code": "3100101802", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR PASSPORT", "code_information": [{"code": "3100101803", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 924.0, "discounted_cash": 1386.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSOR PASSPORT", "code_information": [{"code": "3100103459", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 756.0, "discounted_cash": 1134.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SENSORIMOTOR EXAMINATION", "code_information": [{"code": "92060", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SENSORINEURAL ACUITY TEST", "code_information": [{"code": "92575", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SENSORY INTEGRATION", "code_information": [{"code": "97533", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPARATE EYELID ADHESIONS", "code_information": [{"code": "68340", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 1524.13, "discounted_cash": 3576.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1524.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPRAFILM*4301-02", "code_information": [{"code": "3100205173", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1192.8, "discounted_cash": 1789.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SEPT9 GEN PRMTR MTHYLTN ALYS", "code_information": [{"code": "81327", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 192.0, "discounted_cash": 308.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 192.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH CC", "code_information": [{"code": "549", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5309.71, "maximum": 5309.71, "discounted_cash": 13466.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5309.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [{"code": "548", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12481.75, "maximum": 12481.75, "discounted_cash": 21768.68, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12481.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTIC ARTHRITIS WITHOUT CC/MCC", "code_information": [{"code": "550", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5309.71, "maximum": 5309.71, "discounted_cash": 10280.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5309.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [{"code": "870", "type": "MS-DRG"}], "standard_charges": [{"minimum": 38585.75, "maximum": 38585.75, "discounted_cash": 77760.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38585.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [{"code": "871", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8875.74, "maximum": 8875.74, "discounted_cash": 22134.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8875.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [{"code": "872", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4896.54, "maximum": 4896.54, "discounted_cash": 11498.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4896.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SEPTOPLASTY OR SUBMU", "code_information": [{"code": "30520", "type": "CPT"}, {"code": "3480101834", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 7332.23, "gross_charge": 7559.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7332.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5291.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5669.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6425.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6047.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEPTUM FREER", "code_information": [{"code": "3100104759", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 187.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEPTUM KILLIAN NASAL", "code_information": [{"code": "3100101804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 467.0, "discounted_cash": 700.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY OLECRN PROCES", "code_information": [{"code": "24138", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY RADIAL H/N", "code_information": [{"code": "24136", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEQUESTRECTOMY SHFT/DSTL HUM", "code_information": [{"code": "24134", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERI SURGICAL SCAFFO", "code_information": [{"code": "3100103817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9620.0, "discounted_cash": 14430.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SERIAL SALIVARY IMAGING", "code_information": [{"code": "78231", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERIAL TONOMETRY", "code_information": [{"code": "92100", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEROTONIN", "code_information": [{"code": "84260", "type": "CPT"}, {"code": "3440100988", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 30.98, "maximum": 323.98, "gross_charge": 334.0, "discounted_cash": 49.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 283.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 250.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 233.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 323.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 233.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 34.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 250.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 39.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 283.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 267.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 30.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 33.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 33.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERPINA1 GENE", "code_information": [{"code": "81332", "type": "CPT"}], "standard_charges": [{"minimum": 43.65, "maximum": 79.66, "discounted_cash": 70.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SERUM IMMUNOELECTROPHORESIS", "code_information": [{"code": "86320", "type": "CPT"}], "standard_charges": [{"minimum": 29.92, "maximum": 68.53, "discounted_cash": 48.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.92, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SESAMOIDECTOMY, FIRS", "code_information": [{"code": "28315", "type": "CPT"}, {"code": "3480101771", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SET CYLINDER PUMP", "code_information": [{"code": "3100101805", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14410.0, "discounted_cash": 21615.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET CYLINDER PUMP", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100103460", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10091.2, "maximum": 13983.52, "gross_charge": 14416.0, "discounted_cash": 21624.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12253.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10812.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10091.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13983.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10091.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10812.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12253.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11532.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET CYLINDER TITAN", "code_information": [{"code": "C1813", "type": "HCPCS"}, {"code": "3100103956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13659.8, "maximum": 18928.58, "gross_charge": 19514.0, "discounted_cash": 29271.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16586.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14635.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13659.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18928.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13659.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14635.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16586.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15611.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET INSTRUMENT EXTRA", "code_information": [{"code": "3100101807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1449.0, "discounted_cash": 2173.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET INTRO-TIP PNEUMO", "code_information": [{"code": "3100101808", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 717.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77280", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77285", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SET RADIATION THERAPY FIELD", "code_information": [{"code": "77290", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SET SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW *124.00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 493.5, "maximum": 683.85, "gross_charge": 705.0, "discounted_cash": 1057.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 599.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 528.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 683.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 493.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 528.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 599.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 564.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW *3600215", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW *3600315", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 472.5, "maximum": 654.75, "gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 654.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 472.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 506.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 573.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW *6540530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100204475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW *MD1-10001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 212.8, "maximum": 294.88, "gross_charge": 304.0, "discounted_cash": 456.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 294.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 258.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW 3MM*112727", "code_information": [{"code": "3100209135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.4, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW COMP", "code_information": [{"code": "3100101809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 78306.0, "discounted_cash": 117459.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SCREW YUKON*7601", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*101-10001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*1020-00-00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*108-SS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100205908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*1119.0010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 959.7, "maximum": 1329.87, "gross_charge": 1371.0, "discounted_cash": 2056.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1165.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1028.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 959.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1329.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 959.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1028.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1165.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1096.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*15100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*18100", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*41-1010", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100209248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 201.6, "maximum": 279.36, "gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 201.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 216.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 230.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*6440530", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100207911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*75004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100206414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2800.0, "maximum": 3880.0, "gross_charge": 4000.0, "discounted_cash": 6000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3400.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3880.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*75440020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 98.0, "maximum": 135.8, "gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 98.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 119.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SCREW*LT10-0001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SET SECURITIZATION", "code_information": [{"code": "3100102378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SET-UP CARDIOVERT-DEFIBRILL", "code_information": [{"code": "93745", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 457.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEVER CRANIAL NERVE", "code_information": [{"code": "64771", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88130", "type": "CPT"}], "standard_charges": [{"minimum": 17.98, "maximum": 35.16, "discounted_cash": 28.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX CHROMATIN IDENTIFICATION", "code_information": [{"code": "88140", "type": "CPT"}], "standard_charges": [{"minimum": 7.99, "maximum": 35.16, "discounted_cash": 12.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX HORMONE BINDING", "code_information": [{"code": "84270", "type": "CPT"}, {"code": "3440100989", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.73, "maximum": 190.12, "gross_charge": 196.0, "discounted_cash": 34.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 24.06, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 23.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX OFFEND TX SVC, 15 MIN", "code_information": [{"code": "H2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX OFFEND TX SVC, PER DIEM", "code_information": [{"code": "H2029", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION F TO M", "code_information": [{"code": "55980", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEX TRANSFORMATION M TO F", "code_information": [{"code": "55970", "type": "CPT"}], "standard_charges": [{"minimum": 5158.0, "maximum": 5158.0, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SEXTANT II MAS", "code_information": [{"code": "3100101810", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5847.0, "discounted_cash": 8770.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SF3B1 GENE COMMON VARIANTS", "code_information": [{"code": "81347", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 193.25, "discounted_cash": 310.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SFX A7 IMPLANT*1894-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SGMDSC W/BAND LIGATION", "code_information": [{"code": "45350", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHAFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 409.5, "maximum": 567.45, "gross_charge": 585.0, "discounted_cash": 877.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 567.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 409.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 497.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 468.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAFT AO EXTEND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 993.3, "maximum": 1376.43, "gross_charge": 1419.0, "discounted_cash": 2128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1206.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1064.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 993.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1376.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 993.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1064.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1206.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1135.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAFT DRIVER", "code_information": [{"code": "3100104744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT DRIVER T-15*AR", "code_information": [{"code": "3100204243", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT RETAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102340", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1543.5, "maximum": 2138.85, "gross_charge": 2205.0, "discounted_cash": 3307.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2138.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1543.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1653.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAFT SLEEVE", "code_information": [{"code": "3100101813", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 580.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.", "code_information": [{"code": "11305", "type": "CPT"}, {"code": "3340102454", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 284.21, "gross_charge": 293.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 284.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 219.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 234.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11300", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.5 CM/<", "code_information": [{"code": "11310", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11301", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11306", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 0.6-1.0 CM", "code_information": [{"code": "11311", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11302", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11307", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11303", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11308", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVER TORPEDO ARTH", "code_information": [{"code": "3100101814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.2, "discounted_cash": 484.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH", "code_information": [{"code": "3100102233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH", "code_information": [{"code": "3100103714", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH", "code_information": [{"code": "3100104480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 10FR 25CM*RSS", "code_information": [{"code": "3100206591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.2, "discounted_cash": 118.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 12/14FRX36CM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209491", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 206.5, "maximum": 286.15, "gross_charge": 295.0, "discounted_cash": 442.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 250.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 206.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 286.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 206.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 221.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 250.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 236.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEATH 12X14FRX55CM*", "code_information": [{"code": "3100209313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 4FR 10CM*PRO-", "code_information": [{"code": "3100206585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.68, "discounted_cash": 46.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 5FR 10CM*PRO-", "code_information": [{"code": "3100206588", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.68, "discounted_cash": 46.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 6FR 10CM*PRO-", "code_information": [{"code": "3100206586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.68, "discounted_cash": 46.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 7FR 10CM*PRO-", "code_information": [{"code": "3100206589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.68, "discounted_cash": 46.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 8FR 10CM*PRO-", "code_information": [{"code": "3100206587", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.68, "discounted_cash": 46.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH 8FR 25CM*PSI-", "code_information": [{"code": "3100206590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.92, "discounted_cash": 70.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 12/14*", "code_information": [{"code": "3100204159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS 12/14*", "code_information": [{"code": "3100204160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH ACCESS FORTE*", "code_information": [{"code": "3100205717", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH AMPLATZ*VS-30", "code_information": [{"code": "3100202997", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.48, "discounted_cash": 164.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH AMPLATZ*VS-30", "code_information": [{"code": "3100202998", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.48, "discounted_cash": 164.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH CUR 22CM*MN13", "code_information": [{"code": "3100203423", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH HIGH-FLOW ROT", "code_information": [{"code": "3100104202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH HYDRO*SENSH12", "code_information": [{"code": "3100205141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 477.0, "discounted_cash": 715.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH HYDRO*SENSH14", "code_information": [{"code": "3100205193", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 636.0, "discounted_cash": 954.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH NEEDLE", "code_information": [{"code": "3100101815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1386.0, "discounted_cash": 2079.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URET PARALL*F", "code_information": [{"code": "3100202996", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 512.0, "discounted_cash": 768.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL", "code_information": [{"code": "3100101816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 473.0, "discounted_cash": 709.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL FL*F", "code_information": [{"code": "3100202995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 454.2, "discounted_cash": 681.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL FL*F", "code_information": [{"code": "3100204439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 549.36, "discounted_cash": 824.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEATH URETERAL FL*F", "code_information": [{"code": "3100204440", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 549.36, "discounted_cash": 824.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEET CONFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3867.5, "maximum": 5359.25, "gross_charge": 5525.0, "discounted_cash": 8287.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5359.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3867.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4143.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4696.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEET CONFORM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2811.9, "maximum": 3896.49, "gross_charge": 4017.0, "discounted_cash": 6025.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3414.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3896.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3414.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEET TENOGLIDE TEND", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7757.56, "maximum": 10749.77, "gross_charge": 11082.24, "discounted_cash": 16623.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9419.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8311.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7757.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10749.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7757.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8311.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9419.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8865.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHEETING SILICONE*AP", "code_information": [{"code": "3100204206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHEETING SILICONE*AP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19.04, "maximum": 26.38, "gross_charge": 27.2, "discounted_cash": 40.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 26.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 20.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3972.5, "maximum": 5504.75, "gross_charge": 5675.0, "discounted_cash": 8512.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4823.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4256.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3972.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5504.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3972.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4256.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4823.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4540.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4814.6, "maximum": 6671.66, "gross_charge": 6878.0, "discounted_cash": 10317.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5846.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5158.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4814.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6671.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4814.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5158.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5846.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5502.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR CLU", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR MUL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101819", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR STR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3014.9, "maximum": 4177.79, "gross_charge": 4307.0, "discounted_cash": 6460.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3660.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3230.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3014.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4177.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3014.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3230.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3660.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3445.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL ACETABULAR UNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 46C*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 48D*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 50M*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 52M*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 54M*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 56M*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 58M*70", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR 60MM*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 44B*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 46M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 48M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 52M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204283", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 52M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 54M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 56M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 58M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 60G*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205757", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 62G*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2459.76, "maximum": 3408.53, "gross_charge": 3513.95, "discounted_cash": 5270.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2986.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2635.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2459.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3408.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2459.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2635.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2986.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2811.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 64H*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL CLUSTR HA 66G*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1592.5, "maximum": 2206.75, "gross_charge": 2275.0, "discounted_cash": 3412.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1933.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1706.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1592.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2206.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1592.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1706.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1933.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HEMI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3014.9, "maximum": 4177.79, "gross_charge": 4307.0, "discounted_cash": 6460.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3660.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3230.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3014.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4177.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3014.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3230.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3660.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3445.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HEMI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103462", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5339.6, "maximum": 7399.16, "gross_charge": 7628.0, "discounted_cash": 11442.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6483.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5721.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5339.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7399.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5339.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5721.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6483.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6102.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HEMI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103463", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5553.8, "maximum": 7695.98, "gross_charge": 7934.0, "discounted_cash": 11901.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6743.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5950.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5553.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7695.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5553.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5950.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6743.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6347.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HEMI 58MM*5090", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204429", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5244.23, "maximum": 7267.01, "gross_charge": 7491.77, "discounted_cash": 11237.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6368.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5618.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5244.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7267.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5244.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5618.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6368.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5993.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HEMI 68MM*5090", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204921", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5244.23, "maximum": 7267.01, "gross_charge": 7491.77, "discounted_cash": 11237.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6368.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5618.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5244.23, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7267.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5244.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5618.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6368.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5993.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HOLES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101823", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HOLES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103464", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHELL HOLES", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHIFTER", "code_information": [{"code": "3100101824", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIGA-LIKE TOXIN AG IA", "code_information": [{"code": "87427", "type": "CPT"}], "standard_charges": [{"minimum": 11.98, "maximum": 24.03, "discounted_cash": 19.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHIGELLA AB", "code_information": [{"code": "86771", "type": "CPT"}, {"code": "3440101123", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 24.48, "maximum": 114.46, "gross_charge": 118.0, "discounted_cash": 39.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 114.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 100.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 94.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 24.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 26.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 26.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHIM TEDAN*1100-0031", "code_information": [{"code": "3100207572", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1880.01, "discounted_cash": 2820.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TEDAN*1100-0034", "code_information": [{"code": "3100207571", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1880.01, "discounted_cash": 2820.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SHO ARTHRS DX +- SYNOVIAL BX", "code_information": [{"code": "29805", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHO ARTHRS SRG COMPL SYNVCT", "code_information": [{"code": "29821", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7500.92, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOE SOFTIE", "code_information": [{"code": "3100101825", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE SOFTIE", "code_information": [{"code": "3100103466", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE SOFTIE", "code_information": [{"code": "3100103467", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE SOFTIE", "code_information": [{"code": "3100103468", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE SOFTIE", "code_information": [{"code": "3100103469", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS OR UL", "code_information": [{"code": "25390", "type": "CPT"}, {"code": "3480101597", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF HAND TENDON", "code_information": [{"code": "26479", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHORTENING OF THIGH BONE", "code_information": [{"code": "27465", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER ARTHRO SURG", "code_information": [{"code": "29820", "type": "CPT"}, {"code": "3340102415", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 14459.79, "gross_charge": 14907.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14459.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10434.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11180.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12670.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11925.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER BEARING COM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101826", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1955.8, "maximum": 2710.18, "gross_charge": 2794.0, "discounted_cash": 4191.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2374.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2095.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1955.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2710.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1955.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2095.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2374.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2235.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER BOLT W HEX*", "code_information": [{"code": "3100209124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.8, "discounted_cash": 451.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOULDER JOINT SURGERY", "code_information": [{"code": "23101", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23334", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SHOULDER PROSTHESIS REMOVAL", "code_information": [{"code": "23335", "type": "CPT"}], "standard_charges": [{"minimum": 6445.38, "maximum": 6445.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "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": 12521.71, "maximum": 12521.71, "discounted_cash": 22259.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12521.71, "methodology": "fee schedule"}], "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": 14165.78, "maximum": 14165.78, "discounted_cash": 30374.31, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14165.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "512", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6232.57, "maximum": 6232.57, "discounted_cash": 18017.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6232.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHUKLA HANDLE*SDR219", "code_information": [{"code": "3100207048", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHUKLA HANDLE*SDR220", "code_information": [{"code": "3100207049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHUNTOGRAM FOR NONVA", "code_information": [{"code": "75809", "type": "CPT"}, {"code": "3270102297", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 433.59, "gross_charge": 447.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 379.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 335.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 312.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 433.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 312.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 335.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 379.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 357.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIALIDASE ENZYME ASSAY", "code_information": [{"code": "87905", "type": "CPT"}], "standard_charges": [{"minimum": 12.22, "maximum": 24.03, "discounted_cash": 19.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIALODOCHOPLASTY", "code_information": [{"code": "D7982", "type": "HCPCS"}], "standard_charges": [{"minimum": 3777.61, "maximum": 3777.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIALOENDOSCOPY CAP &", "code_information": [{"code": "D0371", "type": "HCPCS"}, {"code": "3480103295", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 92.73, "maximum": 679.0, "gross_charge": 700.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 595.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 490.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 679.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 490.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 595.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 560.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SICKLING RBC REDUCTI", "code_information": [{"code": "85660", "type": "CPT"}, {"code": "3440101054", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 5.51, "maximum": 45.59, "gross_charge": 47.0, "discounted_cash": 8.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 35.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 45.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 35.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 37.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.9, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIDE TO SIDE CONNECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101827", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIG FEM ADAPTER 5 DE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3694.69, "maximum": 5119.78, "gross_charge": 5278.13, "discounted_cash": 7917.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4486.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3958.59, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3694.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5119.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3694.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3958.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4486.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4222.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY & DECOMPRESS", "code_information": [{"code": "45337", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY FOR BLEEDING", "code_information": [{"code": "45334", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ABLATION", "code_information": [{"code": "45346", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/PLCMT STENT", "code_information": [{"code": "45347", "type": "CPT"}], "standard_charges": [{"minimum": 2076.37, "maximum": 2076.37, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/RESECTION", "code_information": [{"code": "45349", "type": "CPT"}], "standard_charges": [{"minimum": 2076.37, "maximum": 2076.37, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/ULTRASOUND", "code_information": [{"code": "45341", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY W/US GUIDE BX", "code_information": [{"code": "45342", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1806.29, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY, FLEXI", "code_information": [{"code": "45338", "type": "CPT"}, {"code": "3390100660", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2914.85, "gross_charge": 3005.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2554.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2253.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2103.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2914.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2103.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2253.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2554.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2404.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDOSCOPY, FLEXI", "code_information": [{"code": "45340", "type": "CPT"}, {"code": "3390100661", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2914.85, "gross_charge": 3005.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2554.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2253.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2103.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2914.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2103.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2253.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2554.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2404.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDSCOP FLX DX W", "code_information": [{"code": "45330", "type": "CPT"}, {"code": "3390100656", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "gross_charge": 1471.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1426.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDSCOP FLX W/BX", "code_information": [{"code": "45331", "type": "CPT"}, {"code": "3390100657", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "gross_charge": 1471.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1426.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDSCOP FLX W/RM", "code_information": [{"code": "45332", "type": "CPT"}, {"code": "3390100658", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "gross_charge": 1471.0, "discounted_cash": 1806.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1245.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1426.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1240.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1432.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1204.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1228.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGMOIDSCOP FLX W/RM", "code_information": [{"code": "45333", "type": "CPT"}, {"code": "3390100646", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "gross_charge": 1471.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1426.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1103.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1250.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [{"code": "555", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5730.87, "maximum": 5730.87, "discounted_cash": 15619.23, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5730.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [{"code": "556", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3059.41, "maximum": 3059.41, "discounted_cash": 9204.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3059.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [{"code": "947", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6997.43, "maximum": 6997.43, "discounted_cash": 13973.57, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6997.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [{"code": "948", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4001.95, "maximum": 4001.95, "discounted_cash": 8942.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4001.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILICONE DAM*AR-1923", "code_information": [{"code": "3100204690", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 72.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SILICONE PIP SZ1*SPI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8404.2, "maximum": 11645.82, "gross_charge": 12006.0, "discounted_cash": 18009.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11645.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8404.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9004.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10205.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9604.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILICONE PIP SZ3*SPI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3034.77, "maximum": 4205.32, "gross_charge": 4335.39, "discounted_cash": 6503.09, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3685.08, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3251.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3034.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4205.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3034.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3251.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3685.08, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3468.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SILICONE RETRACTOR C", "code_information": [{"code": "3100205155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SIMPLE CYSTOMETROGRAM", "code_information": [{"code": "51725", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 434.32, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [{"code": "194", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4345.03, "maximum": 4345.03, "discounted_cash": 9179.51, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4345.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [{"code": "193", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6654.96, "maximum": 6654.96, "discounted_cash": 14810.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6654.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC", "code_information": [{"code": "195", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3012.07, "maximum": 3012.07, "discounted_cash": 6984.56, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3012.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMPLEX HALF DOSE*61", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 110.12, "maximum": 152.6, "gross_charge": 157.32, "discounted_cash": 235.98, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 133.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.99, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 110.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 152.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 110.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 133.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 125.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMULT PANC KIDN TRANS", "code_information": [{"code": "S2065", "type": "HCPCS"}], "standard_charges": [{"minimum": 11018.2, "maximum": 11018.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11018.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [{"code": "8", "type": "MS-DRG"}], "standard_charges": [{"minimum": 84449.91, "maximum": 84449.91, "discounted_cash": 58744.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 84449.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [{"code": "19", "type": "MS-DRG"}], "standard_charges": [{"minimum": 40970.08, "maximum": 40970.08, "discounted_cash": 89243.94, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 40970.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINCALIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2805", "type": "HCPCS"}], "standard_charges": [{"minimum": 129.74, "maximum": 129.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 129.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINGLE BOND", "code_information": [{"code": "3100102235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 796.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE BOND BX", "code_information": [{"code": "3100101828", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 442.0, "discounted_cash": 663.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SINGLE ENERGY X-RAY STUDY", "code_information": [{"code": "G0130", "type": "HCPCS"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINGLE TRANSFER TOE-HAND", "code_information": [{"code": "26553", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITH CC/MCC", "code_information": [{"code": "135", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13164.83, "maximum": 13164.83, "discounted_cash": 29609.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13164.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "136", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7721.09, "maximum": 7721.09, "discounted_cash": 10484.64, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7721.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SINUS AUG W BONE OR BONE SUB", "code_information": [{"code": "D7951", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS AUGMENTATION VERTICAL", "code_information": [{"code": "D7952", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUS ENDDOSCOPY SUR", "code_information": [{"code": "31276", "type": "CPT"}, {"code": "3480101855", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8311.19, "gross_charge": 7094.0, "discounted_cash": 10476.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7221.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6881.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4965.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7193.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5320.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8311.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6029.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5675.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6984.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7123.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2615.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUSOIDAL ROTATIONAL TEST", "code_information": [{"code": "92546", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY, MAXILLAR", "code_information": [{"code": "31020", "type": "CPT"}, {"code": "3480101844", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SINUSOTOMY, MAXILLAR", "code_information": [{"code": "31030", "type": "CPT"}, {"code": "3480101845", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SIPULEUCEL-T AUTO CD54+", "code_information": [{"code": "Q2043", "type": "HCPCS"}], "standard_charges": [{"minimum": 55453.57, "maximum": 55453.57, "discounted_cash": 85829.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55453.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIROLIMUS, ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.46, "maximum": 2.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER", "code_information": [{"code": "3100101829", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER SALI HP 500CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALI MOD 350CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204351", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALI MOD 375CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALI MOD 425CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALI MOD 500CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALIN", "code_information": [{"code": "3100104209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER SALIN HP 310CC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204076", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALINE 330CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205138", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALINE 380CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SIZER SALINE 400CC*", "code_information": [{"code": "3100207227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SIZER SALINE 420CC*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.0, "maximum": 155.2, "gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKEL MUSC RELAXANT 3 OR MORE", "code_information": [{"code": "80370", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKELETAL MUSCLE RELAXANT 1/2", "code_information": [{"code": "80369", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKILLBUILDERS", "code_information": [{"code": "3100101830", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 531.0, "discounted_cash": 796.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SKILLS TRAIN AND DEV, 15 MIN", "code_information": [{"code": "H2014", "type": "HCPCS"}], "standard_charges": [{"minimum": 85.0, "maximum": 85.0, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ADH", "code_information": [{"code": "3100101831", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SKIN AND MUSCLE REPAIR FACE", "code_information": [{"code": "15845", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH CC", "code_information": [{"code": "571", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7468.39, "maximum": 7468.39, "discounted_cash": 18889.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7468.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [{"code": "570", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9183.16, "maximum": 9183.16, "discounted_cash": 32625.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9183.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN DEBRIDEMENT WITHOUT CC/MCC", "code_information": [{"code": "572", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5655.24, "maximum": 5655.24, "discounted_cash": 12723.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5655.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN FULL GRAFT EY/E", "code_information": [{"code": "15260", "type": "CPT"}, {"code": "3480101370", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4528.93, "gross_charge": 4669.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3968.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3501.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3268.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4528.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3268.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3501.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3968.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3735.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "577", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11170.3, "maximum": 11170.3, "discounted_cash": 29576.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11170.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "576", "type": "MS-DRG"}], "standard_charges": [{"minimum": 31119.21, "maximum": 31119.21, "discounted_cash": 63449.34, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31119.21, "methodology": "fee schedule"}], "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": 7373.7, "maximum": 7373.7, "discounted_cash": 17980.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7373.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [{"code": "574", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12944.1, "maximum": 12944.1, "discounted_cash": 38024.28, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12944.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [{"code": "573", "type": "MS-DRG"}], "standard_charges": [{"minimum": 34053.81, "maximum": 34053.81, "discounted_cash": 69422.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 34053.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC", "code_information": [{"code": "575", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10830.3, "maximum": 10830.3, "discounted_cash": 22842.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10830.3, "methodology": "fee schedule"}], "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": 8836.39, "maximum": 8836.39, "discounted_cash": 20781.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8836.39, "methodology": "fee schedule"}], "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": 22218.26, "maximum": 22218.26, "discounted_cash": 42711.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22218.26, "methodology": "fee schedule"}], "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": 6729.97, "maximum": 6729.97, "discounted_cash": 12442.91, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6729.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITH CC/MCC", "code_information": [{"code": "904", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16895.02, "maximum": 16895.02, "discounted_cash": 36354.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16895.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "905", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10064.83, "maximum": 10064.83, "discounted_cash": 17681.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10064.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN HOOK", "code_information": [{"code": "3100101832", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 364.0, "discounted_cash": 546.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP ARMS/LEGS", "code_information": [{"code": "15572", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEDICLE FLAP TRUNK", "code_information": [{"code": "15570", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN PEEL THERAPY", "code_information": [{"code": "17360", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 277.43, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN SPLT GRFT T/A/L ADD-ON", "code_information": [{"code": "15101", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT T/A/L ADD-ON", "code_information": [{"code": "15272", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRAFT TRNK/ARM/LEG", "code_information": [{"code": "15271", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUB GRFT T/ARM/LG CHILD", "code_information": [{"code": "15273", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN SUBSTITUTE, NOS", "code_information": [{"code": "Q4100", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TE 1 SQ CM", "code_information": [{"code": "Q4200", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST CANDIDA", "code_information": [{"code": "86485", "type": "CPT"}], "standard_charges": [{"minimum": 21.19, "maximum": 30.26, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST TB INTRADE", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "3340100573", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.34, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST TB INTRADE", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "3440101089", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.34, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST TB INTRADE", "code_information": [{"code": "86580", "type": "CPT"}, {"code": "3500102246", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 7.34, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TEST UNLISTED ANTIGN EA", "code_information": [{"code": "86486", "type": "CPT"}], "standard_charges": [{"minimum": 5.6, "maximum": 30.26, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN TISSUE PROCEDUR", "code_information": [{"code": "17999", "type": "CPT"}, {"code": "3480103309", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 592.67, "gross_charge": 611.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 519.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 458.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 427.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 592.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 427.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 458.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 519.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 488.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN TISSUE REARRANG", "code_information": [{"code": "14000", "type": "CPT"}, {"code": "3480101362", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3774.27, "gross_charge": 3891.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3774.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2723.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2918.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3307.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH CC", "code_information": [{"code": "593", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4206.69, "maximum": 4206.69, "discounted_cash": 13508.01, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4206.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITH MCC", "code_information": [{"code": "592", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6150.8, "maximum": 6150.8, "discounted_cash": 23335.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6150.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKIN ULCERS WITHOUT CC/MCC", "code_information": [{"code": "594", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4206.69, "maximum": 4206.69, "discounted_cash": 8790.98, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4206.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT F/N/HF/G ADD", "code_information": [{"code": "15121", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SPLT A-GRFT FAC/NCK/HF/G", "code_information": [{"code": "15120", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CH ADD", "code_information": [{"code": "15278", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT F/N/HF/G CHILD", "code_information": [{"code": "15277", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKN SUB GRFT T/A/L CHILD ADD", "code_information": [{"code": "15274", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61575", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKULL BASE/BRAINSTEM SURGERY", "code_information": [{"code": "61576", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SKYLA, 13.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7301", "type": "HCPCS"}], "standard_charges": [{"minimum": 914.59, "maximum": 914.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 914.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLAP LESION - BANKAR", "code_information": [{"code": "29807", "type": "CPT"}, {"code": "3480101787", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15808.09, "gross_charge": 16297.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15808.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11407.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12222.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13852.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13037.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLCO1B1 GENE COM VARIANTS", "code_information": [{"code": "81328", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 174.81, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 174.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9947", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEP REMOTE*2500N", "code_information": [{"code": "3100206294", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3640.0, "discounted_cash": 5460.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEP STUDY ATTENDED", "code_information": [{"code": "95807", "type": "CPT"}], "standard_charges": [{"minimum": 1871.67, "maximum": 1871.67, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1871.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEP STUDY UNATT&RESP EFFT", "code_information": [{"code": "95806", "type": "CPT"}], "standard_charges": [{"minimum": 400.06, "maximum": 400.06, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 400.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEVE ARM LEVO*7892", "code_information": [{"code": "3100209498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.0, "discounted_cash": 49.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE ARM*AR-1651", "code_information": [{"code": "3100203916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 440.0, "discounted_cash": 660.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE CENT LONG 6MM", "code_information": [{"code": "3100209134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.75, "discounted_cash": 820.13, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE ELBOW KIT*AR-", "code_information": [{"code": "3100203305", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 288.0, "discounted_cash": 432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE IRRIGATION*54", "code_information": [{"code": "3100204211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE LOBECTOMY", "code_information": [{"code": "32486", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEVE METAPHY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104185", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3801.98, "maximum": 5268.45, "gross_charge": 5431.4, "discounted_cash": 8147.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4616.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4073.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3801.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5268.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3801.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4073.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4616.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4345.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE METAPHY 53MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4884.88, "maximum": 6769.04, "gross_charge": 6978.4, "discounted_cash": 10467.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5931.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5233.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4884.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6769.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4884.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5233.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5931.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5582.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE METAPHYSEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4980.5, "maximum": 6901.55, "gross_charge": 7115.0, "discounted_cash": 10672.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6047.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5336.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4980.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6901.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4980.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5336.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6047.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE METAPHYSEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4894.4, "maximum": 6782.24, "gross_charge": 6992.0, "discounted_cash": 10488.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5943.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5244.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4894.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6782.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4894.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5244.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5943.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5593.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE METAPHYSEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5441.1, "maximum": 7539.81, "gross_charge": 7773.0, "discounted_cash": 11659.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6607.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5829.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5441.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7539.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5441.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5829.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6607.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6218.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE METAPHYSEAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4979.8, "maximum": 6900.58, "gross_charge": 7114.0, "discounted_cash": 10671.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6046.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5335.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4979.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6900.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4979.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5335.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6046.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5691.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE PNEUMONECTOMY", "code_information": [{"code": "32442", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLEEVE PROTECTION*03", "code_information": [{"code": "3100202694", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE PROXIMAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3182.2, "maximum": 4409.62, "gross_charge": 4546.0, "discounted_cash": 6819.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3864.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3409.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3182.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4409.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3182.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3409.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3864.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3636.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE PROXIMAL*5214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203957", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3182.08, "maximum": 4409.46, "gross_charge": 4545.84, "discounted_cash": 6818.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3863.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3409.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3182.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4409.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3182.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3409.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3863.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3636.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLEEVE SCD", "code_information": [{"code": "3100101834", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "discounted_cash": 258.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD", "code_information": [{"code": "3100103473", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.0, "discounted_cash": 127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD", "code_information": [{"code": "3100103474", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD", "code_information": [{"code": "3100103475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 226.0, "discounted_cash": 339.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD", "code_information": [{"code": "3100104408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.0, "discounted_cash": 321.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE SCD", "code_information": [{"code": "3100104417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 167.0, "discounted_cash": 250.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE STRYKER", "code_information": [{"code": "3100102286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 592.0, "discounted_cash": 888.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TRACTION", "code_information": [{"code": "3100101835", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE TRACTION", "code_information": [{"code": "3100103476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE ZTT PROXIMAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3245.2, "maximum": 4496.92, "gross_charge": 4636.0, "discounted_cash": 6954.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3940.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3477.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3245.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4496.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3245.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3477.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3940.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3708.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLF CR CUR STAT 0% I", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100359", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SLF CR CUR STAT 0% I", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100491", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "SLF CR CUR STAT 100%", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100364", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "SLF CR CUR STAT 100%", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100492", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "SLF CR CUR STAT 20-3", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100337", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "SLF CR CUR STAT 20-3", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100469", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "SLF CR CUR STAT 40-5", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100361", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "SLF CR CUR STAT 40-5", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100493", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "SLF CR CUR STAT 60-7", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100362", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "SLF CR CUR STAT 60-7", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100494", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "SLF CR CUR STAT 80-9", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100495", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "SLF CR CUR STAT1-19%", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100330", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "SLF CR CUR STAT1-19%", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3330100462", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "SLF CR CUR STAT80-99", "code_information": [{"code": "G8987", "type": "HCPCS"}, {"code": "3320100360", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "SLF CR D/C STAT 0% I", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100503", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "SLF CR D/C STAT 0% I", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100370", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SLF CR D/C STAT 100%", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100373", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "SLF CR D/C STAT 100%", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3330100505", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "SLF CR D/C STAT 20-3", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100363", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "SLF CR D/C STAT 20-3", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3330100496", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "SLF CR D/C STAT 40-5", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100375", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "SLF CR D/C STAT 40-5", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3330100507", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "SLF CR D/C STAT 60-7", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100376", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "SLF CR D/C STAT 60-7", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3330100508", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "SLF CR D/C STAT 80-9", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100377", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "SLF CR D/C STAT 80-9", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3330100509", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "SLF CR D/C STAT1-19%", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3320100372", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "SLF CR D/C STAT1-19%", "code_information": [{"code": "G8989", "type": "HCPCS"}, {"code": "3330100504", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "SLF CR PR STAT 0% IM", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100356", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SLF CR PR STAT 0% IM", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320103018", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SLF CR PR STAT 0% IM", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100489", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "SLF CR PR STAT 100%", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100371", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "SLF CR PR STAT 100%", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100498", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "SLF CR PR STAT 20-39", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100365", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "SLF CR PR STAT 20-39", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100497", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "SLF CR PR STAT 40-59", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100368", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "SLF CR PR STAT 40-59", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100500", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "SLF CR PR STAT 60-79", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100369", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "SLF CR PR STAT 60-79", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100501", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "SLF CR PR STAT 80-99", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100502", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "SLF CR PR STAT1-19%I", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100367", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "SLF CR PR STAT1-19%I", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3330100499", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "SLF CR PR STAT80-99%", "code_information": [{"code": "G8988", "type": "HCPCS"}, {"code": "3320100366", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "SLING ALTIS COLOPLAS", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100205033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2669.94, "maximum": 3699.77, "gross_charge": 3814.2, "discounted_cash": 5721.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3242.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2860.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2669.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3699.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2669.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2860.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3242.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3051.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING CUSH", "code_information": [{"code": "3100101836", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING LATERAL TX-S3*", "code_information": [{"code": "3100203917", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING MINIARC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100101837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2802.8, "maximum": 3883.88, "gross_charge": 4004.0, "discounted_cash": 6006.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3883.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2802.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3403.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3203.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING MONARC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100101838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2202.2, "maximum": 3051.62, "gross_charge": 3146.0, "discounted_cash": 4719.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2674.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2359.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3051.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2202.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2359.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2674.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2516.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING STIRRUP", "code_information": [{"code": "3100101839", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLING SUPRAPUBIC", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100101840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1497.3, "maximum": 2074.83, "gross_charge": 2139.0, "discounted_cash": 3208.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1818.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1604.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1497.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2074.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1497.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1604.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1818.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1711.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING SYS OBTRYX", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100101841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1899.1, "maximum": 2631.61, "gross_charge": 2713.0, "discounted_cash": 4069.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2306.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2034.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1899.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2631.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1899.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2034.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2306.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2170.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING SYS OBTRYX", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100103477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2165.8, "maximum": 3001.18, "gross_charge": 3094.0, "discounted_cash": 4641.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2629.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3001.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2165.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2629.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING SYS OBTRYX *M0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2029.27, "maximum": 2812.0, "gross_charge": 2898.97, "discounted_cash": 4348.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2464.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2174.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2029.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2812.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2029.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2174.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2464.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2319.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLING VIRTUE MALE", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100101842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7980.0, "maximum": 11058.0, "gross_charge": 11400.0, "discounted_cash": 17100.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9690.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8550.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7980.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11058.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7980.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8550.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9690.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLINGSHOT 70 DEG*CAT", "code_information": [{"code": "3100206982", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 881.04, "discounted_cash": 1321.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54000", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 434.32, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}, {"code": "3480103193", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}, {"code": "3480103256", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATND W/ANAL", "code_information": [{"code": "95801", "type": "CPT"}], "standard_charges": [{"minimum": 400.06, "maximum": 400.06, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 400.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SLP STDY UNATTENDED", "code_information": [{"code": "95800", "type": "CPT"}], "standard_charges": [{"minimum": 400.06, "maximum": 400.06, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 400.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SM 153 LEXIDRONAM", "code_information": [{"code": "A9604", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 27727.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SM JOINT OAT SET 10M", "code_information": [{"code": "3100202256", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SM LARYNGEAL STICKR", "code_information": [{"code": "3480103018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMALL ANIMAL INOCULATION", "code_information": [{"code": "87003", "type": "CPT"}], "standard_charges": [{"minimum": 16.84, "maximum": 24.03, "discounted_cash": 27.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.84, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOP", "code_information": [{"code": "44382", "type": "CPT"}, {"code": "3340102417", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 2842.1, "gross_charge": 2930.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2490.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2197.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2051.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2842.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2051.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2197.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2490.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2344.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOP", "code_information": [{"code": "44384", "type": "CPT"}, {"code": "3480103167", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1941.71, "maximum": 8523.39, "gross_charge": 8787.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7468.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6590.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6150.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8523.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6150.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6590.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7468.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7029.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOP", "code_information": [{"code": "44384", "type": "CPT"}, {"code": "3480103211", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 1941.71, "maximum": 10484.73, "gross_charge": 10809.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9187.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8106.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7566.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10484.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7566.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8106.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9187.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2076.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44360", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44364", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44365", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44366", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44369", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44372", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44373", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44376", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44378", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2883.16, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44380", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1705.24, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY BR/WA", "code_information": [{"code": "44381", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/BIOPSY", "code_information": [{"code": "44361", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1526.35, "discounted_cash": 2912.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY/STENT", "code_information": [{"code": "44370", "type": "CPT"}], "standard_charges": [{"minimum": 2883.16, "maximum": 2883.16, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2883.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL FT", "code_information": [{"code": "74248", "type": "CPT"}, {"code": "3270102313", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "gross_charge": 489.0, "discounted_cash": 733.5, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALL INTESTINAL END", "code_information": [{"code": "44377", "type": "CPT"}, {"code": "3480101962", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3058.41, "gross_charge": 3153.0, "discounted_cash": 2912.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2680.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2007.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2364.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2207.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3058.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2207.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1999.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2364.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2310.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2680.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2522.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1941.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1980.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMALLPOX&MONKEYPOX VAC 0.5ML", "code_information": [{"code": "90611", "type": "CPT"}], "standard_charges": [{"discounted_cash": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SMARTNAIL", "code_information": [{"code": "3100103479", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMARTNAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMARTNAIL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 84.0, "maximum": 116.4, "gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMEAR ACID FLRSC FAS", "code_information": [{"code": "87206", "type": "CPT"}, {"code": "3440101184", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 5.39, "maximum": 44.62, "gross_charge": 46.0, "discounted_cash": 8.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMEAR GRAM/GIEMSA ST", "code_information": [{"code": "87205", "type": "CPT"}, {"code": "3440101183", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.27, "maximum": 36.86, "gross_charge": 38.0, "discounted_cash": 6.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMEAR SPEC STAIN BOD", "code_information": [{"code": "87207", "type": "CPT"}, {"code": "3440101185", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 5.99, "maximum": 50.44, "gross_charge": 52.0, "discounted_cash": 9.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 50.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMEAR WET MOUNT INFC", "code_information": [{"code": "87210", "type": "CPT"}, {"code": "3440101187", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 5.82, "maximum": 35.89, "gross_charge": 37.0, "discounted_cash": 9.35, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 35.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 25.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 27.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMN1 GEN NOWN FAMIL SEQ VRNT", "code_information": [{"code": "81337", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMN1 GENE DOS/DELETION ALYS", "code_information": [{"code": "81329", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMN1 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81336", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 301.35, "discounted_cash": 484.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMN1&SMN2 FULL GENE ANALYSIS", "code_information": [{"code": "236U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 968.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMOKE EVAC TUBING*US", "code_information": [{"code": "3100204091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.32, "discounted_cash": 49.98, "setting": "both", "billing_class": "facility"}]}, {"description": "SMOKE EVACUATOR", "code_information": [{"code": "3100102236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 225.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMOKE EVACUATOR", "code_information": [{"code": "3100103716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.0, "discounted_cash": 147.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SMOKING CESSATION CLASS", "code_information": [{"code": "S9453", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMOOTH IMPLANT 345*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1825.46, "maximum": 2529.56, "gross_charge": 2607.8, "discounted_cash": 3911.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2529.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2086.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMOOTH IMPLANT 365*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206189", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1825.46, "maximum": 2529.56, "gross_charge": 2607.8, "discounted_cash": 3911.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2529.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2086.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMOOTH IMPLANT 385*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1825.46, "maximum": 2529.56, "gross_charge": 2607.8, "discounted_cash": 3911.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2529.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2086.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMOOTH IMPLANT 415*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1825.46, "maximum": 2529.56, "gross_charge": 2607.8, "discounted_cash": 3911.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2529.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1825.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2216.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2086.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMPD1 GENE COMMON VARIANTS", "code_information": [{"code": "81330", "type": "CPT"}], "standard_charges": [{"minimum": 47.0, "maximum": 79.66, "discounted_cash": 75.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 47.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMPL REPAIR SCALP/NE", "code_information": [{"code": "12002", "type": "CPT"}, {"code": "3480101340", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 204.29, "maximum": 402.28, "gross_charge": 300.0, "discounted_cash": 306.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 211.24, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 243.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 204.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 208.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SMR PRIM SRC CPLX OV", "code_information": [{"code": "87209", "type": "CPT"}, {"code": "3440101186", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 17.98, "maximum": 188.18, "gross_charge": 194.0, "discounted_cash": 28.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 188.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 22.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 19.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 19.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SNARE", "code_information": [{"code": "3100101844", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE", "code_information": [{"code": "3100103480", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.0, "discounted_cash": 51.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE", "code_information": [{"code": "3100104454", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SNARE MEDIUM STIFF*M", "code_information": [{"code": "3100210237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.76, "discounted_cash": 107.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SNRPN/UBE3A GENE", "code_information": [{"code": "81331", "type": "CPT"}], "standard_charges": [{"minimum": 51.07, "maximum": 79.66, "discounted_cash": 82.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SO GSAP CL FR CPY NMBR&MCRST", "code_information": [{"code": "81463", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP CLL FR DNA/DNA&RNA", "code_information": [{"code": "81462", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP CLL FR MCRSTL INS", "code_information": [{"code": "81464", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO GSAP DNA CPY NMBR&MCRSTL", "code_information": [{"code": "81458", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP 5-50 RNA ALYS", "code_information": [{"code": "81449", "type": "CPT"}], "standard_charges": [{"minimum": 597.91, "maximum": 597.91, "discounted_cash": 960.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 597.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP 5-50DNA/DNA&RNA", "code_information": [{"code": "81445", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 597.91, "discounted_cash": 960.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 597.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP DNA MCRSTL INS", "code_information": [{"code": "81457", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO NEO GSAP DNA/DNA&RNA", "code_information": [{"code": "81459", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SO/HL 51/>GSAP DNA/DNA&RNA", "code_information": [{"code": "81455", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 2919.6, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SO/HL 51/>GSAP RNA ALYS", "code_information": [{"code": "81456", "type": "CPT"}], "standard_charges": [{"minimum": 2919.6, "maximum": 2919.6, "discounted_cash": 4690.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2919.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOCKET INSERT 32MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1560.3, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOCKET INSERT 32MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOCKET INSERT 32MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1560.3, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOCKET INSERT 36MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207353", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOCKET INSERT 36MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1417.5, "maximum": 1964.25, "gross_charge": 2025.0, "discounted_cash": 3037.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1964.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1518.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1721.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM BICARBONATE", "code_information": [{"code": "3400300120", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 18.6, "discounted_cash": 27.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM BICARBONATE", "code_information": [{"code": "3400300125", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.8, "discounted_cash": 14.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM CHLORIDE 3%", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7131", "type": "HCPCS"}, {"code": "3400300068", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 0.04, "maximum": 12.61, "gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SODIUM FLUORIDE F-18", "code_information": [{"code": "A9580", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SODIUM HYPOCHLORITE", "code_information": [{"code": "3400300146", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 31.3, "discounted_cash": 46.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM HYPOCHLORITE", "code_information": [{"code": "3400300147", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 30.2, "discounted_cash": 45.3, "setting": "both", "billing_class": "facility"}]}, {"description": "SODIUM SERM PLSM/WH", "code_information": [{"code": "84295", "type": "CPT"}, {"code": "3440100991", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.81, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 7.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SODIUM SERUM PLSMA/W", "code_information": [{"code": "84295", "type": "CPT"}, {"code": "3440100990", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.81, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 7.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SODIUM URINE", "code_information": [{"code": "84300", "type": "CPT"}, {"code": "3440100992", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.06, "maximum": 41.71, "gross_charge": 43.0, "discounted_cash": 8.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 41.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 30.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 32.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 36.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 34.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SODIUM/POT/CA/MAG", "code_information": [{"code": "3400300028", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 11.9, "discounted_cash": 17.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SOF-LEX MANDRELS*198", "code_information": [{"code": "3100204782", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.2, "discounted_cash": 85.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [{"code": "501", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7943.66, "maximum": 7943.66, "discounted_cash": 19378.34, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7943.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [{"code": "500", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12093.78, "maximum": 12093.78, "discounted_cash": 36204.45, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12093.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOFT TISSUE PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "502", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6768.71, "maximum": 6768.71, "discounted_cash": 15437.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6768.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOFT-VU KUMPE 5 X 65", "code_information": [{"code": "3100205168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 1*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203073", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 2*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 3*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8372.0, "maximum": 11601.2, "gross_charge": 11960.0, "discounted_cash": 17940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11601.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 4*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7182.0, "maximum": 9952.2, "gross_charge": 10260.0, "discounted_cash": 15390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8721.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7695.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9952.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7695.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8721.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 5*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204069", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8568.0, "maximum": 11872.8, "gross_charge": 12240.0, "discounted_cash": 18360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10404.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11872.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10404.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 6*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9954.0, "maximum": 13793.4, "gross_charge": 14220.0, "discounted_cash": 21330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12087.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10665.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9954.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13793.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9954.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10665.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12087.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11376.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA LEVEL 7*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11340.0, "maximum": 15714.0, "gross_charge": 16200.0, "discounted_cash": 24300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13770.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11340.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15714.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11340.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13770.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA MIS 1 LEVEL*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA MIS 2 LEVEL*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9009.0, "maximum": 12483.9, "gross_charge": 12870.0, "discounted_cash": 19305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10939.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9009.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12483.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9009.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10939.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA MIS 3 LEVEL*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8680.0, "maximum": 12028.0, "gross_charge": 12400.0, "discounted_cash": 18600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLERA SPINE SCREWS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOLESTA 50MG/ML*4523", "code_information": [{"code": "L8605", "type": "HCPCS"}, {"code": "3100204284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 11739.52, "discounted_cash": 17609.28, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOLID ORGAN TRANSPL PKG", "code_information": [{"code": "S2152", "type": "HCPCS"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOLUTION BUFFER", "code_information": [{"code": "3100101845", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.5, "discounted_cash": 131.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SOMATOMEDIN", "code_information": [{"code": "84305", "type": "CPT"}, {"code": "3440100993", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.26, "maximum": 170.72, "gross_charge": 176.0, "discounted_cash": 34.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 170.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 123.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 132.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOMATOMSENSORY TESTI", "code_information": [{"code": "95926", "type": "CPT"}, {"code": "3340102409", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 571.33, "gross_charge": 589.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 500.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 571.33, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 412.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 500.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 471.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTIN", "code_information": [{"code": "95926", "type": "CPT"}, {"code": "3400102409", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 312.9, "maximum": 433.59, "gross_charge": 447.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 379.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 335.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 312.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 433.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 312.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 335.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 379.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 357.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOMATOSENSORY TESTING", "code_information": [{"code": "95927", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOMATREM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2940", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SOMATROPIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2941", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.29, "maximum": 87.29, "discounted_cash": 262.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 87.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SONICPIN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 331.8, "maximum": 459.78, "gross_charge": 474.0, "discounted_cash": 711.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 402.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 355.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 331.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 459.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 331.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 355.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 402.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 379.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SONITRODE II ST*52-5", "code_information": [{"code": "3100205860", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1206.0, "discounted_cash": 1809.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SOTROVIMAB", "code_information": [{"code": "Q0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 2394.0, "maximum": 2394.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2394.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SOTROVIMAB INF, HOME ADMIN", "code_information": [{"code": "M0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 750.0, "discounted_cash": 1205.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 750.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOTROVIMAB INFUSION", "code_information": [{"code": "M0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 447.23, "maximum": 450.0, "discounted_cash": 723.74, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SOUND BAHA", "code_information": [{"code": "3100102392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SOUND FEMALE", "code_information": [{"code": "3100101847", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 190.0, "discounted_cash": 285.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SOUND FEMALE", "code_information": [{"code": "3100103481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 191.0, "discounted_cash": 286.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SOUND FEMALE", "code_information": [{"code": "3100103482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SOUND FEMALE", "code_information": [{"code": "3100103483", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 211.0, "discounted_cash": 316.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SOUND FEMALE", "code_information": [{"code": "3100103484", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.0, "discounted_cash": 318.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SOUND FEMALE", "code_information": [{"code": "3100103485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 213.0, "discounted_cash": 319.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SP ACDF 1 LEV W/I*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ACDF 1 LEVEL*M200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1883.7, "maximum": 2610.27, "gross_charge": 2691.0, "discounted_cash": 4036.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2610.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2152.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ACDF 2 LEVEL*M200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ACDF 3 LEVEL*M200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ARTHROPLASTY 1L*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP ARTHROPLASTY 2L*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8680.0, "maximum": 12028.0, "gross_charge": 12400.0, "discounted_cash": 18600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CER AD LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 1 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 2 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8235.5, "maximum": 11412.05, "gross_charge": 11765.0, "discounted_cash": 17647.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10000.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8823.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8235.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11412.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8235.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8823.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10000.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9412.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 3 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8372.0, "maximum": 11601.2, "gross_charge": 11960.0, "discounted_cash": 17940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11601.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 4 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7770.0, "maximum": 10767.0, "gross_charge": 11100.0, "discounted_cash": 16650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9435.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8325.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10767.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8325.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9435.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 4 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7770.0, "maximum": 10767.0, "gross_charge": 11100.0, "discounted_cash": 16650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9435.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8325.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10767.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7770.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8325.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9435.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 5 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9030.0, "maximum": 12513.0, "gross_charge": 12900.0, "discounted_cash": 19350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10965.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9030.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12513.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9030.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10965.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP POST CERV 7 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11550.0, "maximum": 16005.0, "gross_charge": 16500.0, "discounted_cash": 24750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14025.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12375.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16005.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12375.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14025.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP SPINE BUNDLE*M200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL COMP 11+LEV*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 12460.0, "maximum": 17266.0, "gross_charge": 17800.0, "discounted_cash": 26700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15130.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17266.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15130.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL COMP 5-7 LEV*M", "code_information": [{"code": "3100205809", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13400.0, "discounted_cash": 20100.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SP TL COMP 8-10 LEV*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 18060.0, "maximum": 25026.0, "gross_charge": 25800.0, "discounted_cash": 38700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21930.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18060.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25026.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18060.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21930.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS 1 LEV*M200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS 1 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS 2 LEV*M200", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9009.0, "maximum": 12483.9, "gross_charge": 12870.0, "discounted_cash": 19305.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10939.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9652.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9009.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12483.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9009.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9652.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10939.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10296.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS 2 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS 3 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8680.0, "maximum": 12028.0, "gross_charge": 12400.0, "discounted_cash": 18600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS 3 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210084", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8260.0, "maximum": 11446.0, "gross_charge": 11800.0, "discounted_cash": 17700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10030.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11446.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10030.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL MIS ADD LEV*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4641.0, "maximum": 6431.1, "gross_charge": 6630.0, "discounted_cash": 9945.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5635.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6431.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5635.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL OP SYN 1 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SP TL OP SYN 2 LEV*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACE 6MM CERV *PTT-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACE 6MM CERV *PTT-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209779", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACE MAINTAINER FXD UNILAT", "code_information": [{"code": "D1510", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPACEMAKER PRO*SMBTT", "code_information": [{"code": "3100210034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1953.33, "discounted_cash": 2930.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8099.7, "maximum": 11223.87, "gross_charge": 11571.0, "discounted_cash": 17356.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9835.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8678.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8099.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11223.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8099.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8678.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9835.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9256.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103486", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103487", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8517.6, "maximum": 11802.96, "gross_charge": 12168.0, "discounted_cash": 18252.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10342.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8517.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11802.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8517.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9126.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10342.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9734.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8856.4, "maximum": 12272.44, "gross_charge": 12652.0, "discounted_cash": 18978.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10754.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9489.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8856.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12272.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8856.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9489.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10754.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10121.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0614", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0616", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208497", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0618", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208760", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0714", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0718", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0814", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0816", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0816", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0816", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0818", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0916", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER *126-PRO-0918", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10MM CERV*PTT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X10X25*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X25X4-8*484", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X26MMX4DEG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X45*4626104", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 10X55*4626105", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8120.0, "maximum": 11252.0, "gross_charge": 11600.0, "discounted_cash": 17400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8120.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11252.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8120.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 11X10X25*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 11X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 11X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208685", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 11X25X4 *4839", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12 X 55*46321", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12MM*2312-031", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206372", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12X25X4 *4839", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12X55*4622125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12X55*4626125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8120.0, "maximum": 11252.0, "gross_charge": 11600.0, "discounted_cash": 17400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8120.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11252.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8120.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 12X60*4622126", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 13X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 13X10X30*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 13X20MM *4848", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 13X25MM 4DEG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 13X25X4-8*484", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 13X33X18*4021", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 15X10X25*124-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 10*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206063", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 11*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 12*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 13*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207473", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 14*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 6*843324", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 8*843324", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 24 X 9*843324", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 25X10X10 DEG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 10*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 11*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205990", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 12*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 13*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 14*84332", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 6*843328", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 8*843328", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 28 X 9*843328", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 30X8X10DEG*56", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 32X25X10*4650", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207548", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 32X25X10*4650", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 32X25X12*4650", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208088", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 37X29X10*4651", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4882.5, "maximum": 6765.75, "gross_charge": 6975.0, "discounted_cash": 10462.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5928.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5231.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4882.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6765.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4882.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5231.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5928.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5580.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 37X29X12*4651", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 37X29X14*4651", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 37X29X16*4651", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 6MM CERV SM*P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 7MM CERV *PTT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 7MM CERV *PTT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 7X38X28*232-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 8X10X30*124-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 8X50*46260850", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 8X55*46260855", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8120.0, "maximum": 11252.0, "gross_charge": 11600.0, "discounted_cash": 17400.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8120.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11252.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8120.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8700.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9860.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 9MM CERV*PTT-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 9MM CERV*PTT-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER 9X25X4-8*4848", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ACF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102341", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2569.7, "maximum": 3560.87, "gross_charge": 3671.0, "discounted_cash": 5506.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3120.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2753.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2569.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3560.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2569.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2753.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3120.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2936.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ACF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ACIS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF *232-103", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF *232-103", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF *232-104", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF *232-113", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF *232-134", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF*232-0538", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF*232-0634", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF*232-0634", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF*232-0834", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF*232-0838", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ALIF*232-0938", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208379", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7140.0, "maximum": 9894.0, "gross_charge": 10200.0, "discounted_cash": 15300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9894.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7650.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8670.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER AMENDIA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104163", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ANATOMIC 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER ARCTIC 30 X 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203842", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER BREATHERITE", "code_information": [{"code": "3100101849", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER BREATHERITE", "code_information": [{"code": "3100103490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER CER*126-PRO-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208405", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1499.4, "maximum": 2077.74, "gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 5MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203937", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1499.4, "maximum": 2077.74, "gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 6MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1499.4, "maximum": 2077.74, "gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 6MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202825", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1654.24, "maximum": 2292.3, "gross_charge": 2363.2, "discounted_cash": 3544.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2008.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1772.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1654.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2292.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1654.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1772.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2008.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1890.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 7MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1499.4, "maximum": 2077.74, "gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 8MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1499.4, "maximum": 2077.74, "gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 8MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1654.24, "maximum": 2292.3, "gross_charge": 2363.2, "discounted_cash": 3544.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2008.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1772.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1654.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2292.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1654.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1772.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2008.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1890.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER CERVICAL 9MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1499.4, "maximum": 2077.74, "gross_charge": 2142.0, "discounted_cash": 3213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2077.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1606.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1820.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1713.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER END CAP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER FEMOR MED 44X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204267", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER FEMORA LG 53X", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.7, "maximum": 4792.77, "gross_charge": 4941.0, "discounted_cash": 7411.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4792.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER FEMORAL SM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3458.0, "maximum": 4791.8, "gross_charge": 4940.0, "discounted_cash": 7410.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4791.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3458.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3705.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3952.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER HRS 15MM*ARS3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6020.56, "maximum": 8342.77, "gross_charge": 8600.8, "discounted_cash": 12901.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7310.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6450.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6020.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8342.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6020.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6450.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7310.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6880.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER HRS 19MM*ARS3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6842.29, "maximum": 9481.45, "gross_charge": 9774.7, "discounted_cash": 14662.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8308.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7331.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6842.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9481.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6842.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7331.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8308.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7819.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER HRS 19MM*ARS3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6020.56, "maximum": 8342.77, "gross_charge": 8600.8, "discounted_cash": 12901.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7310.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6450.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6020.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8342.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6020.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6450.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7310.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6880.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER HRS 20MM*ARS3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3854.76, "maximum": 5341.59, "gross_charge": 5506.8, "discounted_cash": 8260.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4680.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4130.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3854.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5341.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3854.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4130.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4680.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4405.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER LEAPARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7553.0, "maximum": 10466.3, "gross_charge": 10790.0, "discounted_cash": 16185.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9171.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8092.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7553.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10466.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7553.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8092.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9171.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8632.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER LIF*100-08225", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER LIF*100-08225", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209224", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER LIF*100-PRO-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208876", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8645.0, "maximum": 11979.5, "gross_charge": 12350.0, "discounted_cash": 18525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11979.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER LIF*100-PRO-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8645.0, "maximum": 11979.5, "gross_charge": 12350.0, "discounted_cash": 18525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11979.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8645.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10497.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER MED 12MM*6441", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER NANO 10MM*411", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER NANO 12MM*411", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER NKII TIBA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3758.3, "maximum": 5207.93, "gross_charge": 5369.0, "discounted_cash": 8053.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4563.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4026.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3758.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5207.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3758.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4026.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4563.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER OPAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER OPAL 32X10C11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205060", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER OPAL 32X10C11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER OPAL SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PARALLEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PARALLEL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK *05-090-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X25X9*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202736", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203712", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203806", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 10X30X9*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 5MM*5030", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203337", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 6MM*5030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 7MM*5030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 7MM*5030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 8MM*5030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202783", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203568", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*2701", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206246", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER PEEK 9MM*5030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER POUROUS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1883.7, "maximum": 2610.27, "gross_charge": 2691.0, "discounted_cash": 4036.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2610.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1883.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2018.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2287.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2152.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER REV UNI 39 6M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 823.2, "maximum": 1140.72, "gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 823.2, "maximum": 1140.72, "gross_charge": 1176.0, "discounted_cash": 1764.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1140.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 823.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 882.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 999.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 940.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER REV UNIV*AR-9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1029.0, "maximum": 1425.9, "gross_charge": 1470.0, "discounted_cash": 2205.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1425.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1029.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1249.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER RING FEMORAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER SLAP PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 770.7, "maximum": 1067.97, "gross_charge": 1101.0, "discounted_cash": 1651.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 935.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 825.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 770.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1067.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 770.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 825.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 935.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 880.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER SUSTAIN 10X26", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7238.0, "maximum": 10029.8, "gross_charge": 10340.0, "discounted_cash": 15510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8789.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7755.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10029.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7755.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8789.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER TCS 5MM*5346-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER TCS 6MM*5346-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205634", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER TCS 7MM*5346-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER TLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER TPAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7007.0, "maximum": 9709.7, "gross_charge": 10010.0, "discounted_cash": 15015.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8508.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7507.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7007.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9709.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7007.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7507.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8508.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER UNIV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104273", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2999.5, "maximum": 4156.45, "gross_charge": 4285.0, "discounted_cash": 6427.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3642.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3213.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2999.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4156.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2999.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3213.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3642.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3428.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER UNIV 12MM*106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER UNIV 13MM*106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER UNIV 9MM*1067", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER VERTEBRAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5193.3, "maximum": 7196.43, "gross_charge": 7419.0, "discounted_cash": 11128.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7196.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5193.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5564.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6306.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5935.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER W SCREW 8MM*5", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2113.02, "maximum": 2928.04, "gross_charge": 3018.6, "discounted_cash": 4527.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2565.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2263.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2928.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2113.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2263.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2565.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2414.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER XBOX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3704.4, "maximum": 5133.24, "gross_charge": 5292.0, "discounted_cash": 7938.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5133.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3704.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3969.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4498.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4233.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER*120-09093010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER*120-10092505-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPACER*120-10093010-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPARCSLING TVT SYSTE", "code_information": [{"code": "C1771", "type": "HCPCS"}, {"code": "3100101855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2502.5, "maximum": 3467.75, "gross_charge": 3575.0, "discounted_cash": 5362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3467.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2502.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2681.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3038.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2860.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPATULA", "code_information": [{"code": "3100101856", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPCTRM BLADE HYPNG 4", "code_information": [{"code": "3100210187", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 228.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEARS SURGICAL BX/1", "code_information": [{"code": "3100202618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEC COLL NON-BLOOD:A/D TEST", "code_information": [{"code": "H0048", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEC GENE TEST HYP CARDIOMY", "code_information": [{"code": "S3866", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEC STAINS FOR MICROORGANIS", "code_information": [{"code": "D0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEC STAINS NOT FOR MICROORG", "code_information": [{"code": "D0477", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION TREATMENT", "code_information": [{"code": "77470", "type": "CPT"}], "standard_charges": [{"minimum": 762.73, "maximum": 762.73, "discounted_cash": 901.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 762.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN FRZN B", "code_information": [{"code": "88314", "type": "CPT"}, {"code": "3440101235", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 81.95, "maximum": 182.01, "gross_charge": 155.0, "discounted_cash": 232.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 81.95, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN GROUP", "code_information": [{"code": "88312", "type": "CPT"}, {"code": "3440101233", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 55.3, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 82.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 57.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 65.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 97.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 55.3, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 56.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN GROUP", "code_information": [{"code": "88313", "type": "CPT"}, {"code": "3440101234", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 150.35, "gross_charge": 155.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL STAIN GROUP", "code_information": [{"code": "88319", "type": "CPT"}, {"code": "3440101236", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 108.5, "maximum": 1044.18, "gross_charge": 155.0, "discounted_cash": 1316.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 907.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 150.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 108.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 903.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 116.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1044.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 131.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 122.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 877.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 895.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIAL TELETX PORT PLAN", "code_information": [{"code": "77321", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIFIC GRAVITY EXC", "code_information": [{"code": "84315", "type": "CPT"}, {"code": "3440100994", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 3.28, "maximum": 25.22, "gross_charge": 26.0, "discounted_cash": 5.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.51, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIMEN FAT STAIN", "code_information": [{"code": "89125", "type": "CPT"}], "standard_charges": [{"minimum": 5.88, "maximum": 35.16, "discounted_cash": 9.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECIMEN HANDLING OFFICE-LAB", "code_information": [{"code": "99000", "type": "CPT"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECTINOMYCN DI-HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3320", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SPECTROPHOTOMETRY", "code_information": [{"code": "84311", "type": "CPT"}], "standard_charges": [{"minimum": 8.1, "maximum": 20.92, "discounted_cash": 13.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPECULA VAG", "code_information": [{"code": "3100101857", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 857.0, "discounted_cash": 1285.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULA VAG", "code_information": [{"code": "3100103491", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 347.0, "discounted_cash": 520.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULA VAG", "code_information": [{"code": "3100103492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 885.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULA VAG", "code_information": [{"code": "3100103493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 746.0, "discounted_cash": 1119.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECULUM EAR", "code_information": [{"code": "3100101858", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.0, "discounted_cash": 118.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEECH AUDIOM THRESH & RECOG", "code_information": [{"code": "211T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY COMPLETE", "code_information": [{"code": "92556", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY THRESHOLD", "code_information": [{"code": "210T", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH EVALUATION COMPLEX", "code_information": [{"code": "70371", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH SCREENING", "code_information": [{"code": "V5362", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH SOUND LANG COMPREHEN", "code_information": [{"code": "92523", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH THERAPY, IN THE HOME,", "code_information": [{"code": "S9128", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH THERAPY, RE-EVAL", "code_information": [{"code": "S9152", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH THRESHOLD AUDIOMETRY", "code_information": [{"code": "92555", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92507", "type": "CPT"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92508", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPEED DRILL*703891", "code_information": [{"code": "3100210169", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1386.0, "discounted_cash": 2079.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDBRIDGE ACH*AR99", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209259", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5532.34, "maximum": 7666.24, "gross_charge": 7903.35, "discounted_cash": 11855.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6717.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5927.51, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5532.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7666.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5532.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5927.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6717.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6322.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEEDBRIDGE ROTATOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3245.97, "maximum": 4497.98, "gross_charge": 4637.1, "discounted_cash": 6955.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3941.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3477.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3245.97, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4497.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3245.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3477.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3941.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3709.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEEDGRAFT ACHILLES*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEEDGRAFT*SPD-001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4368.0, "maximum": 6052.8, "gross_charge": 6240.0, "discounted_cash": 9360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6052.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4992.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ANTIBODY TEST", "code_information": [{"code": "89325", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 17.15, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "discounted_cash": 31.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE INIT VISIT", "code_information": [{"code": "S4030", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM PROCURE SUBS VISIT", "code_information": [{"code": "S4031", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPHERE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7396.9, "maximum": 10249.99, "gross_charge": 10567.0, "discounted_cash": 15850.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8981.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7925.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7396.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10249.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7396.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7925.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8981.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8453.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHERE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4315.5, "maximum": 5980.05, "gross_charge": 6165.0, "discounted_cash": 9247.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5240.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4623.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4315.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5980.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4315.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4623.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5240.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4932.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHERE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103495", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8630.3, "maximum": 11959.13, "gross_charge": 12329.0, "discounted_cash": 18493.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10479.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9246.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8630.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11959.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8630.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9246.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10479.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9863.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHERE GLENOID", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHERE STEALTH 1PK*8", "code_information": [{"code": "3100203061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE STEALTH 4PK*8", "code_information": [{"code": "3100203059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHERE STEALTH 5PK*", "code_information": [{"code": "3100203060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 295.96, "discounted_cash": 443.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPHINCTEROTOMY, ANAL", "code_information": [{"code": "46080", "type": "CPT"}, {"code": "3480101972", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4341.72, "gross_charge": 4476.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4341.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3133.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3357.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3804.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3580.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95990", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPIN/BRAIN PUMP REFIL & MAIN", "code_information": [{"code": "95991", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 453.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL BONE ALLOGRAF", "code_information": [{"code": "20930", "type": "CPT"}, {"code": "3480101447", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7945.0, "maximum": 11009.5, "gross_charge": 11350.0, "discounted_cash": 17025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9647.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8512.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11009.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8512.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9647.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9080.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL BONE ALLOGRAF", "code_information": [{"code": "20931", "type": "CPT"}, {"code": "3480101448", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 188.3, "maximum": 7959.27, "gross_charge": 269.0, "discounted_cash": 403.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 228.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 201.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 188.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 260.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 188.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 201.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 228.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 215.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL BONE AUTOGR M", "code_information": [{"code": "20937", "type": "CPT"}, {"code": "3480101450", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 287.0, "maximum": 7959.27, "gross_charge": 410.0, "discounted_cash": 615.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 348.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 307.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 287.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 397.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 287.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 307.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 348.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 328.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL BONE AUTOGRAF", "code_information": [{"code": "20936", "type": "CPT"}, {"code": "3480101449", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7945.0, "maximum": 11009.5, "gross_charge": 11350.0, "discounted_cash": 17025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9647.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8512.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11009.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8512.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9647.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9080.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL BONE AUTOGRAF", "code_information": [{"code": "20938", "type": "CPT"}, {"code": "3480101451", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 311.5, "maximum": 7959.27, "gross_charge": 445.0, "discounted_cash": 667.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 378.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 333.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 311.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 431.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 311.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 333.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 378.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 356.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL CORD STIM KIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 34860.0, "maximum": 48306.0, "gross_charge": 49800.0, "discounted_cash": 74700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 42330.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 37350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 34860.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 48306.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 34860.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 37350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 42330.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 39840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITH CC/MCC", "code_information": [{"code": "52", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10261.58, "maximum": 10261.58, "discounted_cash": 21709.5, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10261.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC", "code_information": [{"code": "53", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6986.97, "maximum": 6986.97, "discounted_cash": 10983.71, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6986.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [{"code": "457", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32867.18, "maximum": 32867.18, "discounted_cash": 67828.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32867.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [{"code": "456", "type": "MS-DRG"}], "standard_charges": [{"minimum": 44486.31, "maximum": 44486.31, "discounted_cash": 94110.59, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44486.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC", "code_information": [{"code": "458", "type": "MS-DRG"}], "standard_charges": [{"minimum": 32307.68, "maximum": 32307.68, "discounted_cash": 50586.65, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 32307.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL NEEDLE 9.1CM*", "code_information": [{"code": "3100209961", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [{"code": "29", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13430.43, "maximum": 13430.43, "discounted_cash": 38274.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13430.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITH MCC", "code_information": [{"code": "28", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22761.15, "maximum": 22761.15, "discounted_cash": 67278.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 22761.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "30", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11411.93, "maximum": 11411.93, "discounted_cash": 25890.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11411.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNC LUMB DIA", "code_information": [{"code": "62328", "type": "CPT"}, {"code": "3430102308", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 705.68, "maximum": 2320.24, "gross_charge": 2392.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2033.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1674.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2320.24, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1674.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1794.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2033.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1913.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL PUNC THER FOR", "code_information": [{"code": "62329", "type": "CPT"}, {"code": "3430102309", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 705.68, "maximum": 2122.36, "gross_charge": 2188.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2122.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1531.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1641.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1859.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINAL SURGERY 1ST 3", "code_information": [{"code": "3480103065", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 7725.0, "discounted_cash": 11587.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINAL SURGERY EA AD", "code_information": [{"code": "3480103070", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1030.0, "discounted_cash": 1545.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINE BRIGADE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101861", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9800.0, "maximum": 13580.0, "gross_charge": 14000.0, "discounted_cash": 21000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13580.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE DEVICE IMPLANT SURGERY", "code_information": [{"code": "C9757", "type": "HCPCS"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63077", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63078", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE ESENTIAL KIT*N", "code_information": [{"code": "3100203542", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINE ESSENT LEV 1*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE FUSION EXTRA S", "code_information": [{"code": "22614", "type": "CPT"}, {"code": "3480101505", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7959.27, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 19732.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINE NEEDLE 18 GA*D", "code_information": [{"code": "3100204976", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINE PEDICLE KIT *9", "code_information": [{"code": "3100203062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1554.0, "discounted_cash": 2331.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINE SX PROCE-UNLIS", "code_information": [{"code": "22899", "type": "CPT"}, {"code": "3480101529", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPINEJACK KIT 5.0*09", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7163.39, "maximum": 9926.41, "gross_charge": 10233.42, "discounted_cash": 15350.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8698.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7675.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7163.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9926.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7163.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7675.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8698.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8186.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINPLUS", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100104570", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 3549.0, "maximum": 4917.9, "gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4917.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPIRMTRY W/BRNCHDIL INF-2 YR", "code_information": [{"code": "94012", "type": "CPT"}], "standard_charges": [{"minimum": 278.57, "maximum": 278.57, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 278.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPIROMETRY UP TO 2 YRS OLD", "code_information": [{"code": "94011", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLEEN IMAGING", "code_information": [{"code": "78185", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH CC", "code_information": [{"code": "800", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10099.88, "maximum": 10099.88, "discounted_cash": 31458.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10099.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITH MCC", "code_information": [{"code": "799", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20604.32, "maximum": 20604.32, "discounted_cash": 55315.95, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20604.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLENIC PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "801", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8605.83, "maximum": 8605.83, "discounted_cash": 19981.22, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8605.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLINED KNEE STM 12X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4081.35, "maximum": 5655.58, "gross_charge": 5830.5, "discounted_cash": 8745.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5655.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4664.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINED KNEE STM 13X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203333", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4353.44, "maximum": 6032.62, "gross_charge": 6219.2, "discounted_cash": 9328.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5286.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4664.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4353.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6032.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4353.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4664.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5286.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4975.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINED KNEE STM 14X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3397.94, "maximum": 4708.57, "gross_charge": 4854.2, "discounted_cash": 7281.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4126.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3640.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3397.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4708.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3397.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3640.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4126.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3883.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINED KNEE STM 19X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203679", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4081.35, "maximum": 5655.58, "gross_charge": 5830.5, "discounted_cash": 8745.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5655.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4664.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINED KNEE STM 20X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4081.35, "maximum": 5655.58, "gross_charge": 5830.5, "discounted_cash": 8745.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5655.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4664.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINED KNEE STM 21X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4081.35, "maximum": 5655.58, "gross_charge": 5830.5, "discounted_cash": 8745.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5655.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4081.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4372.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4955.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4664.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLINT DOYLE OPEN LU", "code_information": [{"code": "3100204333", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.4, "discounted_cash": 117.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT EXTRA-CORONAL", "code_information": [{"code": "D4323", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLINT INTRA-CORONAL", "code_information": [{"code": "D4322", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLINT NASAL", "code_information": [{"code": "3100101863", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.0, "discounted_cash": 187.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL", "code_information": [{"code": "3100103496", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL", "code_information": [{"code": "3100103497", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.0, "discounted_cash": 178.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL DOYLE", "code_information": [{"code": "3100104199", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 98.4, "discounted_cash": 147.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL ELIACHA", "code_information": [{"code": "3100104200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT NASAL TELLE", "code_information": [{"code": "3100104201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.0, "discounted_cash": 64.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLINT ORTHO", "code_information": [{"code": "3100101864", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 157.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLIT BLOOD OR PRODUCTS", "code_information": [{"code": "86985", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLIT GRAFT TRUNK 10", "code_information": [{"code": "15100", "type": "CPT"}, {"code": "3480101368", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6151.74, "gross_charge": 6342.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6151.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4439.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4756.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5390.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5073.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPLIT SINGLE JAW*60-", "code_information": [{"code": "3100209088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2716.19, "discounted_cash": 4074.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SPLITTER KOCH", "code_information": [{"code": "3100101865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 760.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GEL", "code_information": [{"code": "3100104682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE GEL", "code_information": [{"code": "3100104684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.4, "discounted_cash": 114.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONGE LAP", "code_information": [{"code": "3100101866", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS STUDY", "code_information": [{"code": "92531", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPONTANEOUS NYSTAGMUS TEST", "code_information": [{"code": "92541", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "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": 4929.74, "maximum": 4929.74, "discounted_cash": 10796.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4929.74, "methodology": "fee schedule"}], "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": 4435.41, "maximum": 4435.41, "discounted_cash": 7916.79, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4435.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPRAY SOLENOID BODY", "code_information": [{"code": "3100101867", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 795.0, "discounted_cash": 1192.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRING COMPRESSION", "code_information": [{"code": "3100101868", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPRING COMPRESSION", "code_information": [{"code": "3100103498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPS SPINE POSTIONING", "code_information": [{"code": "3100101869", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2964.0, "discounted_cash": 4446.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPTL OPEN 1 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPTL OPEN 2 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204835", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPTL OPEN 3 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPTL OPEN 4 LEVEL*M2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7840.0, "maximum": 10864.0, "gross_charge": 11200.0, "discounted_cash": 16800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9520.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10864.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9520.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPTL OPEN ADD LEV *M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2002.0, "maximum": 2774.2, "gross_charge": 2860.0, "discounted_cash": 4290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2774.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2002.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2431.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2288.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPUN MICROHEMATOCRIT", "code_information": [{"code": "85013", "type": "CPT"}], "standard_charges": [{"minimum": 7.0, "maximum": 20.92, "discounted_cash": 11.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPUTUM INDUCTION", "code_information": [{"code": "94640", "type": "CPT"}, {"code": "3310100274", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 126.38, "maximum": 259.0, "gross_charge": 231.0, "discounted_cash": 326.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 225.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 224.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 161.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 224.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 173.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 259.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 196.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 184.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 217.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPUTUM SPECIMEN COLLECTION", "code_information": [{"code": "89220", "type": "CPT"}], "standard_charges": [{"minimum": 16.27, "maximum": 112.14, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SPYGLASS RET BASKT*M", "code_information": [{"code": "3100204225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPYGLASS RET SNARE*M", "code_information": [{"code": "3100204226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPYSCOPE DEL CATH*M0", "code_information": [{"code": "3100203607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6370.0, "discounted_cash": 9555.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPYSCOPE DEL CATH*M0", "code_information": [{"code": "3100205089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6370.0, "discounted_cash": 9555.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SR89 STRONTIUM", "code_information": [{"code": "A9600", "type": "HCPCS"}], "standard_charges": [{"minimum": 4248.45, "maximum": 4248.45, "discounted_cash": 6677.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4248.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES COMPLEX ADDL", "code_information": [{"code": "61799", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRAN LES SIMPLE ADDL", "code_information": [{"code": "61797", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION SIMPLE", "code_information": [{"code": "61796", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS LINEAR BASED", "code_information": [{"code": "77372", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "discounted_cash": 11919.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS MULTISOURCE", "code_information": [{"code": "77371", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "discounted_cash": 11919.65, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION", "code_information": [{"code": "63620", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 8291.69, "maximum": 8291.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8291.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRSF2 GENE COMMON VARIANTS", "code_information": [{"code": "81348", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 175.4, "discounted_cash": 281.78, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 175.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SSEP IN UPPER LIMBS", "code_information": [{"code": "95925", "type": "CPT"}, {"code": "3340102342", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 320.29, "maximum": 969.03, "gross_charge": 999.0, "discounted_cash": 480.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 849.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 331.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 749.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 969.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 329.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 749.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 381.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 849.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 799.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 320.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 326.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SSEP UPPER AND LOWER", "code_information": [{"code": "95938", "type": "CPT"}, {"code": "3480103012", "type": "CDM"}, {"code": "920", "type": "RC"}], "standard_charges": [{"minimum": 414.74, "maximum": 1034.99, "gross_charge": 1067.0, "discounted_cash": 820.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 906.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 565.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 746.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1034.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 557.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 746.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 563.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 650.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 906.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 546.94, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 557.88, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ST.JUDE LEAD WIRE", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3100101870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1512.0, "maximum": 2095.2, "gross_charge": 2160.0, "discounted_cash": 3240.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2095.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1512.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1620.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1836.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1728.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ST.JUDE LEAD WIRE", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "3100103499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAB PHLEBECTOMY", "code_information": [{"code": "37765", "type": "CPT"}, {"code": "3480101888", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3185.31, "maximum": 7979.22, "gross_charge": 8226.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6992.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6169.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5758.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7979.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5758.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6169.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6992.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6580.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STAB PHLEBECTOMY", "code_information": [{"code": "37766", "type": "CPT"}, {"code": "3480101889", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3185.31, "maximum": 6649.35, "gross_charge": 6855.0, "discounted_cash": 4878.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5826.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3363.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5141.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4798.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6649.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4798.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3350.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5141.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3870.64, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5826.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5484.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3252.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3317.69, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3185.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STABIL TIB INSERT*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STABLYX IMPL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5915.0, "maximum": 8196.5, "gross_charge": 8450.0, "discounted_cash": 12675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7182.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6337.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5915.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8196.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5915.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6337.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7182.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STABLYX IMPL SZ 3*ST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6688.5, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 14332.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STABLYX IMPL SZ 4*ST", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6688.5, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 14332.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAGGERED SPONDAIC WORD TEST", "code_information": [{"code": "92572", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STANDARD HINGE MALE*", "code_information": [{"code": "3100209128", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.44, "discounted_cash": 726.66, "setting": "both", "billing_class": "facility"}]}, {"description": "STANDARD PROCEDURE P", "code_information": [{"code": "3100203485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPH A DNA AMP PROBE", "code_information": [{"code": "87640", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STAPLE 15X15L*AR-871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3621.34, "maximum": 5018.14, "gross_charge": 5173.35, "discounted_cash": 7760.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4397.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3880.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3621.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5018.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3621.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3880.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4397.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4138.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE 18X15L*AR-871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE 18X18L*AR-871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE 18X18L*AR-871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE 20X20L*AR-871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE 25X20L*AR-871", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE ALIGN PIN*AR-", "code_information": [{"code": "3100206428", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE CUSTOM SPINE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 15X15*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 15X15*AR87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205330", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3905.17, "maximum": 5411.45, "gross_charge": 5578.82, "discounted_cash": 8368.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5411.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4463.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 18X15*AR87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3905.17, "maximum": 5411.45, "gross_charge": 5578.82, "discounted_cash": 8368.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5411.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4463.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 18X18*AR87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 20X15*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 20X15*AR87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3905.17, "maximum": 5411.45, "gross_charge": 5578.82, "discounted_cash": 8368.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5411.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4463.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 20X20*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3812.9, "maximum": 5283.59, "gross_charge": 5447.0, "discounted_cash": 8170.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5283.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3812.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4085.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4629.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4357.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 20X20*AR87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DY 25X20*AR87", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3905.17, "maximum": 5411.45, "gross_charge": 5578.82, "discounted_cash": 8368.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5411.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3905.17, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4184.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4741.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4463.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DYNA 11X10*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DYNA 11X10*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DYNA 13X10*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204117", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3448.9, "maximum": 4779.19, "gross_charge": 4927.0, "discounted_cash": 7390.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4779.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3448.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3695.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4187.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3941.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DYNA 13X10*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DYNA 15X12*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE DYNA 20X20*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4176.9, "maximum": 5787.99, "gross_charge": 5967.0, "discounted_cash": 8950.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5071.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4176.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5787.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4176.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5071.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4773.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE LIG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101871", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 221.2, "maximum": 306.52, "gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 306.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 221.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 237.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 268.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLE TRI PURPLE*SI", "code_information": [{"code": "3100208268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.91, "discounted_cash": 728.87, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE TRS BLACK*SIG", "code_information": [{"code": "3100208245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1231.77, "discounted_cash": 1847.66, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLE TRS PURPLE*SI", "code_information": [{"code": "3100208244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1077.21, "discounted_cash": 1615.82, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER", "code_information": [{"code": "3100103501", "type": "CDM"}, {"code": "279", "type": "RC"}], "standard_charges": [{"gross_charge": 568.5, "discounted_cash": 852.75, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.6, "maximum": 415.16, "gross_charge": 428.0, "discounted_cash": 642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 363.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 299.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 415.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 299.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 363.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 342.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 324.8, "maximum": 450.08, "gross_charge": 464.0, "discounted_cash": 696.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 450.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 348.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 394.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 371.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER 60MM LONG*EC", "code_information": [{"code": "3100210076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1205.28, "discounted_cash": 1807.92, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER CUR CUTTER*C", "code_information": [{"code": "3100203159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 992.67, "discounted_cash": 1489.01, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER ECHELON 60MM", "code_information": [{"code": "3100207493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2905.9, "discounted_cash": 4358.85, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER EEA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 627.9, "maximum": 870.09, "gross_charge": 897.0, "discounted_cash": 1345.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 762.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 672.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 627.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 870.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 627.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 672.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 762.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 717.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER EEA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 662.2, "maximum": 917.62, "gross_charge": 946.0, "discounted_cash": 1419.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 917.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 662.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 709.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 804.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 756.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER EEA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 662.9, "maximum": 918.59, "gross_charge": 947.0, "discounted_cash": 1420.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 804.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 710.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 662.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 918.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 662.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 710.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 804.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 757.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER EEA 25MM *EE", "code_information": [{"code": "3100203943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2307.84, "discounted_cash": 3461.76, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER EEA 25MM BX/", "code_information": [{"code": "3100202779", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2723.29, "discounted_cash": 4084.94, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER EEA ORVIL*EE", "code_information": [{"code": "3100204190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.12, "discounted_cash": 637.68, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER J&J", "code_information": [{"code": "3100103787", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER J&J", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 835.1, "maximum": 1157.21, "gross_charge": 1193.0, "discounted_cash": 1789.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1014.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 894.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 835.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1157.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 835.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 894.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1014.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 954.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER LINEAR 60*TX", "code_information": [{"code": "3100203160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.56, "discounted_cash": 455.34, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER LOAD ENDO EC", "code_information": [{"code": "3100101873", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 457.0, "discounted_cash": 685.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER LOAD ENDO EC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 410.9, "maximum": 569.39, "gross_charge": 587.0, "discounted_cash": 880.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 498.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 440.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 410.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 569.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 410.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 440.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 498.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 469.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER RELD ECHLN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104380", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.9, "maximum": 472.39, "gross_charge": 487.0, "discounted_cash": 730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 365.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 472.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 365.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 389.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER RELOAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 149.8, "maximum": 207.58, "gross_charge": 214.0, "discounted_cash": 321.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 181.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 160.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 149.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 207.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 149.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 160.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 181.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER RELOAD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 299.6, "maximum": 415.16, "gross_charge": 428.0, "discounted_cash": 642.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 363.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 299.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 415.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 299.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 321.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 363.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 342.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER RELOAD ECHLN", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 389.2, "maximum": 539.32, "gross_charge": 556.0, "discounted_cash": 834.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 539.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 472.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STAPLER SKIN", "code_information": [{"code": "3100101875", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.0, "discounted_cash": 259.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN", "code_information": [{"code": "3100103504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN", "code_information": [{"code": "3100103505", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN", "code_information": [{"code": "3100103506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.44, "discounted_cash": 114.66, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN PRECISE", "code_information": [{"code": "3100207228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.12, "discounted_cash": 46.68, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN PRECISE", "code_information": [{"code": "3100207546", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.92, "discounted_cash": 53.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN PRECISE", "code_information": [{"code": "3100207579", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.64, "discounted_cash": 93.96, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLER SKIN PROXIMT", "code_information": [{"code": "3100209606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.04, "discounted_cash": 33.06, "setting": "both", "billing_class": "facility"}]}, {"description": "STAPLERECHELON 60MM*", "code_information": [{"code": "3100207509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 911.1, "discounted_cash": 1366.65, "setting": "both", "billing_class": "facility"}]}, {"description": "STAR ST PACK INST*10", "code_information": [{"code": "3100203388", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4118.4, "discounted_cash": 6177.6, "setting": "both", "billing_class": "facility"}]}, {"description": "STARTUP KIT PSI*PT-T", "code_information": [{"code": "3100202598", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STAT GVL", "code_information": [{"code": "3100101877", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STAT GVL", "code_information": [{"code": "3100103988", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEAM TRAP", "code_information": [{"code": "3100101878", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 206.0, "discounted_cash": 309.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEAM TRAP", "code_information": [{"code": "3100103508", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 927.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEAM TRAP", "code_information": [{"code": "3100103509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 684.0, "discounted_cash": 1026.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1948.1, "maximum": 2699.51, "gross_charge": 2783.0, "discounted_cash": 4174.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2365.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2087.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1948.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2699.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1948.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2087.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2365.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2226.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2109.74, "maximum": 2923.5, "gross_charge": 3013.92, "discounted_cash": 4520.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2561.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2260.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2109.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2923.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2109.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2260.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2561.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2411.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2713.9, "maximum": 3760.69, "gross_charge": 3877.0, "discounted_cash": 5815.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3295.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2907.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2713.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3760.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2713.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2907.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3295.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3101.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2800.0, "maximum": 3880.0, "gross_charge": 4000.0, "discounted_cash": 6000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3400.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3880.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3400.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104305", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1978.34, "maximum": 2741.41, "gross_charge": 2826.2, "discounted_cash": 4239.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2741.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2260.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4050.9, "maximum": 5613.39, "gross_charge": 5787.0, "discounted_cash": 8680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4918.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4340.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4050.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5613.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4050.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4340.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4918.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4629.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CELLS TOTAL COUNT", "code_information": [{"code": "86367", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 77.78, "discounted_cash": 124.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 77.78, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STEM CEMENT 15X100MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2013.64, "maximum": 2790.34, "gross_charge": 2876.64, "discounted_cash": 4314.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2445.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2157.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2013.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2790.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2013.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2157.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2445.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2301.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENT 15X50MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENT 9X50MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENT EXETR V4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENTED*1512-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1485.68, "maximum": 2058.72, "gross_charge": 2122.4, "discounted_cash": 3183.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1804.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1591.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1485.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2058.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1485.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1591.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1804.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1697.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENTED*1512-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM CEMENTED*1512-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM DIST 18X140*197", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207877", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4939.48, "maximum": 6844.7, "gross_charge": 7056.4, "discounted_cash": 10584.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5997.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5292.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4939.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6844.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4939.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5292.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5997.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5645.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM DIST 19X140*197", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206935", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4939.48, "maximum": 6844.7, "gross_charge": 7056.4, "discounted_cash": 10584.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5997.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5292.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4939.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6844.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4939.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5292.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5997.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5645.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM DIST 20X140*197", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6593.58, "maximum": 9136.82, "gross_charge": 9419.41, "discounted_cash": 14129.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8006.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7064.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6593.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9136.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6593.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7064.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8006.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7535.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM DIST 20X140*197", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6906.9, "maximum": 9570.99, "gross_charge": 9867.0, "discounted_cash": 14800.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8386.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7400.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6906.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9570.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6906.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7400.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8386.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7893.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM DISTAL 15X90*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7037.94, "maximum": 9752.57, "gross_charge": 10054.2, "discounted_cash": 15081.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8546.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7540.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7037.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9752.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7037.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7540.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8546.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8043.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM DISTAL 17X140*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4939.48, "maximum": 6844.7, "gross_charge": 7056.4, "discounted_cash": 10584.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5997.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5292.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4939.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6844.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4939.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5292.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5997.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5645.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXETER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102348", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXETER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7911.4, "maximum": 10962.94, "gross_charge": 11302.0, "discounted_cash": 16953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9606.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8476.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7911.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10962.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7911.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8476.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9606.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9041.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXETER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8969.1, "maximum": 12428.61, "gross_charge": 12813.0, "discounted_cash": 19219.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10891.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9609.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8969.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12428.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8969.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9609.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10891.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10250.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXETER V40 37.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXETER V40 37.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXT 14X75*42-56", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3516.24, "maximum": 4872.5, "gross_charge": 5023.2, "discounted_cash": 7534.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4269.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3767.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3516.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4872.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3516.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3767.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4269.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4018.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXTENSION 14MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM EXTENSTIONS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104265", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2950.5, "maximum": 4088.55, "gross_charge": 4215.0, "discounted_cash": 6322.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3582.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3161.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2950.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4088.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2950.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3161.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3582.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3372.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL 36*52-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202640", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6521.42, "maximum": 9036.83, "gross_charge": 9316.32, "discounted_cash": 13974.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7918.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6987.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6521.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9036.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6521.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6987.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7918.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7453.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL 36*52-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6521.42, "maximum": 9036.83, "gross_charge": 9316.32, "discounted_cash": 13974.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7918.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6987.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6521.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9036.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6521.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6987.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7918.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7453.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL 36*52-3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203959", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6521.42, "maximum": 9036.83, "gross_charge": 9316.32, "discounted_cash": 13974.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7918.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6987.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6521.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9036.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6521.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6987.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7918.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7453.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101880", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11509.4, "maximum": 15948.74, "gross_charge": 16442.0, "discounted_cash": 24663.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13975.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12331.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11509.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15948.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11509.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12331.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13975.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6521.2, "maximum": 9036.52, "gross_charge": 9316.0, "discounted_cash": 13974.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7918.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6987.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6521.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9036.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6521.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6987.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7918.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7452.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7480.9, "maximum": 10366.39, "gross_charge": 10687.0, "discounted_cash": 16030.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9083.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8015.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7480.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10366.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7480.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8015.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9083.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8549.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FEMORAL DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11066.3, "maximum": 15334.73, "gross_charge": 15809.0, "discounted_cash": 23713.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15334.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12647.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FITFIL", "code_information": [{"code": "3100102349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13554.0, "discounted_cash": 20331.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8652.0, "maximum": 11989.2, "gross_charge": 12360.0, "discounted_cash": 18540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11989.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8652.0, "maximum": 11989.2, "gross_charge": 12360.0, "discounted_cash": 18540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11989.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8652.0, "maximum": 11989.2, "gross_charge": 12360.0, "discounted_cash": 18540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11989.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8652.0, "maximum": 11989.2, "gross_charge": 12360.0, "discounted_cash": 18540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11989.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLEX STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9084.6, "maximum": 12588.66, "gross_charge": 12978.0, "discounted_cash": 19467.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12588.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9084.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9733.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11031.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10382.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2690.8, "maximum": 3728.68, "gross_charge": 3844.0, "discounted_cash": 5766.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3267.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2690.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3728.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2690.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3267.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3075.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE UNI 115X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2261.35, "maximum": 3133.58, "gross_charge": 3230.5, "discounted_cash": 4845.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2745.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2422.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2261.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3133.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2261.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2422.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2745.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2584.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE UNI 115X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2261.35, "maximum": 3133.58, "gross_charge": 3230.5, "discounted_cash": 4845.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2745.92, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2422.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2261.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3133.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2261.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2422.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2745.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2584.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE UNI 115X1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1978.34, "maximum": 2741.41, "gross_charge": 2826.2, "discounted_cash": 4239.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2741.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2260.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE UNI 75X10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2690.68, "maximum": 3728.52, "gross_charge": 3843.84, "discounted_cash": 5765.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3267.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2882.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2690.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3728.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2690.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2882.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3267.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3075.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE UNI 75X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2690.68, "maximum": 3728.52, "gross_charge": 3843.84, "discounted_cash": 5765.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3267.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2882.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2690.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3728.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2690.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2882.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3267.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3075.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTE UNI 75X18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2690.68, "maximum": 3728.52, "gross_charge": 3843.84, "discounted_cash": 5765.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3267.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2882.88, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2690.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3728.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2690.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2882.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3267.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3075.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2109.74, "maximum": 2923.5, "gross_charge": 3013.92, "discounted_cash": 4520.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2561.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2260.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2109.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2923.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2109.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2260.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2561.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2411.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM FLUTED 10X100MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209172", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2109.74, "maximum": 2923.5, "gross_charge": 3013.92, "discounted_cash": 4520.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2561.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2260.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2109.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2923.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2109.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2260.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2561.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2411.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HEAD/ NECK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7476.0, "maximum": 10359.6, "gross_charge": 10680.0, "discounted_cash": 16020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9078.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8010.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7476.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10359.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7476.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8010.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9078.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8544.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HEAD/ NECK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5491.5, "maximum": 7609.65, "gross_charge": 7845.0, "discounted_cash": 11767.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6668.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5883.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5491.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7609.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5491.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5883.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6668.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6276.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101882", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5381.6, "maximum": 7457.36, "gross_charge": 7688.0, "discounted_cash": 11532.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6534.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5766.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5381.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7457.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5381.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5766.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6534.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6150.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104272", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6091.4, "maximum": 8440.94, "gross_charge": 8702.0, "discounted_cash": 13053.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7396.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6526.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6091.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8440.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6091.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6526.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7396.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6961.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP 30X124 SZ 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP 35X131 SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2570.75, "maximum": 3562.32, "gross_charge": 3672.5, "discounted_cash": 5508.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3562.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2570.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2754.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3121.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2938.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP ACCOLADE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101883", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3526.25, "maximum": 4886.37, "gross_charge": 5037.5, "discounted_cash": 7556.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4886.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3526.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3778.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4281.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4030.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP BEADED OFFS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6097.0, "maximum": 8448.7, "gross_charge": 8710.0, "discounted_cash": 13065.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7403.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6532.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6097.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8448.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6097.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6532.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7403.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6968.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP SZ 1*1541-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202912", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6349.34, "maximum": 8798.37, "gross_charge": 9070.49, "discounted_cash": 13605.74, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7709.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6802.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6349.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8798.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6349.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6802.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7709.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7256.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP TOTAL CEMEN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4212.6, "maximum": 5837.46, "gross_charge": 6018.0, "discounted_cash": 9027.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5115.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4513.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4212.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5837.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4212.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4513.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5115.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4814.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HIP W/REINF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2216.9, "maximum": 3071.99, "gross_charge": 3167.0, "discounted_cash": 4750.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2691.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2375.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2216.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3071.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2216.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2375.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2691.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2533.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUM REV 5MM*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3030.2, "maximum": 4199.0, "gross_charge": 4328.87, "discounted_cash": 6493.31, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3679.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3246.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3030.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4199.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3030.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3246.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3679.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3463.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUM UNIV SZ 7*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203847", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.16, "maximum": 5013.73, "gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8692.6, "maximum": 12045.46, "gross_charge": 12418.0, "discounted_cash": 18627.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10555.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9313.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8692.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12045.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8692.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9313.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10555.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9934.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7210.0, "maximum": 9991.0, "gross_charge": 10300.0, "discounted_cash": 15450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8755.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7725.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9991.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7725.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8755.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7945.0, "maximum": 11009.5, "gross_charge": 11350.0, "discounted_cash": 17025.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9647.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8512.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7945.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11009.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7945.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8512.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9647.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103521", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8652.0, "maximum": 11989.2, "gross_charge": 12360.0, "discounted_cash": 18540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11989.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8652.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10506.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9888.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10094.0, "maximum": 13987.4, "gross_charge": 14420.0, "discounted_cash": 21630.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12257.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10815.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10094.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13987.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10094.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10815.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12257.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11536.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103805", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11515.0, "maximum": 15956.5, "gross_charge": 16450.0, "discounted_cash": 24675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13982.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12337.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11515.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15956.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11515.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12337.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13982.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4732.0, "maximum": 6557.2, "gross_charge": 6760.0, "discounted_cash": 10140.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6557.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4732.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5070.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5746.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5408.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5350.8, "maximum": 7414.68, "gross_charge": 7644.0, "discounted_cash": 11466.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7414.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5350.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6497.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6115.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL 18X83MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL 5MM*AR9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6078.8, "maximum": 8423.48, "gross_charge": 8684.0, "discounted_cash": 13026.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8423.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6078.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6513.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7381.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6947.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL ECCENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203722", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3445.04, "maximum": 4773.84, "gross_charge": 4921.49, "discounted_cash": 7382.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4183.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3691.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3445.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4773.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3445.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3691.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4183.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3937.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL FLEX LN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6036.94, "maximum": 8365.47, "gross_charge": 8624.2, "discounted_cash": 12936.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7330.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6468.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6036.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8365.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6036.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6468.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7330.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6899.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL FLEX*DW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205288", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6036.94, "maximum": 8365.47, "gross_charge": 8624.2, "discounted_cash": 12936.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7330.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6468.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6036.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8365.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6036.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6468.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7330.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6899.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL POROCOA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8570.8, "maximum": 11876.68, "gross_charge": 12244.0, "discounted_cash": 18366.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10407.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9183.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8570.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11876.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8570.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9183.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10407.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9795.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL STRYKER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103917", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8857.8, "maximum": 12274.38, "gross_charge": 12654.0, "discounted_cash": 18981.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10755.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9490.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8857.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12274.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8857.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9490.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10755.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10123.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL SZ10*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.16, "maximum": 5013.73, "gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL UNIVERS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101888", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5685.4, "maximum": 7878.34, "gross_charge": 8122.0, "discounted_cash": 12183.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6903.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6091.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5685.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7878.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5685.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6091.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6903.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6497.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL UNIVERS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6688.5, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 14332.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL UNIVERS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7560.0, "maximum": 10476.0, "gross_charge": 10800.0, "discounted_cash": 16200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7560.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10476.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7560.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM HUMERAL ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101889", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5387.2, "maximum": 7465.12, "gross_charge": 7696.0, "discounted_cash": 11544.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6541.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5387.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7465.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5387.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6541.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM KNEE TOTAL CEME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2013.64, "maximum": 2790.34, "gross_charge": 2876.64, "discounted_cash": 4314.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2445.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2157.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2013.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2790.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2013.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2157.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2445.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2301.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM KNEE TOTAL CEME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104497", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM LATERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7812.0, "maximum": 10825.2, "gross_charge": 11160.0, "discounted_cash": 16740.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9486.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8370.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7812.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7812.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8370.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9486.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM LONG ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM LONG ASCEND SZ", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM LPS ST*1987-25-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209814", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6916.0, "maximum": 9583.6, "gross_charge": 9880.0, "discounted_cash": 14820.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9583.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6916.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7410.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8398.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM M 36*5200-02-03", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6860.0, "maximum": 9506.0, "gross_charge": 9800.0, "discounted_cash": 14700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6860.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9506.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6860.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8330.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM MINI 4MM*113624", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5596.5, "maximum": 7755.15, "gross_charge": 7995.0, "discounted_cash": 11992.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7755.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5596.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5996.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6795.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM MINI HUMERAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101891", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7318.5, "maximum": 10141.35, "gross_charge": 10455.0, "discounted_cash": 15682.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8886.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7841.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7318.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10141.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7318.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7841.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8886.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8364.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM MODULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM MODULAR 13X6030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1576.82, "maximum": 2185.02, "gross_charge": 2252.6, "discounted_cash": 3378.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1914.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1689.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1576.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2185.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1576.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1689.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1914.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1802.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM MRS CUR*6485-3-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208838", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4393.33, "maximum": 6087.9, "gross_charge": 6276.19, "discounted_cash": 9414.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5334.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4707.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4393.33, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6087.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4393.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4707.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5334.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5020.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM PRESS 12X150*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2181.38, "maximum": 3022.77, "gross_charge": 3116.26, "discounted_cash": 4674.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2648.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2337.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2181.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3022.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2181.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2337.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2648.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2493.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM PRESS 16X150*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2181.38, "maximum": 3022.77, "gross_charge": 3116.26, "discounted_cash": 4674.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2648.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2337.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2181.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3022.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2181.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2337.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2648.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2493.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM PRESS 18X150*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209077", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2181.38, "maximum": 3022.77, "gross_charge": 3116.26, "discounted_cash": 4674.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2648.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2337.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2181.38, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3022.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2181.38, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2337.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2648.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2493.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM RADIAL*8WR0-M00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7585.2, "maximum": 10510.92, "gross_charge": 10836.0, "discounted_cash": 16254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9210.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8127.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7585.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10510.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7585.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8127.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9210.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8668.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM RADIAL*8WR0-S00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4226.04, "maximum": 5856.08, "gross_charge": 6037.2, "discounted_cash": 9055.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5131.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4527.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4226.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5856.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4226.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4527.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5131.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4829.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 10X60*1513-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206458", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1978.34, "maximum": 2741.41, "gross_charge": 2826.2, "discounted_cash": 4239.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2741.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2260.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 12X110*1513", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2725.45, "maximum": 3776.69, "gross_charge": 3893.5, "discounted_cash": 5840.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3776.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3114.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 12X60*1513-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2725.45, "maximum": 3776.69, "gross_charge": 3893.5, "discounted_cash": 5840.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3776.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3114.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 14X110*1513", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205655", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2725.45, "maximum": 3776.69, "gross_charge": 3893.5, "discounted_cash": 5840.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3776.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3114.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 14X60*1513-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205648", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1978.34, "maximum": 2741.41, "gross_charge": 2826.2, "discounted_cash": 4239.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2741.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2260.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 16X110*1513", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2725.45, "maximum": 3776.69, "gross_charge": 3893.5, "discounted_cash": 5840.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3776.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3114.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 16X60*1513-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205642", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1978.34, "maximum": 2741.41, "gross_charge": 2826.2, "discounted_cash": 4239.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2741.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2260.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 18X110*1513", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205748", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2725.45, "maximum": 3776.69, "gross_charge": 3893.5, "discounted_cash": 5840.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3776.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2725.45, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2920.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3309.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3114.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV 18X60*1513-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1978.34, "maximum": 2741.41, "gross_charge": 2826.2, "discounted_cash": 4239.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2741.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1978.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2119.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2402.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2260.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV SZ 5*AR950", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.16, "maximum": 5013.73, "gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV SZ 5*AR9501", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6688.5, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 14332.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103931", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5199.6, "maximum": 7205.16, "gross_charge": 7428.0, "discounted_cash": 11142.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6313.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5571.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5199.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7205.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5199.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5571.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6313.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5942.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103952", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4522.7, "maximum": 6267.17, "gross_charge": 6461.0, "discounted_cash": 9691.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5491.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4845.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4522.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6267.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4522.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4845.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5491.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5168.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4331.6, "maximum": 6002.36, "gross_charge": 6188.0, "discounted_cash": 9282.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5259.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6002.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4331.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5259.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4950.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.3, "maximum": 5013.93, "gross_charge": 5169.0, "discounted_cash": 7753.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104296", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3844.4, "maximum": 5327.24, "gross_charge": 5492.0, "discounted_cash": 8238.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4668.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4119.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3844.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5327.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3844.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4119.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4668.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4393.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV *AR-95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202901", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6217.12, "maximum": 8615.15, "gross_charge": 8881.6, "discounted_cash": 13322.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7549.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6661.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6217.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8615.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6217.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6661.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7549.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7105.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV SZ 6*A", "code_information": [{"code": "3100203307", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4328.87, "discounted_cash": 6493.31, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM REV UNIV SZ 8*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.16, "maximum": 5013.73, "gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV SZ 9*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203430", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.16, "maximum": 5013.73, "gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV SZ11*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3618.16, "maximum": 5013.73, "gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5013.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3618.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3876.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4393.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4135.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV SZ12*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206062", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3527.7, "maximum": 4888.39, "gross_charge": 5039.58, "discounted_cash": 7559.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4283.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3779.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3527.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4888.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3527.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3779.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4283.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4031.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM REV UNIV SZ13*A", "code_information": [{"code": "3100205663", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5168.8, "discounted_cash": 7753.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM S 32*5200-02-03", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4459.0, "maximum": 6178.9, "gross_charge": 6370.0, "discounted_cash": 9555.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6178.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6433.7, "maximum": 8915.27, "gross_charge": 9191.0, "discounted_cash": 13786.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7812.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6893.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6433.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8915.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6433.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6893.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7812.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7352.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SHOULDR STD 11M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204302", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SHOULDR STD 14M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202774", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6304.48, "maximum": 8736.2, "gross_charge": 9006.4, "discounted_cash": 13509.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8736.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7205.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SHOULDR STD 16M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5824.0, "maximum": 8070.4, "gross_charge": 8320.0, "discounted_cash": 12480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8070.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SHOULDR STD 5MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6304.48, "maximum": 8736.2, "gross_charge": 9006.4, "discounted_cash": 13509.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8736.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7205.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SPLINED KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3397.8, "maximum": 4708.38, "gross_charge": 4854.0, "discounted_cash": 7281.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4125.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3640.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3397.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4708.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3397.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3640.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4125.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3883.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SPLINED KNEE 15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208845", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SPLINED KNEE 16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3397.94, "maximum": 4708.57, "gross_charge": 4854.2, "discounted_cash": 7281.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4126.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3640.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3397.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4708.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3397.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3640.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4126.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3883.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM SPLINED KNEE12X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3789.24, "maximum": 5250.8, "gross_charge": 5413.2, "discounted_cash": 8119.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4601.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4059.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3789.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5250.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3789.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4059.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4601.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4330.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM STAND CEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7812.0, "maximum": 10825.2, "gross_charge": 11160.0, "discounted_cash": 16740.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9486.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8370.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7812.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10825.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7812.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8370.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9486.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8928.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM STAND CEM 3*010", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TALAR*200347901", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101893", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5869.5, "maximum": 8133.45, "gross_charge": 8385.0, "discounted_cash": 12577.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7127.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6288.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5869.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8133.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5869.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6288.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7127.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5132.4, "maximum": 7112.04, "gross_charge": 7332.0, "discounted_cash": 10998.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6232.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5499.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5132.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7112.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5132.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5499.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6232.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5865.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5915.0, "maximum": 8196.5, "gross_charge": 8450.0, "discounted_cash": 12675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7182.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6337.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5915.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8196.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5915.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6337.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7182.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6415.5, "maximum": 8890.05, "gross_charge": 9165.0, "discounted_cash": 13747.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7790.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6873.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6415.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8890.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6415.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6873.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7790.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7332.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TAPER 13X90*86-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TIB TRAY 71MM*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6442.8, "maximum": 8927.88, "gross_charge": 9204.0, "discounted_cash": 13806.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7823.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6903.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6442.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8927.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6442.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6903.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7823.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7363.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM TIBIAL FINNED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM VERSYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6097.0, "maximum": 8448.7, "gross_charge": 8710.0, "discounted_cash": 13065.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7403.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6532.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6097.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8448.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6097.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6532.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7403.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6968.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM XS 28MM*5200-02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208059", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4459.0, "maximum": 6178.9, "gross_charge": 6370.0, "discounted_cash": 9555.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6178.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4459.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4777.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5414.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEM ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEMLESS M 36*5200-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6370.0, "maximum": 8827.0, "gross_charge": 9100.0, "discounted_cash": 13650.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8827.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6370.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6825.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7735.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEMLESS SHOULDER 32", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.0, "maximum": 11203.5, "gross_charge": 11550.0, "discounted_cash": 17325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEMLESS SHOULDER 34", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.0, "maximum": 11203.5, "gross_charge": 11550.0, "discounted_cash": 17325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEMLESS SHOULDER 36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8085.0, "maximum": 11203.5, "gross_charge": 11550.0, "discounted_cash": 17325.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11203.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8085.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8662.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9817.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEMLESS SHOULDER 38", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10815.0, "maximum": 14986.5, "gross_charge": 15450.0, "discounted_cash": 23175.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13132.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11587.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10815.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14986.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10815.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11587.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13132.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT 10.3X24*H74939", "code_information": [{"code": "3100206611", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.28, "discounted_cash": 622.92, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 10.3X26*H74969", "code_information": [{"code": "3100206612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.28, "discounted_cash": 622.92, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 7X14X24*UESS-0", "code_information": [{"code": "3100206069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 499.8, "discounted_cash": 749.7, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 7X3 DBL PIGTL*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 145.6, "maximum": 201.76, "gross_charge": 208.0, "discounted_cash": 312.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 201.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 156.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 176.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT 8.3X24*H749393", "code_information": [{"code": "3100206607", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 8.3X26*H749393", "code_information": [{"code": "3100206609", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 8.3X26*H749393", "code_information": [{"code": "3100206610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 415.28, "discounted_cash": 622.92, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 8.3X28*H749393", "code_information": [{"code": "3100206608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT 8X18*G23419", "code_information": [{"code": "3100206675", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.28, "discounted_cash": 328.92, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT ABRE 16X80*AB9", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT BLACK 7X26*G46", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209503", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 359.03, "maximum": 497.52, "gross_charge": 512.91, "discounted_cash": 769.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 359.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 497.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 359.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 410.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT COLONIC 22X120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT COLONIC 22X60*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT COLONIC 22X90*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT CONT 8X22*M006", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 256.03, "maximum": 354.78, "gross_charge": 365.76, "discounted_cash": 548.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 310.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 274.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 256.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 354.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 256.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 274.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 310.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT CONT 8X26*M006", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 256.03, "maximum": 354.78, "gross_charge": 365.76, "discounted_cash": 548.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 310.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 274.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 256.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 354.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 256.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 274.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 310.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT CONT 8X28*M006", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209438", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 256.03, "maximum": 354.78, "gross_charge": 365.76, "discounted_cash": 548.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 310.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 274.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 256.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 354.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 256.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 274.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 310.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT DUODENAL 22X60", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203569", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT DUODENAL 22X90", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT DUODENAL22X120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4540.9, "maximum": 6292.39, "gross_charge": 6487.0, "discounted_cash": 9730.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6292.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4540.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4865.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5513.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5189.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT ENDOUR 7X26*G1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.8, "maximum": 461.17, "gross_charge": 475.44, "discounted_cash": 713.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 404.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 356.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 461.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 356.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 404.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 380.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT ENDOUR 7X28*G1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204056", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 332.8, "maximum": 461.17, "gross_charge": 475.44, "discounted_cash": 713.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 404.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 356.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 461.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 332.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 356.58, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 404.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 380.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT FILIFORM", "code_information": [{"code": "C1877", "type": "HCPCS"}, {"code": "3100102240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 372.4, "maximum": 516.04, "gross_charge": 532.0, "discounted_cash": 798.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 516.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 372.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 425.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT FILIFORM 6X24*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 359.03, "maximum": 497.52, "gross_charge": 512.91, "discounted_cash": 769.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 359.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 497.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 359.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 410.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT FILIFORM 6X28*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 359.03, "maximum": 497.52, "gross_charge": 512.91, "discounted_cash": 769.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 384.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 359.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 497.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 359.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 384.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 410.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAF BIFUR*ESB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14523.6, "maximum": 20125.56, "gross_charge": 20748.0, "discounted_cash": 31122.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17635.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15561.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14523.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20125.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14523.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15561.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17635.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16598.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAFT", "code_information": [{"code": "3100103718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8567.0, "discounted_cash": 12850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT GRAFT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5450.9, "maximum": 7553.39, "gross_charge": 7787.0, "discounted_cash": 11680.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7553.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5450.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5840.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6618.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6229.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAFT BIF*ETBF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13965.0, "maximum": 19351.5, "gross_charge": 19950.0, "discounted_cash": 29925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16957.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14962.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13965.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19351.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13965.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14962.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16957.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAFT LIMB*ETL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205191", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9318.4, "maximum": 12912.64, "gross_charge": 13312.0, "discounted_cash": 19968.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11315.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9984.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9318.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12912.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9318.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9984.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11315.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10649.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAFT LIMB*ETL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209676", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9318.4, "maximum": 12912.64, "gross_charge": 13312.0, "discounted_cash": 19968.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11315.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9984.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9318.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12912.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9318.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9984.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11315.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10649.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT GRAFT*ETEW2424", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8963.5, "maximum": 12420.85, "gross_charge": 12805.0, "discounted_cash": 19207.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10884.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9603.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8963.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12420.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8963.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9603.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10884.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10244.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 4.7 X 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204141", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 4.7 X 22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 4.7 X 24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 4.7 X 26", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 4.7 X 28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204145", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 4.7 X 30", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 7 X 20*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204147", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 7 X 22*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204148", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 7 X 24*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 7 X 26*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 7 X 28*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204151", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 8 X 26*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY 8X22*778", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209312", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 199.5, "maximum": 276.45, "gross_charge": 285.0, "discounted_cash": 427.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 242.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 213.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 276.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 213.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 242.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 228.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY OPT 6 X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 240.8, "maximum": 333.68, "gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 333.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY OPT 6X22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 240.8, "maximum": 333.68, "gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 333.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY OPT 6X32", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205869", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 240.8, "maximum": 333.68, "gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 333.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY OPT 7 X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 240.8, "maximum": 333.68, "gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 333.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT INLAY OPT 8X22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 10X12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 10X15", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 10X5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 10X7*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 10X9*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 7X12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PANCREAT 7X15*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.0, "maximum": 329.8, "gross_charge": 340.0, "discounted_cash": 510.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PERCUFL 7X28*M", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207626", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 360.57, "maximum": 499.64, "gross_charge": 515.1, "discounted_cash": 772.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 437.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 386.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 360.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 499.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 360.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 386.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 437.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT ANTE CAROTID", "code_information": [{"code": "37218", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLACEMT RETRO CAROTID", "code_information": [{"code": "37217", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLC ARTERY ADD", "code_information": [{"code": "37237", "type": "CPT"}, {"code": "3480103025", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4630.93, "maximum": 8133.27, "gross_charge": 6615.62, "discounted_cash": 9923.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5623.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4961.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4630.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6417.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4630.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4961.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5623.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5292.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLC ARTERY INI", "code_information": [{"code": "37236", "type": "CPT"}, {"code": "3480103024", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8133.27, "maximum": 13358.96, "gross_charge": 13679.55, "discounted_cash": 16839.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11627.61, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11607.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10259.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9575.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13269.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9575.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11562.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10259.66, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13358.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11627.61, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10943.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLC VEIN ADDL", "code_information": [{"code": "37239", "type": "CPT"}, {"code": "3480103027", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4630.93, "maximum": 8133.27, "gross_charge": 6615.62, "discounted_cash": 9923.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5623.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4961.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4630.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6417.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4630.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4961.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5623.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5292.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLC VEIN INTL", "code_information": [{"code": "37238", "type": "CPT"}, {"code": "3480103026", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8133.27, "maximum": 13358.96, "gross_charge": 13679.55, "discounted_cash": 16839.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11627.61, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11607.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10259.66, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9575.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13269.16, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9575.68, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11562.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10259.66, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13358.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11627.61, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10943.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT PLMT CTR DIALY", "code_information": [{"code": "36908", "type": "CPT"}, {"code": "3480103162", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STENT POSIT URE DB*S", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 26.2, "maximum": 36.31, "gross_charge": 37.44, "discounted_cash": 56.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 29.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT POSITIONER*G17", "code_information": [{"code": "3100204231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.16, "discounted_cash": 84.24, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT RESONAN6X30*RM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2083.9, "maximum": 2887.69, "gross_charge": 2977.0, "discounted_cash": 4465.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2530.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2232.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2083.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2887.69, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2083.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2232.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2530.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2381.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SET PED'S SMAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 267.54, "maximum": 370.73, "gross_charge": 382.2, "discounted_cash": 573.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 324.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 286.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 267.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 370.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 267.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 286.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 324.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 305.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SILHOUETTE*B38", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 714.0, "maximum": 989.4, "gross_charge": 1020.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SILICONE 6X26*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 321.44, "maximum": 445.42, "gross_charge": 459.2, "discounted_cash": 688.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 390.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 445.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 390.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 367.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SILICONE 6X28*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 321.44, "maximum": 445.42, "gross_charge": 459.2, "discounted_cash": 688.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 390.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 445.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 390.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 367.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SILICONE 6X30*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206359", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 321.44, "maximum": 445.42, "gross_charge": 459.2, "discounted_cash": 688.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 390.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 445.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 321.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 344.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 390.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 367.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SOF-FLEX 10X24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209557", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 366.49, "maximum": 507.85, "gross_charge": 523.56, "discounted_cash": 785.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 445.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 392.67, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 366.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 507.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 366.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 392.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 445.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 418.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT SOF-FLEX 10X28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 358.28, "maximum": 496.47, "gross_charge": 511.83, "discounted_cash": 767.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 435.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 358.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 496.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 358.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 383.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 435.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 409.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT STENOSTENT 26C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 649.74, "maximum": 900.35, "gross_charge": 928.2, "discounted_cash": 1392.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 788.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 649.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 900.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 649.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 788.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 742.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT STENOSTENT 28C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 649.74, "maximum": 900.35, "gross_charge": 928.2, "discounted_cash": 1392.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 788.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 649.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 900.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 649.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 788.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 742.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT TRIA 8FX24CM*M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 713.87, "maximum": 989.22, "gross_charge": 1019.82, "discounted_cash": 1529.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 866.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 764.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 713.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 713.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 764.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 866.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 815.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT UNIVERSA 6X30*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 226.8, "maximum": 314.28, "gross_charge": 324.0, "discounted_cash": 486.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 314.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 226.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 243.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 275.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 259.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT UNIVERSAL 5X24", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203820", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URET DB PGTL*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 304.19, "maximum": 421.52, "gross_charge": 434.56, "discounted_cash": 651.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 369.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 325.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 304.19, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 421.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 304.19, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 325.92, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 369.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 347.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URET DBL FIRM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 219.24, "maximum": 303.8, "gross_charge": 313.2, "discounted_cash": 469.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 219.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 303.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 219.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 250.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 4.7X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203093", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203096", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 244.44, "maximum": 338.72, "gross_charge": 349.2, "discounted_cash": 523.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 338.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203320", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 360.57, "maximum": 499.64, "gross_charge": 515.1, "discounted_cash": 772.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 437.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 386.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 360.57, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 499.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 360.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 386.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 437.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 412.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203352", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 244.44, "maximum": 338.72, "gross_charge": 349.2, "discounted_cash": 523.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 261.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 338.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 244.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 261.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 296.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 279.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203377", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 182.0, "maximum": 252.2, "gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 182.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 195.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 221.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 208.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 274.14, "maximum": 379.89, "gross_charge": 391.64, "discounted_cash": 587.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 332.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 293.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 274.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 379.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 274.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 293.73, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 332.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 313.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.13, "maximum": 479.64, "gross_charge": 494.48, "discounted_cash": 741.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 370.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.13, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 479.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 370.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 395.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204139", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204140", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 214.03, "maximum": 296.58, "gross_charge": 305.76, "discounted_cash": 458.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 296.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 214.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 229.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 6X 26", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 298.22, "maximum": 413.25, "gross_charge": 426.04, "discounted_cash": 639.06, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 362.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 319.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 298.22, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 413.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 298.22, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 319.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 362.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 340.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 7 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 450.3, "maximum": 623.99, "gross_charge": 643.29, "discounted_cash": 964.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 546.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 482.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 450.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 623.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 450.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 482.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 546.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 514.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 7 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 7 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203098", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 7 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 7 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 240.8, "maximum": 333.68, "gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 333.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 8 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 450.3, "maximum": 623.99, "gross_charge": 643.29, "discounted_cash": 964.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 546.79, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 482.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 450.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 623.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 450.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 482.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 546.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 514.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 8 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETERAL 8 X 2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 271.6, "maximum": 376.36, "gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 376.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 329.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URETH 8.5X22*R", "code_information": [{"code": "3100206604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETH 8.5X26*R", "code_information": [{"code": "3100206605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URETH 805X24*R", "code_information": [{"code": "3100206606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STENT URO PERCUF", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "3100101897", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 394.8, "maximum": 547.08, "gross_charge": 564.0, "discounted_cash": 846.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 479.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 423.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 394.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 547.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 394.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 423.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 479.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 451.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENT URO REASON", "code_information": [{"code": "C1876", "type": "HCPCS"}, {"code": "3100101898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1760.66, "maximum": 2439.78, "gross_charge": 2515.24, "discounted_cash": 3772.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2137.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1886.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1760.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2439.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1760.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1886.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2137.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2012.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STEREO NAVIGATION SP", "code_information": [{"code": "61783", "type": "CPT"}, {"code": "3480102134", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 389.9, "maximum": 5178.02, "gross_charge": 557.0, "discounted_cash": 835.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 473.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 417.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 389.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 540.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 389.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 417.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 473.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 445.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STEREOSCOPIC X-RAY GUIDANCE", "code_information": [{"code": "G6002", "type": "HCPCS"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STEREOTACTIC RADIATION TRMT", "code_information": [{"code": "77432", "type": "CPT"}], "standard_charges": [{"minimum": 586.07, "maximum": 586.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 586.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STERI-STRIP HEMIGARD", "code_information": [{"code": "3100208237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.64, "discounted_cash": 249.96, "setting": "both", "billing_class": "facility"}]}, {"description": "STERILE CLEAR SLEEVE", "code_information": [{"code": "3100204331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STERNAL DEBRIDEMENT", "code_information": [{"code": "21627", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STERNAL LINER SHELL", "code_information": [{"code": "3100103981", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3681.0, "discounted_cash": 5521.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STEROSTAC STIM OF SP", "code_information": [{"code": "63610", "type": "CPT"}, {"code": "3430100742", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4565.79, "gross_charge": 4707.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4565.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3294.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3530.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4000.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3765.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STETHOSCOPE", "code_information": [{"code": "3100101899", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STETHOSCOPE LITTMANN", "code_information": [{"code": "3100101900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STICK SWITCH", "code_information": [{"code": "3100102242", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 513.0, "discounted_cash": 769.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STICK SWITCH", "code_information": [{"code": "3100103719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIM CLIP TEDAN*1100", "code_information": [{"code": "3100207573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1215.0, "discounted_cash": 1822.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMUBLAS PUTTY", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STIMUBLAST GEL", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STIMUBLAST GEL 1CC*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202834", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMUBLAST GEL 5CC*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULAN RAP CURE 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204068", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULAN RAP CURE 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204208", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4631.9, "maximum": 6418.49, "gross_charge": 6617.0, "discounted_cash": 9925.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5624.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4962.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4631.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6418.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4631.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4962.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5624.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5293.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULANT 5CC*620-00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210091", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULANTS SYNTHETIC", "code_information": [{"code": "80371", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STIMULATED DILATOR*9", "code_information": [{"code": "3100203406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.5, "discounted_cash": 1856.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATED IUI CASE RATE", "code_information": [{"code": "S4035", "type": "HCPCS"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STIMULATING DIL KIT*", "code_information": [{"code": "3100208880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATING PROBE*27", "code_information": [{"code": "3100209749", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.25, "discounted_cash": 921.38, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATION LEAD*406", "code_information": [{"code": "C1778", "type": "HCPCS"}, {"code": "3100206292", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3549.0, "maximum": 4917.9, "gross_charge": 5070.0, "discounted_cash": 7605.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4917.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3549.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3802.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4309.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4056.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STIMULATION PACING HEART", "code_information": [{"code": "93623", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STIMULATOR CHECKPOIN", "code_information": [{"code": "3100204224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2120.0, "discounted_cash": 3180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR*97725", "code_information": [{"code": "3100207036", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 116.0, "discounted_cash": 174.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STM SPLINED 10X80*14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STM SPLINED 14X80*14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOCKINETTE", "code_information": [{"code": "3100101903", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE", "code_information": [{"code": "3100101904", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 10.7, "discounted_cash": 16.05, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE", "code_information": [{"code": "3100103528", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE", "code_information": [{"code": "3100104506", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKINETTE", "code_information": [{"code": "3100104758", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING", "code_information": [{"code": "3100101905", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING", "code_information": [{"code": "3100103530", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100101906", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100103529", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100103531", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100103532", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100103533", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 82.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100104439", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED", "code_information": [{"code": "3100104442", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STOCKING TED XL LONG", "code_information": [{"code": "3100206043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.44, "discounted_cash": 33.66, "setting": "both", "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [{"code": "327", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10767.59, "maximum": 10767.59, "discounted_cash": 27882.39, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10767.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [{"code": "326", "type": "MS-DRG"}], "standard_charges": [{"minimum": 20616.61, "maximum": 20616.61, "discounted_cash": 56704.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20616.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "328", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5925.77, "maximum": 5925.77, "discounted_cash": 17833.16, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5925.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STONE BASKET 1.7FR*N", "code_information": [{"code": "3100207040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.39, "discounted_cash": 927.59, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE BASKET 1.9FR*M", "code_information": [{"code": "3100205758", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 780.63, "discounted_cash": 1170.95, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE BASKET 1.9FR*N", "code_information": [{"code": "3100207785", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE BASKET 5FR*G07", "code_information": [{"code": "3100206643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1523.82, "discounted_cash": 2285.73, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE BSKT/EXTRA 3 W", "code_information": [{"code": "3100204357", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.56, "discounted_cash": 1523.34, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE BSKT/EXTRA 6 W", "code_information": [{"code": "3100204358", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1015.56, "discounted_cash": 1523.34, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE COLLECTION BTL", "code_information": [{"code": "3100208286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 118.0, "discounted_cash": 177.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STONE ENTRAP*NTP-028", "code_information": [{"code": "3100203001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 582.0, "discounted_cash": 873.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STORAGE/YEAR EMBRYO(S)", "code_information": [{"code": "89342", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR OOCYTE(S)", "code_information": [{"code": "89346", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR REPROD TISSUE", "code_information": [{"code": "89344", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STORAGE/YEAR SPERM/SEMEN", "code_information": [{"code": "89343", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STORE PREV FROZ EMBRYOS", "code_information": [{"code": "S4027", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STR KNIFE DVIU*WA350", "code_information": [{"code": "3100209300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.5, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "STR MARKERS SPEC ANAL ADDL", "code_information": [{"code": "81266", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 304.81, "discounted_cash": 489.68, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 304.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STR MARKERS SPECIMEN ANAL", "code_information": [{"code": "81265", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 233.07, "discounted_cash": 374.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 233.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAP WRIST TOWER*10", "code_information": [{"code": "3100205951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.64, "discounted_cash": 243.96, "setting": "both", "billing_class": "facility"}]}, {"description": "STRAPPING OF ANKLE AND/OR FT", "code_information": [{"code": "29540", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF CHEST", "code_information": [{"code": "29200", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF ELBOW OR WRIST", "code_information": [{"code": "29260", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HAND OR FINGER", "code_information": [{"code": "29280", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF HIP", "code_information": [{"code": "29520", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF KNEE", "code_information": [{"code": "29530", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF SHOULDER", "code_information": [{"code": "29240", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAPPING OF TOES", "code_information": [{"code": "29550", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRATOFUSE DBM100*BA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204342", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 525.0, "maximum": 727.5, "gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 727.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 525.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 562.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 637.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRATTICE 9X18.5CM*C", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100104243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4968.6, "maximum": 6885.06, "gross_charge": 7098.0, "discounted_cash": 10647.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6033.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5323.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4968.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6885.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4968.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5323.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6033.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5678.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRATTICE TM", "code_information": [{"code": "Q4130", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRAVIX PL 2 X 4CM*P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3039.4, "maximum": 4211.74, "gross_charge": 4342.0, "discounted_cash": 6513.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3690.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3256.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3039.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4211.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3039.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3256.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3690.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3473.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRAVIX PL 3 X 6CM*P", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4833.01, "maximum": 6697.17, "gross_charge": 6904.3, "discounted_cash": 10356.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5868.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5178.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4833.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6697.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4833.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5178.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5868.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5523.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREP A AG IA", "code_information": [{"code": "87430", "type": "CPT"}], "standard_charges": [{"minimum": 16.81, "maximum": 24.03, "discounted_cash": 27.0, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREP A DNA DIR PROBE", "code_information": [{"code": "87650", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREP A DNA QUANT", "code_information": [{"code": "87652", "type": "CPT"}], "standard_charges": [{"minimum": 41.76, "maximum": 41.83, "discounted_cash": 67.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREP A NAP AMPLIFIE", "code_information": [{"code": "87651", "type": "CPT"}, {"code": "3440103059", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 35.09, "maximum": 278.39, "gross_charge": 287.0, "discounted_cash": 56.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 243.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 215.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 200.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 278.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 200.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 215.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 44.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 243.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 37.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 38.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREP B ASSAY W/OPTIC", "code_information": [{"code": "87802", "type": "CPT"}], "standard_charges": [{"minimum": 12.73, "maximum": 24.03, "discounted_cash": 20.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREP B DNA AMP PROBE", "code_information": [{"code": "87653", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREPTOCOCCUS GROUP", "code_information": [{"code": "87880", "type": "CPT"}, {"code": "3440101210", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 16.53, "maximum": 105.73, "gross_charge": 109.0, "discounted_cash": 26.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 105.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 76.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 92.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 87.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREPTOKINASE ANTIBODY", "code_information": [{"code": "86590", "type": "CPT"}], "standard_charges": [{"minimum": 12.66, "maximum": 30.26, "discounted_cash": 20.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STREPTOMYCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3000", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.06, "maximum": 23.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STREPTOZOCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9320", "type": "HCPCS"}], "standard_charges": [{"minimum": 370.18, "maximum": 370.18, "discounted_cash": 594.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 370.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRESS BREAKER", "code_information": [{"code": "D6940", "type": "HCPCS"}], "standard_charges": [{"minimum": 202.48, "maximum": 202.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 202.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRESS MGMT CLASS", "code_information": [{"code": "S9454", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRESS POST", "code_information": [{"code": "3100101907", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1056.0, "discounted_cash": 1584.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STRESS TTE COMPLETE", "code_information": [{"code": "93351", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRESS TTE ONLY", "code_information": [{"code": "93350", "type": "CPT"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRIP ILEUM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2465.74, "gross_charge": 2542.0, "discounted_cash": 3813.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2160.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1906.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1779.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2465.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1779.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1906.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2160.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2033.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRIP INTEGRA MOZAIK", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104166", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 1556.0, "discounted_cash": 2334.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRIP INTEGRA MOZAIK", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "3100101908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2552.26, "gross_charge": 2631.2, "discounted_cash": 3946.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2236.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1973.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1841.84, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2552.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1841.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1973.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2236.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2104.96, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRIP MAS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3640.0, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRIP VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100101909", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2784.87, "gross_charge": 2871.0, "discounted_cash": 4306.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2440.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2153.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2009.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2784.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2009.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2153.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2440.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2296.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRIP VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100103534", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3202.94, "gross_charge": 3302.0, "discounted_cash": 4953.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2806.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2311.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3202.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2311.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2476.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2806.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2641.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRTCTC CPTR ASST PX", "code_information": [{"code": "61782", "type": "CPT"}, {"code": "3480102133", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 324.1, "maximum": 5831.73, "gross_charge": 463.0, "discounted_cash": 694.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 393.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 347.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 324.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 449.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 324.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 347.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 393.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 370.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "STRUT 5X14X11*624104", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203652", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STRUT MEDIUM*7107-57", "code_information": [{"code": "3100209117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4619.16, "discounted_cash": 6928.74, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET", "code_information": [{"code": "3100101910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET CLEANING*AR-8", "code_information": [{"code": "3100210124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLET GLIDERITE RIG", "code_information": [{"code": "3100104739", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.0, "discounted_cash": 205.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STYLUS VIVAIR ARC*CA", "code_information": [{"code": "3100204259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUB GR F/S/N/H/F/G/M", "code_information": [{"code": "15276", "type": "CPT"}, {"code": "3480101282", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 2188.07, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUB GRFT F/S/N/H/F/G", "code_information": [{"code": "15275", "type": "CPT"}, {"code": "3480101371", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 616.0, "maximum": 2214.46, "gross_charge": 880.0, "discounted_cash": 2791.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1924.16, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 853.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 616.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2214.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 748.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 704.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1860.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1898.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUB OT CUR STAT 0% I", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100401", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SUB OT CUR STAT 100%", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100402", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "SUB OT CUR STAT 20-3", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100400", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "SUB OT CUR STAT 40-5", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100403", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "SUB OT CUR STAT 60-7", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100404", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "SUB OT CUR STAT 80-9", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100405", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "SUB OT CUR STAT1-19%", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3320100393", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "SUB OT D/C STAT 0% I", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100415", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SUB OT D/C STAT 100%", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100416", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "SUB OT D/C STAT 20-3", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100406", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "SUB OT D/C STAT 40-5", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100417", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "SUB OT D/C STAT 60-7", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100418", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "SUB OT D/C STAT 80-9", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100419", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "SUB OT D/C STAT1-19%", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3320100413", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "SUB OT PR STAT 0% IM", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100408", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CH"}, {"description": "SUB OT PR STAT 100%", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100409", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CN"}, {"description": "SUB OT PR STAT 20-39", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100407", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CJ"}, {"description": "SUB OT PR STAT 40-59", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100410", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CK"}, {"description": "SUB OT PR STAT 60-79", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100411", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CL"}, {"description": "SUB OT PR STAT 80-99", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100412", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CM"}, {"description": "SUB OT PR STAT1-19%", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3320100394", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GO|CI"}, {"description": "SUB PT CUR STAT 0% I", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100533", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "SUB PT CUR STAT 100%", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100534", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "SUB PT CUR STAT 20-3", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100532", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "SUB PT CUR STAT 40-5", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100535", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "SUB PT CUR STAT 60-7", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100536", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "SUB PT CUR STAT 80-9", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100537", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "SUB PT CUR STAT1-19%", "code_information": [{"code": "G8993", "type": "HCPCS"}, {"code": "3330100525", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "SUB PT D/C STAT 0% I", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100547", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "SUB PT D/C STAT 100%", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100548", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "SUB PT D/C STAT 20-3", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100538", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "SUB PT D/C STAT 40-5", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100549", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "SUB PT D/C STAT 60-7", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100550", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "SUB PT D/C STAT 80-9", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100551", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "SUB PT D/C STAT1-19%", "code_information": [{"code": "G8995", "type": "HCPCS"}, {"code": "3330100545", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "SUB PT PR STAT 0% IM", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100540", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CH"}, {"description": "SUB PT PR STAT 100%", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100541", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CN"}, {"description": "SUB PT PR STAT 20-39", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100539", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CJ"}, {"description": "SUB PT PR STAT 40-59", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100542", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CK"}, {"description": "SUB PT PR STAT 60-79", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100543", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CL"}, {"description": "SUB PT PR STAT 80-99", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100544", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CM"}, {"description": "SUB PT PR STAT1-19%", "code_information": [{"code": "G8994", "type": "HCPCS"}, {"code": "3330100526", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "billing_class": "facility"}], "modifiers": "GP|CI"}, {"description": "SUBCUTANEOUS HORMONE", "code_information": [{"code": "11980", "type": "CPT"}, {"code": "3480103287", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1338.6, "gross_charge": 1380.0, "discounted_cash": 609.87, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 420.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1338.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 966.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 418.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1035.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 483.83, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1173.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1104.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 406.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 414.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBMUCOUS RESECTION", "code_information": [{"code": "30140", "type": "CPT"}, {"code": "3480101828", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT OBSERVATI", "code_information": [{"code": "99225", "type": "CPT"}, {"code": "3500102297", "type": "CDM"}, {"code": "982", "type": "RC"}], "standard_charges": [{"minimum": 262.5, "maximum": 363.75, "gross_charge": 375.0, "discounted_cash": 562.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 318.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 281.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 363.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 281.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 318.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBSEQUENT REPAIR OF NERVE", "code_information": [{"code": "64872", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6624.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6624.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/DEB", "code_information": [{"code": "29906", "type": "CPT"}], "standard_charges": [{"minimum": 3461.21, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/EXC", "code_information": [{"code": "29905", "type": "CPT"}], "standard_charges": [{"minimum": 3461.21, "maximum": 3461.21, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FB RMVL", "code_information": [{"code": "29904", "type": "CPT"}], "standard_charges": [{"minimum": 3461.21, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR ARTHRO W/FUSION", "code_information": [{"code": "29907", "type": "CPT"}], "standard_charges": [{"minimum": 7500.92, "maximum": 7500.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUBTALAR IMPLANT*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1992.9, "maximum": 2761.59, "gross_charge": 2847.0, "discounted_cash": 4270.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2761.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1992.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2135.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2419.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2277.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUBTEMPORAL DECOMPRESSION", "code_information": [{"code": "61340", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCCINYCHOLINE CHLORIDE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0330", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.53, "maximum": 0.53, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUCTION CURETTE", "code_information": [{"code": "3100101911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION CURETTE", "code_information": [{"code": "3100103535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION CURETTE", "code_information": [{"code": "3100103536", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION CURETTE 6MM*", "code_information": [{"code": "3100209717", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.68, "discounted_cash": 73.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION DISP", "code_information": [{"code": "3100101912", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION DISP", "code_information": [{"code": "3100103537", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.0, "discounted_cash": 24.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION DISP", "code_information": [{"code": "3100103538", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION FRAZIER ANG", "code_information": [{"code": "3100104086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY HEAD&NECK", "code_information": [{"code": "15876", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY LW", "code_information": [{"code": "15879", "type": "CPT"}, {"code": "3340102446", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7674.64, "gross_charge": 7912.0, "discounted_cash": 5491.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3785.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7674.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5538.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3770.79, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5934.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4356.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6725.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6329.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3660.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3734.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION LIPECTOMY UPR EXTREM", "code_information": [{"code": "15878", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3196.88, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3196.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUCTION TIP", "code_information": [{"code": "3100101913", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 553.0, "discounted_cash": 829.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TIP", "code_information": [{"code": "3100103539", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 601.0, "discounted_cash": 901.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TIP", "code_information": [{"code": "3100103986", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.0, "discounted_cash": 1023.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TUBE", "code_information": [{"code": "3100101914", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 246.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION TUBE", "code_information": [{"code": "3100103540", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTION VALVE", "code_information": [{"code": "3100101915", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUCTIONER", "code_information": [{"code": "3100101916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUAL", "code_information": [{"code": "84377", "type": "CPT"}], "standard_charges": [{"minimum": 5.5, "maximum": 20.92, "discounted_cash": 8.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUGARS MULTIPLE QUANT", "code_information": [{"code": "84379", "type": "CPT"}], "standard_charges": [{"minimum": 11.53, "maximum": 40.05, "discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUAL", "code_information": [{"code": "84376", "type": "CPT"}], "standard_charges": [{"minimum": 5.5, "maximum": 20.92, "discounted_cash": 8.84, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUGARS SINGLE QUANT", "code_information": [{"code": "84378", "type": "CPT"}], "standard_charges": [{"minimum": 11.53, "maximum": 40.05, "discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SULFAMETHOXAZOLE/TMP", "code_information": [{"code": "3400300178", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 19.9, "discounted_cash": 29.85, "setting": "both", "billing_class": "facility"}]}, {"description": "SUMATRIPTAN SUCCINATE / 6 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3030", "type": "HCPCS"}], "standard_charges": [{"minimum": 51.25, "maximum": 51.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUPER SHEALTH 2.0*15", "code_information": [{"code": "3100209679", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.8, "discounted_cash": 55.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPER SHEALTH 2.7*15", "code_information": [{"code": "3100209680", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.8, "discounted_cash": 55.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPERIMPOSED PROSTHESIS", "code_information": [{"code": "D5954", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUPPLEMENTAL ELECTRICAL TEST", "code_information": [{"code": "92547", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUPPORT FOR ORGAN DONOR", "code_information": [{"code": "1990", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUPPORTER", "code_information": [{"code": "3100101917", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER", "code_information": [{"code": "3100103541", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER", "code_information": [{"code": "3100104448", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPORTER", "code_information": [{"code": "3100104449", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUPPRELIN LA IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9226", "type": "HCPCS"}], "standard_charges": [{"minimum": 44578.75, "maximum": 44578.75, "discounted_cash": 71611.25, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 44578.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUREFIL CAULK*61C103", "code_information": [{"code": "3100202286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 867.0, "discounted_cash": 1300.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURESCAN MRI NEUROST", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "3100104517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 21336.0, "maximum": 29565.6, "gross_charge": 30480.0, "discounted_cash": 45720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25908.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22860.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29565.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21336.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22860.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25908.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURF 3-4 14MM YEL*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1234.8, "maximum": 1711.08, "gross_charge": 1764.0, "discounted_cash": 2646.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1234.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1711.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1234.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1499.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1411.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURFACE ARTICULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101918", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURFACE ARTICULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103542", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1260.0, "maximum": 1746.0, "gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1746.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURFACE ARTICULAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103543", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURFACE EMG", "code_information": [{"code": "S3900", "type": "HCPCS"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURFACTANT ADMIN THRU TUBE", "code_information": [{"code": "94610", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 326.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURFACTOR /NUDYN PER 0.5 CC", "code_information": [{"code": "Q4233", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG ARTHROSCOPY - S", "code_information": [{"code": "29806", "type": "CPT"}, {"code": "3480101786", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 13173.57, "gross_charge": 13581.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13173.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9506.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10185.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11543.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10864.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF ANTERIOR", "code_information": [{"code": "D3501", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF MOLAR", "code_information": [{"code": "D3503", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG EXP ROOT SURF PREMOLAR", "code_information": [{"code": "D3502", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG PATH EXAM SAT B", "code_information": [{"code": "G0416", "type": "HCPCS"}, {"code": "3440101252", "type": "CDM"}, {"code": "314", "type": "RC"}], "standard_charges": [{"minimum": 182.01, "maximum": 1002.01, "gross_charge": 1033.0, "discounted_cash": 550.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1002.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 377.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 436.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 826.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 366.8, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 374.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG PATH EXAM SAT B", "code_information": [{"code": "G0417", "type": "HCPCS"}, {"code": "3440101253", "type": "CDM"}, {"code": "314", "type": "RC"}], "standard_charges": [{"minimum": 723.1, "maximum": 1002.01, "gross_charge": 1033.0, "discounted_cash": 1549.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1002.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 826.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PATH EXAM SAT B", "code_information": [{"code": "G0418", "type": "HCPCS"}, {"code": "3440101254", "type": "CDM"}, {"code": "314", "type": "RC"}], "standard_charges": [{"minimum": 723.1, "maximum": 1002.01, "gross_charge": 1033.0, "discounted_cash": 1549.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1002.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 826.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PATH EXAM SAT B", "code_information": [{"code": "G0419", "type": "HCPCS"}, {"code": "3440101255", "type": "CDM"}, {"code": "314", "type": "RC"}], "standard_charges": [{"minimum": 723.1, "maximum": 1002.01, "gross_charge": 1033.0, "discounted_cash": 1549.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1002.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 723.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 774.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 878.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 826.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURG PLACE CRANIOFACIAL IMPL", "code_information": [{"code": "D7993", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG PLACE ZYGOMATIC IMPL", "code_information": [{"code": "D7994", "type": "HCPCS"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REDCT FIBROUS TUBEROSIT", "code_information": [{"code": "D7972", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REDUCT OSSEOUSTUBEROSIT", "code_information": [{"code": "D7485", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REMOVAL OF IMPLANT BODY", "code_information": [{"code": "D6100", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES ANTERIOR", "code_information": [{"code": "D3471", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES MOLAR", "code_information": [{"code": "D3473", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG REP ROOT RES PREMOLAR", "code_information": [{"code": "D3472", "type": "HCPCS"}], "standard_charges": [{"minimum": 874.43, "maximum": 874.43, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 874.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURG SYSTEM ST SLEEV", "code_information": [{"code": "3100204325", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGARS CHROMATO TLC", "code_information": [{"code": "84375", "type": "CPT"}, {"code": "3440100995", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 39.0, "maximum": 166.84, "gross_charge": 172.0, "discounted_cash": 62.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 166.84, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 120.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 43.02, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 49.71, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 146.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 137.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 41.77, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY ELECTROCORTICOGRAM", "code_information": [{"code": "95829", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY FOR URETHRA POUCH", "code_information": [{"code": "53240", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY OF BREAST CA", "code_information": [{"code": "19370", "type": "CPT"}, {"code": "3480101414", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 8347.82, "gross_charge": 8606.0, "discounted_cash": 5834.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4021.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8347.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6024.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4006.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4628.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7315.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6884.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3889.65, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3967.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4656.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY OF GREAT VESSEL", "code_information": [{"code": "33916", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY OF PANCREATIC CYST", "code_information": [{"code": "48500", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27475", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27477", "type": "CPT"}], "standard_charges": [{"minimum": 4111.8, "maximum": 4111.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27479", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY TO STOP LEG GROWTH", "code_information": [{"code": "27485", "type": "CPT"}], "standard_charges": [{"minimum": 4111.8, "maximum": 4111.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGERY/SPEECH PROSTHESIS", "code_information": [{"code": "31611", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3345.07, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3345.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGI DRILL 1.1X3.5M", "code_information": [{"code": "3100210245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 640.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGI DRILL 2.0X3.5M", "code_information": [{"code": "3100210246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 427.0, "discounted_cash": 640.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICAL EXPOSURE PROSTATE", "code_information": [{"code": "55860", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5791.23, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OBTURATOR", "code_information": [{"code": "D5931", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43351", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING ESOPHAGUS", "code_information": [{"code": "43352", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43500", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF STOMACH", "code_information": [{"code": "43510", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL OPENING OF THROAT", "code_information": [{"code": "42955", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL PLACE MINI IMPLANT", "code_information": [{"code": "D6013", "type": "HCPCS"}], "standard_charges": [{"minimum": 1983.37, "maximum": 1983.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1983.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL PREP WOUND", "code_information": [{"code": "15004", "type": "CPT"}, {"code": "3480101367", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2771.02, "gross_charge": 1056.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1024.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 739.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 792.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 897.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 844.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43501", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL REPAIR OF STOMACH", "code_information": [{"code": "43502", "type": "CPT"}], "standard_charges": [{"minimum": 6075.59, "maximum": 6075.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6075.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL REVISION INTESTINE", "code_information": [{"code": "44680", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL SIALOLITHOTOMY", "code_information": [{"code": "D7980", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL SPLINT", "code_information": [{"code": "D5988", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL STENT", "code_information": [{"code": "D5982", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL TREATM OF A", "code_information": [{"code": "46270", "type": "CPT"}, {"code": "3480101980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6210.91, "gross_charge": 6403.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6210.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICAL TREATM OF A", "code_information": [{"code": "46280", "type": "CPT"}, {"code": "3480101981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6210.91, "gross_charge": 6403.0, "discounted_cash": 4297.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2962.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6210.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4482.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2951.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4802.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3409.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5442.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2865.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2922.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3271.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGICEL", "code_information": [{"code": "3100101919", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 108.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL", "code_information": [{"code": "3100103544", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "discounted_cash": 411.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL", "code_information": [{"code": "3100104511", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.0, "discounted_cash": 313.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICEL FIBRILLAR H", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101920", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 401.1, "maximum": 555.81, "gross_charge": 573.0, "discounted_cash": 859.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 487.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 429.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 401.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 555.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 401.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 429.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 487.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 458.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGICEL LARGE", "code_information": [{"code": "3100102350", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.64, "discounted_cash": 168.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGICORD PER SQ CM", "code_information": [{"code": "Q4218", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGIFLO APPLICATOR*", "code_information": [{"code": "3100209501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.76, "discounted_cash": 260.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFOAM", "code_information": [{"code": "3100104683", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.8, "discounted_cash": 385.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIFOAM SZ 50*1973", "code_information": [{"code": "3100205054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.96, "discounted_cash": 76.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SURGIGRAFT DUAL PER SQ CM", "code_information": [{"code": "Q4219", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGIGRAFT, 1 SQ CM", "code_information": [{"code": "Q4183", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGIMEND, NEONATAL", "code_information": [{"code": "C9360", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGISIS ANAL F PLUG", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100101922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1519.0, "maximum": 2104.9, "gross_charge": 2170.0, "discounted_cash": 3255.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2104.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1519.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1627.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1844.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1736.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGRAFT FT PER SQ CM", "code_information": [{"code": "Q4268", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SURGRAFT PER SQ CM", "code_information": [{"code": "Q4209", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SURGRAFT TL, PER SQ CM", "code_information": [{"code": "Q4263", "type": "HCPCS"}], "standard_charges": [{"minimum": 1004.13, "maximum": 1004.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1004.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SURGRAFT XT PER SQ CM", "code_information": [{"code": "Q4269", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBILITY BETA", "code_information": [{"code": "87185", "type": "CPT"}, {"code": "3440101181", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.75, "maximum": 46.56, "gross_charge": 48.0, "discounted_cash": 7.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY MICRO/A", "code_information": [{"code": "87186", "type": "CPT"}, {"code": "3440101182", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 8.65, "maximum": 74.69, "gross_charge": 77.0, "discounted_cash": 13.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 74.69, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 53.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 57.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 65.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 61.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSCEPTIBLTY STDY DI", "code_information": [{"code": "87184", "type": "CPT"}, {"code": "3440101180", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 7.48, "maximum": 62.08, "gross_charge": 64.0, "discounted_cash": 12.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 62.08, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 44.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 9.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 54.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 51.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSCPTIBLTY STDY GRA", "code_information": [{"code": "87181", "type": "CPT"}, {"code": "3440101179", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 4.75, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 7.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.09, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPEND BOWEL W/PROSTHESIS", "code_information": [{"code": "44700", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58400", "type": "CPT"}], "standard_charges": [{"minimum": 3553.77, "maximum": 3553.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTR ANCHBIO-COM", "code_information": [{"code": "3100104752", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1559.25, "discounted_cash": 2338.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE", "code_information": [{"code": "3100101923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.7, "discounted_cash": 62.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE", "code_information": [{"code": "3100101924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.5, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE #2 FW*AR7208", "code_information": [{"code": "3100204406", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 0-5", "code_information": [{"code": "3100103548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 10-15", "code_information": [{"code": "3100103550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 15-20", "code_information": [{"code": "3100103551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.08, "discounted_cash": 154.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 20-25", "code_information": [{"code": "3100103552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 25-30", "code_information": [{"code": "3100103553", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 30-35", "code_information": [{"code": "3100103554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 35-40", "code_information": [{"code": "3100103555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 40-45", "code_information": [{"code": "3100103556", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 45-50", "code_information": [{"code": "3100103557", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE 5-10", "code_information": [{"code": "3100103549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ABS", "code_information": [{"code": "3100102351", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.0, "discounted_cash": 196.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 670.6, "maximum": 929.26, "gross_charge": 958.0, "discounted_cash": 1437.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 814.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 718.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 670.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 929.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 670.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 718.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 814.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 766.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 808.5, "maximum": 1120.35, "gross_charge": 1155.0, "discounted_cash": 1732.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 981.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1120.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 808.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 866.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 981.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 924.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 5.5 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 483.0, "maximum": 669.3, "gross_charge": 690.0, "discounted_cash": 1035.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 669.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 483.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 517.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 586.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR 6.5*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.5, "maximum": 712.95, "gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR ARTHRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 346.5, "maximum": 480.15, "gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 480.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 346.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 371.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 420.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR ARTHRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 388.5, "maximum": 538.35, "gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 538.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR ARTHRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103958", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 756.0, "maximum": 1047.6, "gross_charge": 1080.0, "discounted_cash": 1620.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1047.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 810.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 918.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 864.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR ARTHRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 598.5, "maximum": 829.35, "gross_charge": 855.0, "discounted_cash": 1282.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 829.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 598.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 641.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR FASTAK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE ANCHOR*AR-166", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 861.0, "maximum": 1193.1, "gross_charge": 1230.0, "discounted_cash": 1845.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1045.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 922.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 861.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1193.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 861.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 922.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1045.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 984.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE BILE DUCT INJURY", "code_information": [{"code": "47900", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE BUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE BUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 266.0, "maximum": 368.6, "gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 368.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE CETERIX", "code_information": [{"code": "3100102244", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROM G", "code_information": [{"code": "3100101928", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.7, "discounted_cash": 35.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC", "code_information": [{"code": "3100101929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 0*884", "code_information": [{"code": "3100210150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.04, "discounted_cash": 13.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 2-0*8", "code_information": [{"code": "3100210151", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.04, "discounted_cash": 13.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 5-0*7", "code_information": [{"code": "3100210152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.8, "discounted_cash": 32.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 5-0*K", "code_information": [{"code": "3100210153", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.16, "discounted_cash": 30.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC 7-0 D", "code_information": [{"code": "3100210154", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.84, "discounted_cash": 115.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC COVID", "code_information": [{"code": "3100102354", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 172.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CHROMIC GUT", "code_information": [{"code": "3100102353", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.5, "discounted_cash": 95.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CLOSURE DEVIC", "code_information": [{"code": "3100101930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 213.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE COMPLICATE WND > 5 CM", "code_information": [{"code": "D7912", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE CORKSCREW", "code_information": [{"code": "3100102352", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1005.0, "discounted_cash": 1507.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CTD", "code_information": [{"code": "3100101931", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.7, "discounted_cash": 59.55, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE CUP 33MM*AR95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE CUP 33MM*AR95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE CUP 33MM*AR95", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2176.62, "maximum": 3016.18, "gross_charge": 3109.47, "discounted_cash": 4664.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3016.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2176.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2332.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2643.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2487.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE DERMABOND", "code_information": [{"code": "3100101932", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 94.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE DEXON", "code_information": [{"code": "3100101933", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.4, "discounted_cash": 38.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND", "code_information": [{"code": "3100101934", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 39.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 2-0*", "code_information": [{"code": "3100210146", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.32, "discounted_cash": 9.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 2-0*", "code_information": [{"code": "3100210147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 3-0*", "code_information": [{"code": "3100203736", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.28, "discounted_cash": 18.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 3-0*", "code_information": [{"code": "3100203947", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.4, "discounted_cash": 69.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 4-0*", "code_information": [{"code": "3100203737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.96, "discounted_cash": 16.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 4-0*", "code_information": [{"code": "3100210148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.36, "discounted_cash": 9.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHIBOND 5-0*", "code_information": [{"code": "3100210149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.04, "discounted_cash": 10.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON", "code_information": [{"code": "3100101935", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 0*L88", "code_information": [{"code": "3100210164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.64, "discounted_cash": 14.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 1*830", "code_information": [{"code": "3100210163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.64, "discounted_cash": 6.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 10-0*", "code_information": [{"code": "3100210168", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.04, "discounted_cash": 63.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 3-0*1", "code_information": [{"code": "3100208990", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.08, "discounted_cash": 34.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 4-0*6", "code_information": [{"code": "3100210165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.24, "discounted_cash": 15.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 7-0*1", "code_information": [{"code": "3100203735", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.64, "discounted_cash": 17.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 8-0*1", "code_information": [{"code": "3100210166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.56, "discounted_cash": 50.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON 9-0*2", "code_information": [{"code": "3100210167", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.36, "discounted_cash": 59.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE ETHILON SZ 9", "code_information": [{"code": "3100102355", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.0, "discounted_cash": 111.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE FIBERWIRE", "code_information": [{"code": "3100101936", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 117.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GORE-TEX*8J02", "code_information": [{"code": "3100205216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.32, "discounted_cash": 180.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GORETEX", "code_information": [{"code": "3100102401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 142.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE GRASPER", "code_information": [{"code": "3100101937", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE KIT UNIV APEX", "code_information": [{"code": "3100104118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LARGE INTESTINE", "code_information": [{"code": "44604", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE LASSO", "code_information": [{"code": "3100101938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE LASSO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103546", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 392.0, "maximum": 543.2, "gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 543.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 392.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 476.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE MAXBRAID #2*9", "code_information": [{"code": "3100206872", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.04, "discounted_cash": 118.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MAXBRAID #2*9", "code_information": [{"code": "3100207410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.04, "discounted_cash": 118.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERS", "code_information": [{"code": "3100102356", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MERSILENE", "code_information": [{"code": "3100101939", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.1, "discounted_cash": 145.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL", "code_information": [{"code": "3100101940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.1, "discounted_cash": 27.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 3-0", "code_information": [{"code": "3100202399", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.36, "discounted_cash": 24.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 5-0", "code_information": [{"code": "3100202361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.36, "discounted_cash": 24.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONOCRYL 5-0*", "code_information": [{"code": "3100210136", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.04, "discounted_cash": 10.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE MONODERM", "code_information": [{"code": "3100101941", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.0, "discounted_cash": 169.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NUROLON", "code_information": [{"code": "3100101942", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.1, "discounted_cash": 66.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NYLON", "code_information": [{"code": "3100101943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE NYLON", "code_information": [{"code": "3100102403", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE OF INFRAPATEL", "code_information": [{"code": "27381", "type": "CPT"}, {"code": "3480101693", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE OF QUADRI OR", "code_information": [{"code": "27385", "type": "CPT"}, {"code": "3480101694", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE OF QUADRI OR", "code_information": [{"code": "27386", "type": "CPT"}, {"code": "3480101695", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 9397.36, "gross_charge": 9688.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9397.36, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6781.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8234.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7750.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE PARS IMPLA KI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURE PASS NOVOS", "code_information": [{"code": "3100102245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER", "code_information": [{"code": "3100101944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER HIP*AR", "code_information": [{"code": "3100206037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSER LOOP*A", "code_information": [{"code": "3100207100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PASSING WIRE", "code_information": [{"code": "3100101945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 4-0*PDP31", "code_information": [{"code": "3100210141", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.2, "discounted_cash": 13.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 5-0 D/A*P", "code_information": [{"code": "3100210142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.16, "discounted_cash": 30.24, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 5-0 D/A*P", "code_information": [{"code": "3100210143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 5-0*PDP12", "code_information": [{"code": "3100210144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.44, "discounted_cash": 74.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS 6-0 D/A*P", "code_information": [{"code": "3100210145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.28, "discounted_cash": 76.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II", "code_information": [{"code": "3100101946", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS II SZ 1 T", "code_information": [{"code": "3100205833", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.44, "discounted_cash": 41.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS PLUS 2-0*", "code_information": [{"code": "3100210140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.84, "discounted_cash": 11.76, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PDS ll SZ1*Z7", "code_information": [{"code": "3100202500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.04, "discounted_cash": 82.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN", "code_information": [{"code": "3100101947", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN 2-0*N86", "code_information": [{"code": "3100210155", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.08, "discounted_cash": 13.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN 4-0*G32", "code_information": [{"code": "3100210157", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.8, "discounted_cash": 13.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN 4-0*U20", "code_information": [{"code": "3100210156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.56, "discounted_cash": 14.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN 5-0*191", "code_information": [{"code": "3100210158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.88, "discounted_cash": 29.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN 6-0*774", "code_information": [{"code": "3100210159", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.4, "discounted_cash": 38.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLAIN GUT 5-0", "code_information": [{"code": "3100203802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.56, "discounted_cash": 26.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PLEDGET", "code_information": [{"code": "3100101948", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.5, "discounted_cash": 108.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE POLYSORB", "code_information": [{"code": "3100101949", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLEN 5-0 D/", "code_information": [{"code": "3100210138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.12, "discounted_cash": 93.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE", "code_information": [{"code": "3100101950", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.1, "discounted_cash": 30.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0*8", "code_information": [{"code": "3100205264", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.12, "discounted_cash": 45.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0*8", "code_information": [{"code": "3100210139", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.8, "discounted_cash": 23.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 5-0*H", "code_information": [{"code": "3100210137", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.52, "discounted_cash": 62.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 *", "code_information": [{"code": "3100202370", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.56, "discounted_cash": 23.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE 6-0 P", "code_information": [{"code": "3100202360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.56, "discounted_cash": 23.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 2*", "code_information": [{"code": "3100210011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.8, "discounted_cash": 53.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE PROLENE SZ 4-", "code_information": [{"code": "3100203881", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.28, "discounted_cash": 24.42, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE QUILL*VLM-100", "code_information": [{"code": "3100207112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.64, "discounted_cash": 129.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RETRIEVER", "code_information": [{"code": "3100101951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RETRIEVER", "code_information": [{"code": "3100103547", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE RETRIEVER MIC", "code_information": [{"code": "3100202354", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SHARPOINT 4-0", "code_information": [{"code": "3100209608", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.32, "discounted_cash": 12.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK", "code_information": [{"code": "3100101952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.2, "discounted_cash": 49.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 2-0 POP", "code_information": [{"code": "3100208322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.24, "discounted_cash": 39.36, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 3-0*C053", "code_information": [{"code": "3100210160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.76, "discounted_cash": 46.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 4-0*A183", "code_information": [{"code": "3100204427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.56, "discounted_cash": 8.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 4-0*C054", "code_information": [{"code": "3100210161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.8, "discounted_cash": 49.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SILK 4-0*K831", "code_information": [{"code": "3100210162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.76, "discounted_cash": 5.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44602", "type": "CPT"}], "standard_charges": [{"minimum": 5608.78, "maximum": 5608.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5608.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE SMALL INTESTINE", "code_information": [{"code": "44603", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SUTURE SNARE *A6060-", "code_information": [{"code": "3100202495", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STEEL", "code_information": [{"code": "3100101953", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.8, "discounted_cash": 47.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 0*S", "code_information": [{"code": "3100202231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.04, "discounted_cash": 138.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 0*S", "code_information": [{"code": "3100208989", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.36, "discounted_cash": 146.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 3-0", "code_information": [{"code": "3100202858", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.72, "discounted_cash": 191.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATAFIX 4-0", "code_information": [{"code": "3100203238", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.52, "discounted_cash": 50.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE STRATFIX 1*SX", "code_information": [{"code": "3100206905", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.68, "discounted_cash": 121.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SUPRAMID", "code_information": [{"code": "3100101954", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE SURGILON", "code_information": [{"code": "3100101955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.1, "discounted_cash": 33.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TICRON", "code_information": [{"code": "3100101956", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.5, "discounted_cash": 35.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE TIGERWIRE", "code_information": [{"code": "3100101957", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 0*VLOCM", "code_information": [{"code": "3100208982", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.28, "discounted_cash": 139.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 0*VLOCM", "code_information": [{"code": "3100208983", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.88, "discounted_cash": 157.32, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 0*VLOCM", "code_information": [{"code": "3100208984", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 0*VLOCN", "code_information": [{"code": "3100209272", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.96, "discounted_cash": 149.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 2-0*VLO", "code_information": [{"code": "3100208986", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 2-0*VLO", "code_information": [{"code": "3100208987", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 2-0*VLO", "code_information": [{"code": "3100208994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 2-0*VLO", "code_information": [{"code": "3100209109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 99.96, "discounted_cash": 149.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 3-0*VLO", "code_information": [{"code": "3100203069", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.76, "discounted_cash": 109.14, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 3-0*VLO", "code_information": [{"code": "3100208985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 3-0*VLO", "code_information": [{"code": "3100208988", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 3-0*VLO", "code_information": [{"code": "3100208995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 3-0*VLO", "code_information": [{"code": "3100208996", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC 4-0*VLO", "code_information": [{"code": "3100209239", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 133.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE V-LOC*VLOCA20", "code_information": [{"code": "3100209144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL", "code_information": [{"code": "3100101958", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.4, "discounted_cash": 59.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 2-0CT-", "code_information": [{"code": "3100203374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.96, "discounted_cash": 55.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 4-0*VC", "code_information": [{"code": "3100210135", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.4, "discounted_cash": 44.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 5-0 RB", "code_information": [{"code": "3100204485", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL 9-0 *2", "code_information": [{"code": "3100202373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.92, "discounted_cash": 74.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE VICRYL2-0 CT1", "code_information": [{"code": "3100203375", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.12, "discounted_cash": 55.68, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE WIRE", "code_information": [{"code": "3100101959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO", "code_information": [{"code": "3100101960", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO", "code_information": [{"code": "3100103558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 742.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO", "code_information": [{"code": "3100103559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 801.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO", "code_information": [{"code": "3100104504", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO BANANA", "code_information": [{"code": "3100104038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO LEFT", "code_information": [{"code": "3100204583", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 801.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELASSO RIGHT*AR", "code_information": [{"code": "3100204584", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 765.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURELOC IMPL SYSTE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209149", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3822.0, "maximum": 5296.2, "gross_charge": 5460.0, "discounted_cash": 8190.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5296.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTUREPLATE HUMERAL*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK 3.0MM*AR-8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209146", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1157.62, "maximum": 1604.13, "gross_charge": 1653.75, "discounted_cash": 2480.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1405.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1240.31, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1157.62, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1604.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1157.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1240.31, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1405.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO", "code_information": [{"code": "3100103562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101961", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 937.12, "maximum": 1298.58, "gross_charge": 1338.75, "discounted_cash": 2008.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1137.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1004.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1298.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1004.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1137.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103560", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 514.5, "maximum": 712.95, "gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 712.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 514.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 551.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 588.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 672.0, "maximum": 931.2, "gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 931.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103563", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 714.0, "maximum": 989.4, "gross_charge": 1020.0, "discounted_cash": 1530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 989.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 867.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 915.6, "maximum": 1268.76, "gross_charge": 1308.0, "discounted_cash": 1962.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1111.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 981.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 915.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1268.76, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 915.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 981.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1111.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1046.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO 2.4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 837.9, "maximum": 1161.09, "gross_charge": 1197.0, "discounted_cash": 1795.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1017.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1161.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 837.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 897.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1017.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 957.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK BIO 2.4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAK HIP 2.4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 997.5, "maximum": 1382.25, "gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1382.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 997.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1068.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1211.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1140.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAPE", "code_information": [{"code": "3100104698", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 0.9MM *AR", "code_information": [{"code": "3100206928", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 1.3M RE/C", "code_information": [{"code": "3100204567", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.0, "discounted_cash": 210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 1.3MM*AR-", "code_information": [{"code": "3100204415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 535.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 1.3MM*AR-", "code_information": [{"code": "3100209213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 231.48, "discounted_cash": 347.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 1.3MM*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUTURETAPE 1.7MM*AR-", "code_information": [{"code": "3100206165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 1.7MM*AR-", "code_information": [{"code": "3100209214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.08, "discounted_cash": 315.12, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURETAPE 2-0MEN/ND", "code_information": [{"code": "3100204449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 724.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SVNT SARSCOV2 ELISA PLSM SRM", "code_information": [{"code": "226U", "type": "CPT"}], "standard_charges": [{"minimum": 42.28, "maximum": 68.53, "discounted_cash": 67.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 42.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SVS BY OT IN HOME HEALTH", "code_information": [{"code": "G2169", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SVS BY PT IN HOME HEALTH", "code_information": [{"code": "G2168", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SWIFT-LOCK ANCHOR*11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204532", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 341.6, "maximum": 473.36, "gross_charge": 488.0, "discounted_cash": 732.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 473.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 341.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 366.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 414.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 390.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWISS TROCAR SYSTEM*", "code_information": [{"code": "3100209589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 866.49, "discounted_cash": 1299.74, "setting": "both", "billing_class": "facility"}]}, {"description": "SWITCH", "code_information": [{"code": "3100101962", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SWITCH STICK ARTHREX", "code_information": [{"code": "3100103849", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SWIVELOC BIO 4.75X22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 937.12, "maximum": 1298.58, "gross_charge": 1338.75, "discounted_cash": 2008.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1137.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1004.06, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1298.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 937.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1004.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1137.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOC KNOTLESS*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1113.0, "maximum": 1542.3, "gross_charge": 1590.0, "discounted_cash": 2385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1351.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1113.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1542.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1113.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1351.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1272.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101963", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 913.5, "maximum": 1265.85, "gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1265.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 798.0, "maximum": 1105.8, "gross_charge": 1140.0, "discounted_cash": 1710.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1105.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 798.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 969.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 912.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103566", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK 9X19.5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 913.5, "maximum": 1265.85, "gross_charge": 1305.0, "discounted_cash": 1957.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1265.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 913.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 978.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1109.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1044.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK ANCH 4.75*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203810", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1207.5, "maximum": 1673.25, "gross_charge": 1725.0, "discounted_cash": 2587.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1673.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1207.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1293.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1466.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1380.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK BIO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 875.7, "maximum": 1213.47, "gross_charge": 1251.0, "discounted_cash": 1876.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1063.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 938.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 875.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1213.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 875.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 938.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1063.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1000.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCK BIO 3.9MM*", "code_information": [{"code": "3100206768", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 1890.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SWIVELOCK DX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SWIVELOCKBC 4.75*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208923", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 970.2, "maximum": 1344.42, "gross_charge": 1386.0, "discounted_cash": 2079.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1178.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 970.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1344.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 970.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1178.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1108.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYFLS TST NONTREPONEMAL ANTB", "code_information": [{"code": "65U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 29.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY CERVIC", "code_information": [{"code": "64802", "type": "CPT"}, {"code": "3480103087", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4698.68, "gross_charge": 4844.0, "discounted_cash": 2955.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2037.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4698.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3390.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2029.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3633.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2344.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4117.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3875.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1970.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2009.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY DIGITAL ARTERY", "code_information": [{"code": "64820", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2242.36, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYMPATHECTOMY SUPFC PALMAR", "code_information": [{"code": "64823", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2242.36, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2242.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNCHFIX #5 SUTURE*8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209953", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2171.26, "maximum": 3008.74, "gross_charge": 3101.8, "discounted_cash": 4652.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2636.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2326.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2171.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3008.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2171.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2326.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2636.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2481.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNCOPE AND COLLAPSE", "code_information": [{"code": "312", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4029.01, "maximum": 4029.01, "discounted_cash": 9640.61, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4029.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNDES TIGHTROPE XP*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNDESMOSIS KIT*FGS-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206099", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2676.7, "maximum": 3709.15, "gross_charge": 3823.87, "discounted_cash": 5735.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3250.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2867.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3709.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2676.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2867.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3250.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3059.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11900.0, "maximum": 16490.0, "gross_charge": 17000.0, "discounted_cash": 25500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16490.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104277", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8820.0, "maximum": 12222.0, "gross_charge": 12600.0, "discounted_cash": 18900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10710.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8820.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12222.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8820.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10710.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 12 MED *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8554.0, "maximum": 11853.4, "gross_charge": 12220.0, "discounted_cash": 18330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11853.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 12HIGH *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203357", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 12HIGH *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 12HIGH 10DEG*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202695", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 12HIGH 6DEG*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 12MM X 14 *0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 13.5 MED *08.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 13.5 SM *08.8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 13.5 X 18 *0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 13.5MM *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 13.5MM *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 13.5MM *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8554.0, "maximum": 11853.4, "gross_charge": 12220.0, "discounted_cash": 18330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11853.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 15 MED *08.81", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203956", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX 15MM X 14 *0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8540.0, "maximum": 11834.0, "gross_charge": 12200.0, "discounted_cash": 18300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11834.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8540.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10370.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9760.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX SPACER SMALL*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205947", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8554.0, "maximum": 11853.4, "gross_charge": 12220.0, "discounted_cash": 18330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11853.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNFIX SYNTHES", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11900.0, "maximum": 16490.0, "gross_charge": 17000.0, "discounted_cash": 25500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16490.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYNOVECTOMY INTERTAT", "code_information": [{"code": "28070", "type": "CPT"}, {"code": "3340102308", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 5893.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5716.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4714.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC GRAFT FACIAL BONES", "code_information": [{"code": "D7995", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNTHETIC SENTENCE TEST", "code_information": [{"code": "92576", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNVCT IT/TMT JNT EA", "code_information": [{"code": "28070", "type": "CPT"}, {"code": "3340102305", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 8687.35, "gross_charge": 5893.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5716.21, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4125.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4419.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5009.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4714.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYNVISC OR SYNVISC-ONE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7325", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.88, "maximum": 8.88, "discounted_cash": 14.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SYPHILIS NON-TREPNML", "code_information": [{"code": "86592", "type": "CPT"}, {"code": "3440101090", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 4.27, "maximum": 36.86, "gross_charge": 38.0, "discounted_cash": 6.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 36.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 32.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.57, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TEST QUANTI", "code_information": [{"code": "86593", "type": "CPT"}, {"code": "3440101091", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 4.4, "maximum": 37.83, "gross_charge": 39.0, "discounted_cash": 7.07, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 37.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 27.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.71, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYPHILIS TST ANTB IA QUAN", "code_information": [{"code": "210U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 29.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SYRINGE ALLIANCE", "code_information": [{"code": "3100102246", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE CALIBRATION", "code_information": [{"code": "3100101965", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1177.0, "discounted_cash": 1765.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE CTA F1510", "code_information": [{"code": "3100102247", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE DENTAL", "code_information": [{"code": "3100102248", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.0, "discounted_cash": 123.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE DENTAL", "code_information": [{"code": "3100103721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 46.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE DOUBLE ACP", "code_information": [{"code": "3100102249", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE GLASS", "code_information": [{"code": "3100102250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.04, "discounted_cash": 39.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE INFLATION*AO", "code_information": [{"code": "3100203541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 540.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE MED RAD 150M", "code_information": [{"code": "3100206650", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.4, "discounted_cash": 101.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE MIXING 14CC*", "code_information": [{"code": "3100205982", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYS IMPL GRAFT ANCH", "code_information": [{"code": "3100104337", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3250.0, "discounted_cash": 4875.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYSTEM MIX DLVRY", "code_information": [{"code": "3100102251", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Sanopellis, per sq cm", "code_information": [{"code": "Q4308", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sarscov2 Vac 10 Mcg Trs-Sucr", "code_information": [{"code": "91307", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sarscov2 Vac 50mcg/0.25ml Im", "code_information": [{"code": "91306", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Schizophrenia, Major", "code_information": [{"code": "750.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23901.26, "maximum": 23901.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23901.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Schizophrenia, Minor", "code_information": [{"code": "750.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10650.55, "maximum": 10650.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10650.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Schizophrenia, Moderate", "code_information": [{"code": "750.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12731.7, "maximum": 12731.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12731.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Schizophrenia, Severe", "code_information": [{"code": "750.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33180.6, "maximum": 33180.6, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33180.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Scr mammo bi incl cad", "code_information": [{"code": "G0202", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Screening Hearing Loss Test", "code_information": [{"code": "92560", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Seizure, Major", "code_information": [{"code": "53.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10207.15, "maximum": 10207.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10207.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Seizure, Minor", "code_information": [{"code": "53.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6183.24, "maximum": 6183.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6183.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Seizure, Moderate", "code_information": [{"code": "53.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8105.49, "maximum": 8105.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8105.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Seizure, Severe", "code_information": [{"code": "53.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21021.73, "maximum": 21021.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21021.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Self care current status", "code_information": [{"code": "G8987", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Self care d/c status", "code_information": [{"code": "G8989", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Self care goal status", "code_information": [{"code": "G8988", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Major", "code_information": [{"code": "720.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17865.39, "maximum": 17865.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17865.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Minor", "code_information": [{"code": "720.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8416.89, "maximum": 8416.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8416.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Moderate", "code_information": [{"code": "720.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10758.19, "maximum": 10758.19, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10758.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Severe", "code_information": [{"code": "720.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32937.11, "maximum": 32937.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32937.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Adenovirus Type 26 (Ad26) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91303", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Chimpanzee Adenovirus Oxford 1 (Chadox1) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91302", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 100 Mcg/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91301", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted, For Intramuscular Use", "code_information": [{"code": "91300", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Major", "code_information": [{"code": "322.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 39987.93, "maximum": 39987.93, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 39987.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Minor", "code_information": [{"code": "322.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17902.56, "maximum": 17902.56, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17902.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Moderate", "code_information": [{"code": "322.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16221.23, "maximum": 16221.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16221.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Severe", "code_information": [{"code": "322.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 52687.59, "maximum": 52687.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 52687.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Major", "code_information": [{"code": "315.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31150.7, "maximum": 31150.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31150.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Minor", "code_information": [{"code": "315.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13886.33, "maximum": 13886.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13886.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Moderate", "code_information": [{"code": "315.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21517.67, "maximum": 21517.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21517.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Severe", "code_information": [{"code": "315.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43863.18, "maximum": 43863.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43863.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Major", "code_information": [{"code": "662.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 14086.25, "maximum": 14086.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14086.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Minor", "code_information": [{"code": "662.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9721.46, "maximum": 9721.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9721.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Moderate", "code_information": [{"code": "662.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11178.52, "maximum": 11178.52, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11178.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Severe", "code_information": [{"code": "662.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27679.12, "maximum": 27679.12, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27679.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Major", "code_information": [{"code": "861.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13431.4, "maximum": 13431.4, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13431.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Minor", "code_information": [{"code": "861.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6543.34, "maximum": 6543.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6543.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Moderate", "code_information": [{"code": "861.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8401.51, "maximum": 8401.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8401.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Severe", "code_information": [{"code": "861.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21525.36, "maximum": 21525.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21525.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Single Measurement Of Remaining Air Or Lung Capacity After Exhalation", "code_information": [{"code": "94250", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Major", "code_information": [{"code": "361.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 43741.44, "maximum": 43741.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43741.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Minor", "code_information": [{"code": "361.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21453.59, "maximum": 21453.59, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21453.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Moderate", "code_information": [{"code": "361.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23837.18, "maximum": 23837.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23837.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Severe", "code_information": [{"code": "361.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 79686.23, "maximum": 79686.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79686.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Major", "code_information": [{"code": "312.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48115.2, "maximum": 48115.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48115.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Minor", "code_information": [{"code": "312.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17146.47, "maximum": 17146.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17146.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Moderate", "code_information": [{"code": "312.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24443.33, "maximum": 24443.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24443.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Severe", "code_information": [{"code": "312.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 94095.42, "maximum": 94095.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 94095.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Major", "code_information": [{"code": "380.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15151.17, "maximum": 15151.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15151.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Minor", "code_information": [{"code": "380.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8475.84, "maximum": 8475.84, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8475.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Moderate", "code_information": [{"code": "380.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10464.73, "maximum": 10464.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10464.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Severe", "code_information": [{"code": "380.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26359.17, "maximum": 26359.17, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26359.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Skin substitute, synthetic", "code_information": [{"code": "C1849", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spec coll snf/lab covid-19", "code_information": [{"code": "G2024", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 25.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Specialty Services Observation Hours", "code_information": [{"code": "762", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Specialty Services Treatment Room", "code_information": [{"code": "761", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Specimen collect covid-19", "code_information": [{"code": "G2023", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 23.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Major", "code_information": [{"code": "40.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 27867.5, "maximum": 27867.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 27867.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Minor", "code_information": [{"code": "40.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12260.11, "maximum": 12260.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12260.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Moderate", "code_information": [{"code": "40.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12827.82, "maximum": 12827.82, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12827.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Severe", "code_information": [{"code": "40.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42222.86, "maximum": 42222.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42222.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures, Major", "code_information": [{"code": "321.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 46057.11, "maximum": 46057.11, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 46057.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures, Minor", "code_information": [{"code": "321.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13208.42, "maximum": 13208.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13208.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures, Moderate", "code_information": [{"code": "321.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33735.49, "maximum": 33735.49, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33735.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures, Severe", "code_information": [{"code": "321.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 65866.54, "maximum": 65866.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65866.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion Except Cervical With MCC", "code_information": [{"code": "459", "type": "MS-DRG"}], "standard_charges": [{"minimum": 29085.95, "maximum": 29085.95, "discounted_cash": 74046.74, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29085.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion Except Cervical Without MCC", "code_information": [{"code": "460", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19301.48, "maximum": 19301.48, "discounted_cash": 40838.87, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19301.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Spinal Procedures, Major", "code_information": [{"code": "23.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55140.38, "maximum": 55140.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55140.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Procedures, Minor", "code_information": [{"code": "23.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 23216.94, "maximum": 23216.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23216.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Procedures, Moderate", "code_information": [{"code": "23.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33042.2, "maximum": 33042.2, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33042.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Procedures, Severe", "code_information": [{"code": "23.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 98848.5, "maximum": 98848.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 98848.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Splenectomy, Major", "code_information": [{"code": "650.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 38371.95, "maximum": 38371.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38371.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Splenectomy, Minor", "code_information": [{"code": "650.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18256.25, "maximum": 18256.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18256.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Splenectomy, Moderate", "code_information": [{"code": "650.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20051.63, "maximum": 20051.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20051.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Splenectomy, Severe", "code_information": [{"code": "650.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 74904.96, "maximum": 74904.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 74904.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sub pt/ot current status", "code_information": [{"code": "G8993", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sub pt/ot d/c status", "code_information": [{"code": "G8995", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Sub pt/ot goal status", "code_information": [{"code": "G8994", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Subseq  psych care man,60mi", "code_information": [{"code": "G0503", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Subsequent Cardiac Output Measurements", "code_information": [{"code": "93562", "type": "CPT"}], "standard_charges": [{"minimum": 668.39, "maximum": 668.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Supply And Technical Support For Remote Therapeutic Monitoring Of Standardized Online Digital Cognitive Behavioral Therapy Program, Per 30 Days", "code_information": [{"code": "702T", "type": "CPT"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Syncope And Collapse, Major", "code_information": [{"code": "204.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10194.33, "maximum": 10194.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10194.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Syncope And Collapse, Minor", "code_information": [{"code": "204.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5619.38, "maximum": 5619.38, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5619.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Syncope And Collapse, Moderate", "code_information": [{"code": "204.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7448.08, "maximum": 7448.08, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7448.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Syncope And Collapse, Severe", "code_information": [{"code": "204.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18293.41, "maximum": 18293.41, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18293.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T & A UNDER 12", "code_information": [{"code": "42820", "type": "CPT"}, {"code": "3480101930", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7111.29, "gross_charge": 6299.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T CELLS ABSOLUTE CD4", "code_information": [{"code": "86361", "type": "CPT"}, {"code": "3440101085", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 26.78, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 43.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.13, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 28.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T CELLS CD4&CD8 ABSL", "code_information": [{"code": "86360", "type": "CPT"}, {"code": "3440101084", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 46.98, "maximum": 410.31, "gross_charge": 423.0, "discounted_cash": 75.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 359.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 52.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 296.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 410.31, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 296.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.83, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 317.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.32, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 59.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 359.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 50.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 338.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 50.32, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 51.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T CELLS TOTAL COUNT", "code_information": [{"code": "86359", "type": "CPT"}, {"code": "3440101083", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 37.73, "maximum": 327.86, "gross_charge": 338.0, "discounted_cash": 60.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 287.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 327.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 236.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 253.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 48.09, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 287.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 270.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 40.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T THERMO VENT", "code_information": [{"code": "3100101966", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T-CELL DEPLETION OF HARVEST", "code_information": [{"code": "38210", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T-PLATE 1.4 8H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-SCOPE", "code_information": [{"code": "3100102045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 335.0, "discounted_cash": 502.5, "setting": "both", "billing_class": "facility"}]}, {"description": "T-SCOPE INCISION PAD", "code_information": [{"code": "3100102046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.0, "discounted_cash": 48.0, "setting": "both", "billing_class": "facility"}]}, {"description": "T-SPACE PEEK", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "T-SPINE FUSION ANTER", "code_information": [{"code": "22556", "type": "CPT"}, {"code": "3480101499", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2856.7, "maximum": 14462.5, "gross_charge": 4081.0, "discounted_cash": 6121.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3468.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3060.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2856.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3958.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2856.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3060.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3468.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3264.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T-SPINE FUSION POSTE", "code_information": [{"code": "22610", "type": "CPT"}, {"code": "3480101503", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2167.2, "maximum": 14462.5, "gross_charge": 3096.0, "discounted_cash": 4644.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2631.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2322.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2167.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3003.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2167.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2322.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2631.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2476.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "T6 DRIVER TIP*80-175", "code_information": [{"code": "3100210243", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 803.25, "discounted_cash": 1204.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TA MV RPR W/ARTIF CHORD TEND", "code_information": [{"code": "543T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TACRINE HYDROCHLORIDE, 10 MG", "code_information": [{"code": "S0014", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TACROL ENVARSUS EX REL ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.73, "maximum": 1.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS", "code_information": [{"code": "80197", "type": "CPT"}, {"code": "3440100828", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.73, "maximum": 118.34, "gross_charge": 122.0, "discounted_cash": 22.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 118.34, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 91.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 103.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 97.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TACROLIMUS INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7525", "type": "HCPCS"}], "standard_charges": [{"minimum": 248.77, "maximum": 248.77, "discounted_cash": 399.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 248.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACTILE BREAST IMG UNI/BI", "code_information": [{"code": "422T", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TACTRA MALLEABLE PRO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207833", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13104.0, "maximum": 18158.4, "gross_charge": 18720.0, "discounted_cash": 28080.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15912.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14040.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13104.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18158.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13104.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14040.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15912.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14976.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TACTRA MALLEABLE PRO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209336", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13105.05, "maximum": 18159.85, "gross_charge": 18721.5, "discounted_cash": 28082.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 15913.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14041.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13105.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18159.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13105.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14041.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 15913.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14977.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAH RAD DEBULK/LYMPH REMOVE", "code_information": [{"code": "58954", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAH RAD DISSECT FOR DEBULK", "code_information": [{"code": "58953", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TALAR ANKLE X-SMALL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203386", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10395.0, "maximum": 14404.5, "gross_charge": 14850.0, "discounted_cash": 22275.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12622.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11137.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10395.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14404.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10395.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11137.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12622.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11880.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALAR DOME SZ 2*3368", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9660.0, "maximum": 13386.0, "gross_charge": 13800.0, "discounted_cash": 20700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13386.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALAR DOME SZ 3*3368", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208489", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9660.0, "maximum": 13386.0, "gross_charge": 13800.0, "discounted_cash": 20700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13386.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALAR DOME SZ 4*3368", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9660.0, "maximum": 13386.0, "gross_charge": 13800.0, "discounted_cash": 20700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13386.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11730.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALAR DOME*220220903", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8433.88, "maximum": 11686.94, "gross_charge": 12048.4, "discounted_cash": 18072.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10241.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9036.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8433.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11686.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8433.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9036.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10241.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9638.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TALYMED", "code_information": [{"code": "Q4127", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.49, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 68.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN SINGLE LES", "code_information": [{"code": "11102", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TANTALUM RING APPLICATION", "code_information": [{"code": "S8030", "type": "HCPCS"}], "standard_charges": [{"minimum": 1367.49, "maximum": 1367.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP", "code_information": [{"code": "3100101967", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 481.0, "discounted_cash": 721.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP", "code_information": [{"code": "3100103567", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 739.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP", "code_information": [{"code": "3100103568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 514.0, "discounted_cash": 771.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP", "code_information": [{"code": "3100103569", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 649.0, "discounted_cash": 973.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3.2AO*TAP-3.2AO", "code_information": [{"code": "3100205867", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3.5*DRUJ-T35", "code_information": [{"code": "3100207301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 486.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 3.5MM*48560314", "code_information": [{"code": "3100207818", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 769.35, "discounted_cash": 1154.03, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP 4.0MM*48560414", "code_information": [{"code": "3100207819", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 769.35, "discounted_cash": 1154.03, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP AO", "code_information": [{"code": "3100104635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BLOCK BI BY INFUSION", "code_information": [{"code": "64489", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK BI INJECTION", "code_information": [{"code": "64488", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 448.56, "maximum": 448.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNILAT BY", "code_information": [{"code": "64486", "type": "CPT"}, {"code": "3480103149", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 196.0, "maximum": 448.56, "gross_charge": 280.0, "discounted_cash": 420.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 271.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 196.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 238.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNILAT BY", "code_information": [{"code": "64486", "type": "CPT"}, {"code": "3480103310", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 220.5, "maximum": 448.56, "gross_charge": 315.0, "discounted_cash": 472.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 305.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 236.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 267.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAP GLENOID 6.5MM*80", "code_information": [{"code": "3100209910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 2700.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP POST APEX*121-00", "code_information": [{"code": "3100208943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP QUICK", "code_information": [{"code": "3100101968", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1980.0, "discounted_cash": 2970.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SYNTHES", "code_information": [{"code": "3100102253", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1482.0, "discounted_cash": 2223.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SYNTHES", "code_information": [{"code": "3100103722", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1008.0, "discounted_cash": 1512.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TAPER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101969", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4641.0, "maximum": 6431.1, "gross_charge": 6630.0, "discounted_cash": 9945.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5635.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6431.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4641.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5635.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAPER ADAPTER*5120-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 313.6, "maximum": 434.56, "gross_charge": 448.0, "discounted_cash": 672.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 434.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 313.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 380.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 358.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAPER POST*8WC5-0016", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208471", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 541.8, "maximum": 750.78, "gross_charge": 774.0, "discounted_cash": 1161.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 750.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 541.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 580.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 657.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAPPER", "code_information": [{"code": "3100101970", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TARGETED CASE MANAGEMENT", "code_information": [{"code": "T1017", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TARGETED CASE MGMT PER MONTH", "code_information": [{"code": "T2023", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAS CONGENITAL CAR ANOMAL", "code_information": [{"code": "33741", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 10MM*230", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 10MM*230", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 10MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 11MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 12MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9765.0, "maximum": 13531.5, "gross_charge": 13950.0, "discounted_cash": 20925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13531.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9765.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11857.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 14MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 14MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206041", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAS IMPLANT 15MM*231", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 68.53, "maximum": 100.0, "discounted_cash": 160.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TB TEST CELL IMMUN M", "code_information": [{"code": "86480", "type": "CPT"}, {"code": "3440103017", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 61.98, "maximum": 524.77, "gross_charge": 541.0, "discounted_cash": 99.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 524.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 68.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 78.99, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 66.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 61.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 66.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 67.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGG", "code_information": [{"code": "44U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 23.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TBRF B GRP ANTB 4 PRTN IGM", "code_information": [{"code": "43U", "type": "CPT"}], "standard_charges": [{"minimum": 30.26, "maximum": 30.26, "discounted_cash": 23.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TBS TECHL CALCULATION ONLY", "code_information": [{"code": "77091", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TBS TECHL PREP&TRANSMIS DATA", "code_information": [{"code": "77090", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TC IMPLANT LRG*5186-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC IMPLANT LRG*5186-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206846", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC IMPLANT LRG*5186-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC IMPLANT SM*5146-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2047.5, "maximum": 2837.25, "gross_charge": 2925.0, "discounted_cash": 4387.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2837.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2486.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC IMPLANT SM*5146-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2730.0, "maximum": 3783.0, "gross_charge": 3900.0, "discounted_cash": 5850.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3783.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2730.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2925.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3315.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3120.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC IMPLANT SM*5146-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207995", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1734.6, "maximum": 2403.66, "gross_charge": 2478.0, "discounted_cash": 3717.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2403.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1734.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1858.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2106.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1982.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC MEAS 5 BMRK SFDI M-S ALYS", "code_information": [{"code": "61U", "type": "CPT"}], "standard_charges": [{"minimum": 56.96, "maximum": 56.96, "discounted_cash": 40.32, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TC99 TILMANOCEPT DIAG 0.5MCI", "code_information": [{"code": "A9520", "type": "HCPCS"}], "standard_charges": [{"minimum": 468.86, "maximum": 468.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 468.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M APCITIDE", "code_information": [{"code": "A9504", "type": "HCPCS"}], "standard_charges": [{"minimum": 527.96, "maximum": 527.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 527.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M BICISATE", "code_information": [{"code": "A9557", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M DEPREOTIDE", "code_information": [{"code": "A9536", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M DISOFENIN", "code_information": [{"code": "A9510", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.6, "maximum": 66.6, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 66.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M EXAMETAZIME", "code_information": [{"code": "A9521", "type": "HCPCS"}], "standard_charges": [{"minimum": 1674.52, "maximum": 1674.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1674.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M FANOLESOMAB", "code_information": [{"code": "A9566", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M GLUCEPTATE", "code_information": [{"code": "A9550", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M LABELED RBC", "code_information": [{"code": "A9560", "type": "HCPCS"}], "standard_charges": [{"minimum": 115.99, "maximum": 115.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 115.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M MAA", "code_information": [{"code": "A9540", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.41, "maximum": 29.41, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M MEBROFENIN", "code_information": [{"code": "A9537", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.39, "maximum": 63.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 63.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M MEDRONATE", "code_information": [{"code": "A9503", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.8, "maximum": 16.8, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M MERTIATIDE", "code_information": [{"code": "A9562", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TC99M OXIDRONATE", "code_information": [{"code": "A9561", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.4, "maximum": 46.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M PENTETATE", "code_information": [{"code": "A9539", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.21, "maximum": 31.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 31.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M PERTECHNETATE", "code_information": [{"code": "A9512", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.92, "maximum": 7.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M PYROPHOSPHATE", "code_information": [{"code": "A9538", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.1, "maximum": 50.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M SESTAMIBI", "code_information": [{"code": "A9500", "type": "HCPCS"}], "standard_charges": [{"minimum": 107.02, "maximum": 107.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 107.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M SUCCIMER", "code_information": [{"code": "A9551", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.51, "maximum": 684.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 684.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M SULFUR COLLOID", "code_information": [{"code": "A9541", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.95, "maximum": 197.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 197.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TC99M TETROFOSMIN", "code_information": [{"code": "A9502", "type": "HCPCS"}], "standard_charges": [{"minimum": 306.79, "maximum": 306.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 306.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT DLVR ENHNCD FIXJ DEV", "code_information": [{"code": "34712", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 30118.94, "maximum": 30118.94, "discounted_cash": 44487.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30118.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 29825.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 8741.14, "maximum": 8741.14, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8741.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 9092.24, "maximum": 9092.24, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9092.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCAT TV ANNULUS RCNSTJ", "code_information": [{"code": "545T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/INJ", "code_information": [{"code": "93893", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCD EMBOLI DETECT W/O INJ", "code_information": [{"code": "93892", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCD VASOREACTIVITY STUDY", "code_information": [{"code": "93890", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCRAN MAGN STIM REDETEMINE", "code_information": [{"code": "90869", "type": "CPT"}], "standard_charges": [{"minimum": 382.26, "maximum": 382.26, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 382.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX DELI", "code_information": [{"code": "90868", "type": "CPT"}], "standard_charges": [{"minimum": 382.26, "maximum": 382.26, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 382.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCRANIAL MAGN STIM TX PLAN", "code_information": [{"code": "90867", "type": "CPT"}], "standard_charges": [{"minimum": 382.26, "maximum": 382.26, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 382.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TCS IMPLANT 6MM*5366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4817.54, "maximum": 6675.73, "gross_charge": 6882.2, "discounted_cash": 10323.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5849.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5161.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4817.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6675.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4817.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5161.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5849.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5505.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCS IMPLANT 7MM*5366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205492", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4817.54, "maximum": 6675.73, "gross_charge": 6882.2, "discounted_cash": 10323.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5849.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5161.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4817.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6675.73, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4817.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5161.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5849.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5505.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCS IMPLANT 8MM*5366", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4914.0, "maximum": 6809.4, "gross_charge": 7020.0, "discounted_cash": 10530.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6809.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4914.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5265.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5616.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TD VACC NO PRESV 7 YRS+ IM", "code_information": [{"code": "90714", "type": "CPT"}], "standard_charges": [{"minimum": 18.83, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 18.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TDAP VACCINE 7 YRS/> IM", "code_information": [{"code": "90715", "type": "CPT"}], "standard_charges": [{"minimum": 39.09, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 39.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TDAP VACCINE ADMIN", "code_information": [{"code": "90471", "type": "CPT"}, {"code": "3500102302", "type": "CDM"}, {"code": "771", "type": "RC"}], "standard_charges": [{"minimum": 23.14, "maximum": 162.96, "gross_charge": 168.0, "discounted_cash": 107.84, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 162.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 85.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 71.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY HC PRO", "code_information": [{"code": "99368", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/O PAT BY PHYS", "code_information": [{"code": "99367", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEAM CONF W/PAT BY HC PROF", "code_information": [{"code": "99366", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M AEROSOL", "code_information": [{"code": "A9567", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M AUTO WBC", "code_information": [{"code": "A9569", "type": "HCPCS"}], "standard_charges": [{"minimum": 1674.52, "maximum": 1674.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1674.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC-99M TEBOROXIME", "code_information": [{"code": "A9501", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TECHNETIUM TC99M ARCITUMOMAB", "code_information": [{"code": "A9568", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT, MON", "code_information": [{"code": "C8927", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEE W OR W/O FOL W/CONT,CONG", "code_information": [{"code": "C8926", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELAVANCIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3095", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.13, "maximum": 7.13, "discounted_cash": 11.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TELEDENTISTRY DENT REVIEW", "code_information": [{"code": "D9996", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELEDENTISTRY REAL-TIME", "code_information": [{"code": "D9995", "type": "HCPCS"}], "standard_charges": [{"minimum": 354.67, "maximum": 354.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 354.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH FACILITY FEE", "code_information": [{"code": "Q3014", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.84, "maximum": 45.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELEHEALTH INPT PHARM MGMT", "code_information": [{"code": "G0459", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.48, "maximum": 24.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELEMONITORING/HOME PER MNTH", "code_information": [{"code": "S9110", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN CPLX", "code_information": [{"code": "77307", "type": "CPT"}], "standard_charges": [{"minimum": 541.57, "maximum": 541.57, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 541.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TELETHX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77306", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 565.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8700", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.19, "maximum": 0.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMOZOLOMIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.4, "maximum": 10.4, "discounted_cash": 16.71, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W FLAP", "code_information": [{"code": "D7293", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7294", "type": "HCPCS"}], "standard_charges": [{"minimum": 3522.18, "maximum": 3522.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VALVE-PMP RPLCMT", "code_information": [{"code": "597T", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP FML IU VLV-PMP 1ST INSJ", "code_information": [{"code": "596T", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 1045.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP OBTURATOR PROSTHESIS", "code_information": [{"code": "D5936", "type": "HCPCS"}], "standard_charges": [{"minimum": 182.9, "maximum": 182.9, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 182.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMP PIN*3030003", "code_information": [{"code": "3100203522", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 276.0, "discounted_cash": 414.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPLATE GRID*610-90", "code_information": [{"code": "3100203088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 218.4, "discounted_cash": 327.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPLATE HTO PIN*AR-", "code_information": [{"code": "3100204674", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPORAL ARTERY PROCEDURE", "code_information": [{"code": "37609", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2718.95, "discounted_cash": 2481.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPORARY EXTERNAL PACING", "code_information": [{"code": "92953", "type": "CPT"}], "standard_charges": [{"minimum": 903.35, "maximum": 903.35, "discounted_cash": 996.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 903.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPORARY FIX PIN*05", "code_information": [{"code": "3100203535", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPORARY PIN*AP2-10", "code_information": [{"code": "3100209265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPORARY PIN*AP2-10", "code_information": [{"code": "3100210004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEMPOROMANDIBULAR JOINT DYSF", "code_information": [{"code": "D9130", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMPR", "code_information": [{"code": "278T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEMSIROLIMUS INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.86, "maximum": 28.86, "discounted_cash": 49.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102406", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4095.0, "maximum": 5674.5, "gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5674.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4095.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4387.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4972.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100101971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 4098.25, "gross_charge": 4225.0, "discounted_cash": 6337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4098.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2957.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3591.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3380.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3133.23, "gross_charge": 3230.14, "discounted_cash": 4845.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2745.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2422.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2261.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3133.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2261.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2422.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2745.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2584.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103571", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5273.89, "gross_charge": 5437.0, "discounted_cash": 8155.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4621.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4077.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3805.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5273.89, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3805.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4077.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4621.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4349.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103572", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 4754.94, "gross_charge": 4902.0, "discounted_cash": 7353.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4166.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3676.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3431.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4754.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3431.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3676.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4166.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3921.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON ACHILLE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 7729.93, "gross_charge": 7969.0, "discounted_cash": 11953.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6773.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5976.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5578.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7729.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5578.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5976.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6773.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6375.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON ACHILLE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 6343.8, "gross_charge": 6540.0, "discounted_cash": 9810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5559.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4905.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4578.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6343.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4578.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4905.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5559.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5232.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON EXC PALM/FING", "code_information": [{"code": "26145", "type": "CPT"}, {"code": "3480101625", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 4024.53, "gross_charge": 4149.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4024.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2904.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3111.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3526.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3319.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON HUNTER 4MM*TR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON HUNTER 5MM*TR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202384", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON HUNTER 6MM*TR", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100202385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON HUNTER PC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100104249", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON LENGTHENING", "code_information": [{"code": "26476", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON PATALLA", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100101972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 10202.46, "gross_charge": 10518.0, "discounted_cash": 15777.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8940.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7888.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7362.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10202.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7362.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7888.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8940.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8414.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON PRE-SHAPE LIG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5190.27, "maximum": 7192.23, "gross_charge": 7414.68, "discounted_cash": 11122.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6302.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5561.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5190.27, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7192.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5190.27, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5561.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6302.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5931.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON PRE-SUTURED*F", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2313.56, "maximum": 3205.93, "gross_charge": 3305.09, "discounted_cash": 4957.64, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2809.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2478.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2313.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3205.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2313.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2478.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2809.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2644.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON REPAIR KIT*FA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5096.0, "maximum": 7061.6, "gross_charge": 7280.0, "discounted_cash": 10920.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7061.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5096.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5824.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON SHORTENING", "code_information": [{"code": "26477", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1856.1, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDON TISSUETAK*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206927", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.0, "maximum": 2376.5, "gross_charge": 2450.0, "discounted_cash": 3675.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2376.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1715.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2082.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDON TRANSFER WITH GRAFT", "code_information": [{"code": "26492", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [{"code": "557", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5384.72, "maximum": 5384.72, "discounted_cash": 17381.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5384.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [{"code": "558", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3874.68, "maximum": 3874.68, "discounted_cash": 9806.96, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3874.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENDOR HARVESTER", "code_information": [{"code": "3100101973", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3091.0, "discounted_cash": 4636.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TENECTEPLASE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3101", "type": "HCPCS"}], "standard_charges": [{"minimum": 153.11, "maximum": 153.11, "discounted_cash": 245.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 153.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENIPOSIDE, 50 MG", "code_information": [{"code": "Q2017", "type": "HCPCS"}], "standard_charges": [{"minimum": 389.69, "maximum": 389.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 389.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENODESIS SIZER", "code_information": [{"code": "3100103979", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TENOFOVIR LIQ CHROM UR QUAN", "code_information": [{"code": "25U", "type": "CPT"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "discounted_cash": 137.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 78.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOGLIDE", "code_information": [{"code": "C9356", "type": "HCPCS"}, {"code": "3100102254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 7070.87, "gross_charge": 7289.56, "discounted_cash": 10934.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6196.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5467.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5102.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7070.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5102.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5467.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6196.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5831.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS TRICEPS", "code_information": [{"code": "24332", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6445.38, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOLYSIS, FLEXOR OR", "code_information": [{"code": "27680", "type": "CPT"}, {"code": "3480101724", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOPLASTY ELBOW TO SHO 1", "code_information": [{"code": "24320", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6445.38, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6445.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, ADDUCTOR O", "code_information": [{"code": "27001", "type": "CPT"}, {"code": "3480101659", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, LENGTHENIN", "code_information": [{"code": "28240", "type": "CPT"}, {"code": "3480101760", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5377.68, "gross_charge": 5544.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5377.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4158.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4712.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4435.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, OPEN, EXTE", "code_information": [{"code": "28234", "type": "CPT"}, {"code": "3480101759", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, OPEN, HAMS", "code_information": [{"code": "27390", "type": "CPT"}, {"code": "3480101696", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, OPEN, TEND", "code_information": [{"code": "28230", "type": "CPT"}, {"code": "3480101757", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, OPEN, TEND", "code_information": [{"code": "28232", "type": "CPT"}, {"code": "3480101758", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 6453.41, "gross_charge": 6653.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6453.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4657.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4989.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5655.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5322.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENOTOMY, PERCUTANEO", "code_information": [{"code": "27606", "type": "CPT"}, {"code": "3480101713", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 5280.68, "gross_charge": 5444.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5280.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3810.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4083.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4627.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TENSILE BAR 20X105*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7885.87, "maximum": 10927.57, "gross_charge": 11265.54, "discounted_cash": 16898.31, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9575.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8449.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7885.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10927.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7885.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8449.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9575.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9012.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TENSIX, 1CM", "code_information": [{"code": "Q4146", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7680", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULF COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7681", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TERBUTALINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3105", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.09, "maximum": 6.09, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERIPARATIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3110", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.23, "maximum": 41.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TERT GENE TARGETED SEQ ALYS", "code_information": [{"code": "81345", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 185.2, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESERA K SC LOCK*106", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209456", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 420.0, "maximum": 582.0, "gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 582.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 420.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 510.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 480.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TEST FECES FOR TRYPSIN", "code_information": [{"code": "84488", "type": "CPT"}], "standard_charges": [{"minimum": 7.3, "maximum": 20.92, "discounted_cash": 11.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR BLOOD FLOW IN GRAFT", "code_information": [{"code": "15860", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 668.39, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 668.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR CHLOROHYDROCARBONS", "code_information": [{"code": "82441", "type": "CPT"}], "standard_charges": [{"minimum": 6.01, "maximum": 20.03, "discounted_cash": 9.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR G6PD ENZYME", "code_information": [{"code": "82960", "type": "CPT"}], "standard_charges": [{"minimum": 6.05, "maximum": 20.92, "discounted_cash": 9.72, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR PORPHOBILINOGEN", "code_information": [{"code": "84106", "type": "CPT"}], "standard_charges": [{"minimum": 5.82, "maximum": 20.92, "discounted_cash": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.82, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST FOR URINE CYSTINES", "code_information": [{"code": "82615", "type": "CPT"}], "standard_charges": [{"minimum": 9.55, "maximum": 20.92, "discounted_cash": 15.35, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST KIT WATER", "code_information": [{"code": "3100104081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 392.0, "discounted_cash": 588.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TEST RBC PROTOPORPHYRIN", "code_information": [{"code": "84203", "type": "CPT"}], "standard_charges": [{"minimum": 9.74, "maximum": 20.92, "discounted_cash": 15.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST URINE FOR LACTOSE", "code_information": [{"code": "83633", "type": "CPT"}], "standard_charges": [{"minimum": 11.25, "maximum": 40.05, "discounted_cash": 18.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TEST URINE UROBILINOGEN", "code_information": [{"code": "84578", "type": "CPT"}], "standard_charges": [{"minimum": 4.47, "maximum": 20.92, "discounted_cash": 7.19, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTER HOOD", "code_information": [{"code": "3100101974", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITH CC/MCC", "code_information": [{"code": "711", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13100.88, "maximum": 13100.88, "discounted_cash": 23701.26, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13100.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTES PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "712", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5363.81, "maximum": 5363.81, "discounted_cash": 13267.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5363.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTICULAR IMAGING W/FLOW", "code_information": [{"code": "78761", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE BIOAVAILABLE", "code_information": [{"code": "84410", "type": "CPT"}], "standard_charges": [{"minimum": 51.28, "maximum": 68.09, "discounted_cash": 82.38, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE FREE", "code_information": [{"code": "84402", "type": "CPT"}, {"code": "3440100996", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 25.47, "maximum": 258.02, "gross_charge": 266.0, "discounted_cash": 40.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 186.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 258.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.83, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 186.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE RESPONSE PANEL", "code_information": [{"code": "80414", "type": "CPT"}], "standard_charges": [{"minimum": 51.64, "maximum": 68.09, "discounted_cash": 82.97, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE UNDECANOATE 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.93, "maximum": 1.93, "discounted_cash": 2.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TESTOSTERONE, TOTAL", "code_information": [{"code": "84403", "type": "CPT"}, {"code": "3440100997", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 25.81, "maximum": 269.66, "gross_charge": 278.0, "discounted_cash": 41.46, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 236.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 208.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 194.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 269.66, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 194.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 208.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 32.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 236.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 222.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 25.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TETANUS AB", "code_information": [{"code": "86774", "type": "CPT"}, {"code": "3440101124", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.8, "maximum": 129.01, "gross_charge": 133.0, "discounted_cash": 23.78, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 113.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 93.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 129.01, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 93.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 99.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 113.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.85, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TETANUS IG IM", "code_information": [{"code": "90389", "type": "CPT"}], "standard_charges": [{"minimum": 255.62, "maximum": 255.62, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 255.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS IMMUNE GLOBULIN INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1670", "type": "HCPCS"}], "standard_charges": [{"minimum": 578.78, "maximum": 578.78, "discounted_cash": 929.54, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 578.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETANUS TOXOID ADSOR", "code_information": [{"code": "90703", "type": "CPT"}, {"code": "3400300325", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 70.0, "maximum": 97.0, "gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 97.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 70.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 85.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 80.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TETRACAINE HCL", "code_information": [{"code": "3400300027", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.8, "discounted_cash": 16.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TETRACYCLIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0120", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.7, "maximum": 6.7, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TGFBI GENE COMMON VARIANTS", "code_information": [{"code": "81333", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 137.0, "discounted_cash": 220.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 137.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TGSAP NSM LUNG NEO DNA&RNA23", "code_information": [{"code": "22U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 3132.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THAW CRYOPRSVRD REPROD TISS", "code_information": [{"code": "89354", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THAW PRESERVED STEM CELLS", "code_information": [{"code": "38208", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED EMBRYO", "code_information": [{"code": "89352", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED OOCYTE", "code_information": [{"code": "89356", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THAWING CRYOPRESRVED SPERM", "code_information": [{"code": "89353", "type": "CPT"}], "standard_charges": [{"minimum": 59.63, "maximum": 59.63, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 59.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THEOPHYLLINE", "code_information": [{"code": "80198", "type": "CPT"}, {"code": "3440100829", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.14, "maximum": 122.22, "gross_charge": 126.0, "discounted_cash": 22.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER BEHAV SVC, PER 15 MIN", "code_information": [{"code": "H2019", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER BEHAV SVC, PER DIEM", "code_information": [{"code": "H2020", "type": "HCPCS"}], "standard_charges": [{"minimum": 392.94, "maximum": 392.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 392.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ 1ST 15 MIN", "code_information": [{"code": "97129", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER IVNTJ EA ADDL 15 MIN", "code_information": [{"code": "97130", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER NMA RDCTJ INTUS/OBSTRCJ", "code_information": [{"code": "74283", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THER/PROPH/DIAG INJ IA", "code_information": [{"code": "96373", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 328.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERA PAR DRUGS 2 OR > ADMIN", "code_information": [{"code": "D9612", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAP SPINAL PUNCT-", "code_information": [{"code": "62272", "type": "CPT"}, {"code": "3480102135", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1020.44, "gross_charge": 1052.0, "discounted_cash": 1058.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 729.67, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1020.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 736.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 726.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 789.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 839.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 894.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 841.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 705.68, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 719.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC ACTIVITIES", "code_information": [{"code": "97530", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC EXERCISES", "code_information": [{"code": "97110", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PNEUMOTHORAX", "code_information": [{"code": "32960", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1282.05, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PROCD STRG ENDUR", "code_information": [{"code": "G0237", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.59, "maximum": 116.59, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 116.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC PULPOTOMY", "code_information": [{"code": "D3220", "type": "HCPCS"}], "standard_charges": [{"minimum": 794.77, "maximum": 794.77, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 794.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERAPEUTIC ULTRAFILTRATION", "code_information": [{"code": "692T", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERASEED BRACHYTHER", "code_information": [{"code": "C2641", "type": "HCPCS"}, {"code": "3100203461", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5523.34, "maximum": 5523.34, "gross_charge": 69.0, "discounted_cash": 118.65, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5523.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERASKIN", "code_information": [{"code": "Q4121", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.13, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THERMOMETER TEMPORAL", "code_information": [{"code": "3100101976", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 993.0, "discounted_cash": 1489.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THIAMINE HCL (VITA B", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3411", "type": "HCPCS"}, {"code": "3400300267", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.26, "maximum": 19.88, "gross_charge": 20.5, "discounted_cash": 30.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THIAMINE VITAMIN B1", "code_information": [{"code": "84425", "type": "CPT"}, {"code": "3440100998", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 21.23, "maximum": 80.51, "gross_charge": 83.0, "discounted_cash": 34.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.51, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 62.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 80.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 58.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 62.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 27.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 70.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 66.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3280", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THIETHYLPERAZINE MALEATE10MG", "code_information": [{"code": "Q0174", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "THIOTEPA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9340", "type": "HCPCS"}], "standard_charges": [{"minimum": 228.36, "maximum": 228.36, "discounted_cash": 403.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 228.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THOR LAM HOOK LT*486", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THOR LAM HOOK RT*486", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43336", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORABD DIAPHR HERN REPAIR", "code_information": [{"code": "43337", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACENTESIS", "code_information": [{"code": "32554", "type": "CPT"}, {"code": "3480101876", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 641.05, "maximum": 1399.71, "gross_charge": 1443.0, "discounted_cash": 961.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1226.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1082.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1010.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1399.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1010.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1082.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1226.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1154.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACENTESIS, PUNCT", "code_information": [{"code": "32421", "type": "CPT"}, {"code": "3480101875", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 641.2, "maximum": 888.52, "gross_charge": 916.0, "discounted_cash": 1374.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 778.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 687.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 641.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 888.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 641.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 687.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 778.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 732.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACIC AORTIC GRAFT", "code_information": [{"code": "33875", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38380", "type": "CPT"}], "standard_charges": [{"minimum": 3504.82, "maximum": 3504.82, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38381", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACIC DUCT PROCEDURE", "code_information": [{"code": "38382", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOABDOMINAL GRAFT", "code_information": [{"code": "33877", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOP W/ESOPH MUSC EXC", "code_information": [{"code": "32665", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY BILOBECTOMY", "code_information": [{"code": "32670", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY CONTRL BLEEDING", "code_information": [{"code": "32654", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY PNEUMONECTOMY", "code_information": [{"code": "32671", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REM TOTL CORTEX", "code_information": [{"code": "32652", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX INFILTRATE", "code_information": [{"code": "32607", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/LOBECTOMY", "code_information": [{"code": "32663", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/MEDIAST EXC", "code_information": [{"code": "32662", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PERICARD EXC", "code_information": [{"code": "32661", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURODESIS", "code_information": [{"code": "32650", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC DRAINAGE", "code_information": [{"code": "32659", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/SAC FB REMOVE", "code_information": [{"code": "32658", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/THYMUS RESECT", "code_information": [{"code": "32673", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT ADDL", "code_information": [{"code": "32667", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THREADED INSERTER", "code_information": [{"code": "3100101977", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2779.0, "discounted_cash": 4168.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED ROD 100MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205124", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 269.69, "maximum": 373.72, "gross_charge": 385.28, "discounted_cash": 577.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 327.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 269.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 373.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 269.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 327.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 308.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THREADED ROD 60MM*03", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 269.69, "maximum": 373.72, "gross_charge": 385.28, "discounted_cash": 577.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 327.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 269.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 373.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 269.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 327.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 308.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THREADED ROD 80MM*03", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 269.69, "maximum": 373.72, "gross_charge": 385.28, "discounted_cash": 577.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 327.48, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 288.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 269.69, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 373.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 269.69, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 288.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 327.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 308.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS", "code_information": [{"code": "36904", "type": "CPT"}, {"code": "3480103158", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5001.8, "maximum": 6940.66, "gross_charge": 0.01, "discounted_cash": 8748.74, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6030.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6007.46, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6940.66, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS", "code_information": [{"code": "36905", "type": "CPT"}, {"code": "3480103159", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7310.46, "maximum": 13358.96, "gross_charge": 0.01, "discounted_cash": 16839.03, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11607.7, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11562.8, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 13358.96, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 11226.02, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 11450.54, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS", "code_information": [{"code": "36906", "type": "CPT"}, {"code": "3480103160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8133.27, "maximum": 21293.3, "gross_charge": 0.01, "discounted_cash": 26840.3, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18501.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18251.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18430.34, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17893.53, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21293.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17893.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17893.53, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18251.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4566.59, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4566.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROAT X-RAY & FLUOROSCOPY", "code_information": [{"code": "70370", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}, {"code": "3440101055", "type": "CDM"}, {"code": "305", "type": "RC"}], "standard_charges": [{"minimum": 5.77, "maximum": 47.53, "gross_charge": 49.0, "discounted_cash": 9.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.18, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME TITER", "code_information": [{"code": "85675", "type": "CPT"}], "standard_charges": [{"minimum": 6.85, "maximum": 20.47, "discounted_cash": 11.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC ART THERAPY", "code_information": [{"code": "37211", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC THERAPY STROKE", "code_information": [{"code": "37195", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 518.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC VENOUS THERAPY", "code_information": [{"code": "37212", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 17.27, "maximum": 20.47, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN INHIBITION", "code_information": [{"code": "85705", "type": "CPT"}], "standard_charges": [{"minimum": 9.63, "maximum": 20.47, "discounted_cash": 15.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOPLASTIN TIME PARTIAL", "code_information": [{"code": "85732", "type": "CPT"}], "standard_charges": [{"minimum": 6.47, "maximum": 20.47, "discounted_cash": 10.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOXANE URINE", "code_information": [{"code": "84431", "type": "CPT"}], "standard_charges": [{"minimum": 35.11, "maximum": 53.85, "discounted_cash": 56.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.11, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMBOYSIS CORON IV", "code_information": [{"code": "92977", "type": "CPT"}, {"code": "3340100574", "type": "CDM"}, {"code": "480", "type": "RC"}], "standard_charges": [{"minimum": 345.59, "maximum": 772.12, "gross_charge": 796.0, "discounted_cash": 518.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 676.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 357.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 597.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 557.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 772.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 352.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 557.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 355.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 597.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 411.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 676.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 636.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 345.59, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 352.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THROMINATOR/THROMBIN", "code_information": [{"code": "3100204678", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26820", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUMB FUSION WITH GRAFT", "code_information": [{"code": "26842", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3676.59, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUMB TENDON TRANSFER", "code_information": [{"code": "26510", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THUNDERBEAT", "code_information": [{"code": "3100104740", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THUNDERBEAT 5X35*TB-", "code_information": [{"code": "3100207610", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THUNDERBEAT 5X35*TB-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7860.58, "maximum": 10892.51, "gross_charge": 11229.4, "discounted_cash": 16844.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9544.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8422.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7860.58, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10892.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7860.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8422.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9544.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8983.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THUNDERBEAT 5X45*TB-", "code_information": [{"code": "3100207457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "discounted_cash": 7083.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN AB", "code_information": [{"code": "86800", "type": "CPT"}, {"code": "3440101131", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.91, "maximum": 165.87, "gross_charge": 171.0, "discounted_cash": 25.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 165.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 119.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 128.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 145.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 136.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID HORMONE UPTA", "code_information": [{"code": "84479", "type": "CPT"}, {"code": "3440101007", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.47, "maximum": 56.26, "gross_charge": 58.0, "discounted_cash": 10.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.17, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 56.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 40.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 43.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 49.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 46.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.93, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78013", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID IMAGING W/BLOOD FLOW", "code_information": [{"code": "78014", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING", "code_information": [{"code": "78015", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING BODY", "code_information": [{"code": "78018", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID MET IMAGING/STUDIES", "code_information": [{"code": "78016", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID MET UPTAKE", "code_information": [{"code": "78020", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID PARTIAL", "code_information": [{"code": "60210", "type": "CPT"}, {"code": "3480102125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5635.04, "maximum": 12463.53, "gross_charge": 12849.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10921.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9636.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8994.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12463.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8994.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9636.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10921.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10279.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID STIMLTNG HOR", "code_information": [{"code": "84443", "type": "CPT"}, {"code": "3440101001", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.8, "maximum": 147.44, "gross_charge": 152.0, "discounted_cash": 26.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 147.44, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 106.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.53, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 114.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 129.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 121.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID TOTAL", "code_information": [{"code": "60240", "type": "CPT"}, {"code": "3480102127", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5635.04, "maximum": 12463.53, "gross_charge": 12849.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10921.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9636.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8994.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12463.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8994.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9636.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10921.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10279.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID UPTAKE MEASUREMENT", "code_information": [{"code": "78012", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [{"code": "626", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10111.56, "maximum": 10111.56, "discounted_cash": 16656.42, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10111.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [{"code": "625", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17472.97, "maximum": 17472.97, "discounted_cash": 32613.93, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17472.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "627", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5046.56, "maximum": 5046.56, "discounted_cash": 13799.4, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5046.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY, REMOV", "code_information": [{"code": "60260", "type": "CPT"}, {"code": "3480102130", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5635.04, "maximum": 13357.87, "gross_charge": 13771.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13357.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9639.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10328.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11705.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11016.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY, TOTAL", "code_information": [{"code": "60252", "type": "CPT"}, {"code": "3480102128", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5635.04, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROIDECTOMY, TOTAL", "code_information": [{"code": "60254", "type": "CPT"}, {"code": "3480102129", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2926.7, "maximum": 5635.04, "gross_charge": 4181.0, "discounted_cash": 6271.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3553.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3135.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2926.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4055.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2926.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3135.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3553.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3344.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY FEMALE 0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204749", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY FEMALE 0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204787", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY FEMALE 0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 772.8, "maximum": 1070.88, "gross_charge": 1104.0, "discounted_cash": 1656.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1070.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 883.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY FEMALE 0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204866", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 772.8, "maximum": 1070.88, "gross_charge": 1104.0, "discounted_cash": 1656.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1070.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 883.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY FEMALE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204867", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY FEMALE 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 772.8, "maximum": 1070.88, "gross_charge": 1104.0, "discounted_cash": 1656.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1070.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 772.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 828.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 938.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 883.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY KIT FEMA", "code_information": [{"code": "3100204725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THYROPLASTY KIT MALE", "code_information": [{"code": "3100204606", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 08*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 09*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 11*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 11*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROPLASTY MALE 13*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 892.5, "maximum": 1236.75, "gross_charge": 1275.0, "discounted_cash": 1912.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1236.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 892.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1083.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROTROPIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3240", "type": "HCPCS"}], "standard_charges": [{"minimum": 2022.37, "maximum": 2022.37, "discounted_cash": 3247.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2022.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROXINE TOTAL", "code_information": [{"code": "84436", "type": "CPT"}, {"code": "3440100999", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 6.87, "maximum": 46.56, "gross_charge": 48.0, "discounted_cash": 11.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 46.56, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 40.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 38.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TI FEM SSK 65MM*CP11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17728.2, "maximum": 24566.22, "gross_charge": 25326.0, "discounted_cash": 37989.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 21527.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18994.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17728.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 24566.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17728.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18994.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 21527.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20260.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI FEM SSK 65MM*CP11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 23046.66, "maximum": 31936.08, "gross_charge": 32923.8, "discounted_cash": 49385.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 27985.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 24692.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 23046.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 31936.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 23046.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 24692.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 27985.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26339.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI FEM SSK 70MM*CP11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9406.6, "maximum": 13034.86, "gross_charge": 13438.0, "discounted_cash": 20157.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11422.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10078.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9406.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13034.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9406.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10078.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11422.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10750.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI HALF RING 160MM*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1473.21, "maximum": 2041.45, "gross_charge": 2104.59, "discounted_cash": 3156.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1788.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1578.44, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1473.21, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2041.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1473.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1578.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1788.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1683.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI RING 180MM*03.311", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2131.8, "maximum": 2954.06, "gross_charge": 3045.43, "discounted_cash": 4568.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2588.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2284.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2131.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2954.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2131.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2284.07, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2588.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2436.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI Z ROD 300MM*15240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 630.0, "maximum": 873.0, "gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 873.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 630.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 675.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 765.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TI-MAX X SERIES", "code_information": [{"code": "3100104719", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIAGABINE", "code_information": [{"code": "80199", "type": "CPT"}, {"code": "3440100830", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 27.11, "maximum": 157.14, "gross_charge": 162.0, "discounted_cash": 43.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 157.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 113.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 121.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 137.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 129.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 27.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.03, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.61, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB BEARING CR /12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202233", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING CR 7*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 10*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207328", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 2*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 2*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 2*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 3*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 3*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206559", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 3*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207154", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 3*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207817", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206064", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 6*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 6*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206217", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 6*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 6*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207545", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 6*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209326", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 7*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 7*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 7*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 7*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 7*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 8*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 8*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206698", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 8*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 8*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 9*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BEARING PS 9*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1495.55, "maximum": 2072.41, "gross_charge": 2136.51, "discounted_cash": 3204.77, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2072.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1495.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1602.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1816.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1709.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB BLOCK 6MM*141743", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2525.25, "maximum": 3499.27, "gross_charge": 3607.5, "discounted_cash": 5411.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3066.37, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2705.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3499.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2525.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2705.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3066.37, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2886.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB COMPONENT SZ4*00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB CRUCIATE WING 36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1628.76, "maximum": 2256.99, "gross_charge": 2326.8, "discounted_cash": 3490.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1977.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1745.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1628.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2256.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1628.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1745.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1977.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1861.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB CUT GUIDE RT*AR-", "code_information": [{"code": "3100209405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIB INS HIN 14MM*198", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208583", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5432.7, "maximum": 7528.17, "gross_charge": 7761.0, "discounted_cash": 11641.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6596.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5820.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5432.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7528.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5432.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5820.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6596.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6208.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INS HIN UNI 31MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203989", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7295.4, "maximum": 10109.34, "gross_charge": 10422.0, "discounted_cash": 15633.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8858.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7816.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7295.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10109.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7295.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7816.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8858.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8337.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSER PS 11*5532", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT 11MM*5532", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209432", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT CS SZ5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT PS S2 10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT PS S2 9*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205928", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT PS S5*553", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT PS S6 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT PS S7 10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT PS12*5532", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206054", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ2 14M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205412", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3568.56, "maximum": 4945.01, "gross_charge": 5097.95, "discounted_cash": 7646.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4333.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3823.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3568.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4945.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3568.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3823.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4333.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4078.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ3 10MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205707", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ3 11M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ3 12M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205952", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ4 10MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ4 12M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205767", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ4 14M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ6 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ6 12M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205756", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ6 14M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206203", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ7 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ7 11M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ7 12M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ7 14M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ7 14M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205794", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ8 *5531", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208949", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT SZ8 11M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT X3 1X9M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206859", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT X3 6X13*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206176", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERT X3 7X9M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB INSERTPS S4 14*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205839", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB TRAY ADAPTOR*141", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208775", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1493.1, "maximum": 2069.01, "gross_charge": 2133.0, "discounted_cash": 3199.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1813.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1599.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1493.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2069.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1493.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1599.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1813.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1706.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC ADD-ON", "code_information": [{"code": "37232", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STENT & ATHER", "code_information": [{"code": "37231", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC STNT & ATHER", "code_information": [{"code": "37235", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/ATHER", "code_information": [{"code": "37229", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/STENT", "code_information": [{"code": "37230", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIB/PER REVASC W/TLA", "code_information": [{"code": "37228", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBAL BASEPLT TS SZ1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBAL BPL RT SZ4*630", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202801", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBAL TRAY FIXE BEAR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204132", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4042.03, "maximum": 5601.1, "gross_charge": 5774.34, "discounted_cash": 8661.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4908.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4330.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4042.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5601.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4042.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4330.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4908.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4619.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIA FIXED SZF*42-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5569.2, "maximum": 7717.32, "gross_charge": 7956.0, "discounted_cash": 11934.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6762.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5569.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7717.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5569.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5967.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6762.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6364.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2377.2, "maximum": 3294.12, "gross_charge": 3396.0, "discounted_cash": 5094.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2886.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2547.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2377.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3294.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2377.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2547.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2886.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2716.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205782", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ2*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208387", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ2*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 1/2 BLCK SZ3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1954.98, "maximum": 2709.04, "gross_charge": 2792.83, "discounted_cash": 4189.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2709.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1954.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2094.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2373.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2234.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL 6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL ANKLE TALAR M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9381.4, "maximum": 12999.94, "gross_charge": 13402.0, "discounted_cash": 20103.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11391.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10051.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9381.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12999.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9381.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10051.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11391.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10721.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTHROSCOPY/SURGERY", "code_information": [{"code": "29856", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7500.92, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIBIAL ARTICULAR ZIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101980", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG 10MM*1523", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG 5MM SZ 6*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2057.32, "maximum": 2850.86, "gross_charge": 2939.04, "discounted_cash": 4408.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2498.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2204.28, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2057.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2850.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2057.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2204.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2498.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2351.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG 5MM*1523-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209987", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ 1-2*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8003.92, "maximum": 11091.15, "gross_charge": 11434.18, "discounted_cash": 17151.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11091.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9147.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ 1-2*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8003.92, "maximum": 11091.15, "gross_charge": 11434.18, "discounted_cash": 17151.27, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11091.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8003.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8575.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9719.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9147.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ A*5549", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206786", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7028.11, "maximum": 9738.95, "gross_charge": 10040.16, "discounted_cash": 15060.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9738.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8032.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ B*5549", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7028.11, "maximum": 9738.95, "gross_charge": 10040.16, "discounted_cash": 15060.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9738.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8032.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ D*5549", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7028.11, "maximum": 9738.95, "gross_charge": 10040.16, "discounted_cash": 15060.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9738.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8032.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ E*5549", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209345", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7028.11, "maximum": 9738.95, "gross_charge": 10040.16, "discounted_cash": 15060.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9738.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7028.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7530.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8534.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8032.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ2 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1997.14, "maximum": 2767.46, "gross_charge": 2853.06, "discounted_cash": 4279.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2425.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2139.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1997.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2767.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1997.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2139.79, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2425.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2282.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ2 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1997.14, "maximum": 2767.46, "gross_charge": 2853.06, "discounted_cash": 4279.59, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2425.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2139.79, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1997.14, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2767.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1997.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2139.79, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2425.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2282.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL AUG SZ3 10M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1906.98, "maximum": 2642.53, "gross_charge": 2724.26, "discounted_cash": 4086.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2315.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2043.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1906.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2642.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1906.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2043.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2315.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2179.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 3*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207654", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6537.44, "maximum": 9059.02, "gross_charge": 9339.2, "discounted_cash": 14008.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9059.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7471.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 3*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207892", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 4*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205677", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8171.8, "maximum": 11323.78, "gross_charge": 11674.0, "discounted_cash": 17511.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9922.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8755.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8171.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11323.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8171.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8755.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9922.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9339.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 4*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 4*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4295.2, "maximum": 5951.92, "gross_charge": 6136.0, "discounted_cash": 9204.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5215.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4602.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5951.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4602.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5215.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4908.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 5*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205751", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6537.44, "maximum": 9059.02, "gross_charge": 9339.2, "discounted_cash": 14008.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9059.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7471.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 5*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 5*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4295.2, "maximum": 5951.92, "gross_charge": 6136.0, "discounted_cash": 9204.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5215.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4602.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5951.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4602.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5215.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4908.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 6*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6537.44, "maximum": 9059.02, "gross_charge": 9339.2, "discounted_cash": 14008.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9059.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7471.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 6*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207900", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 6*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208523", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4295.2, "maximum": 5951.92, "gross_charge": 6136.0, "discounted_cash": 9204.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5215.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4602.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5951.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4295.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4602.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5215.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4908.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 7*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6537.44, "maximum": 9059.02, "gross_charge": 9339.2, "discounted_cash": 14008.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9059.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6537.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7004.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7938.32, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7471.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 7*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 7*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208188", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 8*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8171.8, "maximum": 11323.78, "gross_charge": 11674.0, "discounted_cash": 17511.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9922.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8755.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8171.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11323.78, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8171.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8755.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9922.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9339.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 8*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASE SZ 9*150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 1*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208872", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 2*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206297", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 3*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 4*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205879", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 5*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205613", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2152.09, "maximum": 2982.18, "gross_charge": 3074.42, "discounted_cash": 4611.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2613.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2305.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2152.09, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2982.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2152.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2305.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2613.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2459.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 7*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE 8*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205830", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2195.37, "maximum": 3042.16, "gross_charge": 3136.25, "discounted_cash": 4704.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3042.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2195.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2352.18, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2665.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2509.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206199", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205840", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206082", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205977", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206231", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206389", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE SZ8", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207881", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BASEPLATE*180", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205301", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1521.1, "maximum": 2107.81, "gross_charge": 2173.0, "discounted_cash": 3259.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1847.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1629.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1521.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2107.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1521.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1629.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1847.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1738.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING 18X67", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205687", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING 8X13M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING AS*VE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2327.78, "maximum": 3225.63, "gross_charge": 3325.4, "discounted_cash": 4988.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3225.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2660.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING COMP*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8279.54, "maximum": 11473.08, "gross_charge": 11827.92, "discounted_cash": 17741.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10053.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8870.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8279.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11473.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8279.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8870.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10053.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9462.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING CR *E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202420", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2375.1, "maximum": 3291.21, "gross_charge": 3393.0, "discounted_cash": 5089.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3291.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2714.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING CR *E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202972", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2327.78, "maximum": 3225.63, "gross_charge": 3325.4, "discounted_cash": 4988.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3225.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2660.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING CR 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING PS 20", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5405.4, "maximum": 7490.34, "gross_charge": 7722.0, "discounted_cash": 11583.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6563.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5791.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5405.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7490.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5405.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5791.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6563.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6177.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING PS*EP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2375.1, "maximum": 3291.21, "gross_charge": 3393.0, "discounted_cash": 5089.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3291.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2714.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING PS*EP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2375.1, "maximum": 3291.21, "gross_charge": 3393.0, "discounted_cash": 5089.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3291.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2375.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2544.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2884.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2714.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING PS*EP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203555", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2327.78, "maximum": 3225.63, "gross_charge": 3325.4, "discounted_cash": 4988.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3225.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2660.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING PS*VE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING VG 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1930.6, "maximum": 2675.26, "gross_charge": 2758.0, "discounted_cash": 4137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2675.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1930.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2068.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2344.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2206.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL BEARING VG E1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2327.78, "maximum": 3225.63, "gross_charge": 3325.4, "discounted_cash": 4988.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3225.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2327.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2494.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2826.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2660.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM LT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM LT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM LT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204759", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM LT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204844", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM RT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204382", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM RT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205481", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM RT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM RT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM RT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEM RT MED *4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEMNT", "code_information": [{"code": "3100104104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4195.0, "discounted_cash": 6292.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL CEMNT SZ4 12.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2691.68, "maximum": 3729.91, "gross_charge": 3845.27, "discounted_cash": 5767.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3268.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2691.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3729.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2691.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3268.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEMNT SZ4 15M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2691.68, "maximum": 3729.91, "gross_charge": 3845.27, "discounted_cash": 5767.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3268.47, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2883.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2691.68, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3729.91, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2691.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2883.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3268.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CEMNT SZ5 12.", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2692.2, "maximum": 3730.62, "gross_charge": 3846.0, "discounted_cash": 5769.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3269.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2884.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2692.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3730.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2692.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2884.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3269.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3076.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CHECKPOINT*11", "code_information": [{"code": "3100208039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 331.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL COMPNT SZ4*59", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210183", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL COMPONENT SZ5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL COMPONENT*599", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207247", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL CONE*42-5450-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8395.66, "maximum": 11633.98, "gross_charge": 11993.8, "discounted_cash": 17990.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10194.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8995.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8395.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11633.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8395.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8995.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10194.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9595.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL HALF BLOCK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101982", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1920.8, "maximum": 2661.68, "gross_charge": 2744.0, "discounted_cash": 4116.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2661.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1920.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2058.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2332.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2195.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104561", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.9, "maximum": 6612.49, "gross_charge": 6817.0, "discounted_cash": 10225.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INS SZ2 12.5M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202454", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INS SZ2.5 15M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.03, "maximum": 6611.29, "gross_charge": 6815.77, "discounted_cash": 10223.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5793.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5111.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.03, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6611.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.03, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5111.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5793.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5452.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INS SZ2.5 17.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204137", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2530.5, "maximum": 3506.55, "gross_charge": 3615.0, "discounted_cash": 5422.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3072.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2711.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2530.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3506.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2530.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2711.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3072.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2892.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSER SZ5 22.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104358", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1909.82, "maximum": 2646.47, "gross_charge": 2728.32, "discounted_cash": 4092.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2646.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2182.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104644", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4916.8, "maximum": 6813.28, "gross_charge": 7024.0, "discounted_cash": 10536.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5970.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5268.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4916.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6813.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4916.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5268.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5970.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5619.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #1 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #2 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207354", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #2 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208385", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #2 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #2 19M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #2 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206129", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #3 *55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207776", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT #3*553", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 10MM*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 12.5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2609.88, "maximum": 3616.54, "gross_charge": 3728.4, "discounted_cash": 5592.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3169.14, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2796.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3616.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2609.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2796.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3169.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2982.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 15MM*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 2 12M*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 22.5M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 25MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4771.76, "maximum": 6612.3, "gross_charge": 6816.81, "discounted_cash": 10225.22, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6612.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4771.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5112.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5794.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5453.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 2X11*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206158", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 30MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206812", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3643.64, "maximum": 5049.04, "gross_charge": 5205.2, "discounted_cash": 7807.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4424.42, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3903.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3643.64, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5049.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3643.64, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3903.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4424.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4164.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 5X9M*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205945", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 8X11*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207474", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 9MM*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205895", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT 9MM*66", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204947", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.49, "maximum": 2173.47, "gross_charge": 2240.7, "discounted_cash": 3361.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2173.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT CR14*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT HINGE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202344", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5064.05, "maximum": 7017.33, "gross_charge": 7234.37, "discounted_cash": 10851.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6149.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5425.77, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5064.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7017.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5064.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5425.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6149.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5787.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT HINGE*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5432.7, "maximum": 7528.17, "gross_charge": 7761.0, "discounted_cash": 11641.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6596.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5820.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5432.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7528.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5432.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5820.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6596.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6208.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT LIPPED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202475", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1779.28, "maximum": 2465.58, "gross_charge": 2541.84, "discounted_cash": 3812.76, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1906.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1779.28, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2465.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1779.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1906.38, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2160.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2033.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT LIPPED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.49, "maximum": 2173.47, "gross_charge": 2240.7, "discounted_cash": 3361.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2173.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT LIPPED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204388", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.49, "maximum": 2173.47, "gross_charge": 2240.7, "discounted_cash": 3361.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2173.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.49, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT ONLAY*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205300", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3610.88, "maximum": 5003.64, "gross_charge": 5158.4, "discounted_cash": 7737.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4384.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3868.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3610.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5003.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3610.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3868.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4384.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4126.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PKR 8M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1809.86, "maximum": 2507.95, "gross_charge": 2585.52, "discounted_cash": 3878.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2197.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1939.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1809.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2507.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1809.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1939.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2197.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2068.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS 10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS 12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205863", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS 14*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS S2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209807", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS S2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS S6", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206304", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS S7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS S8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS S8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS SZ3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS SZ5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT PS4 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206081", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT S4 12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT S4*553", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT S6 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT S6 12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205873", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT S7 12*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT S7 13*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207355", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 1 *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 3*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207894", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 3*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208090", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 3*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 3*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 4*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207651", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 4*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 4*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208976", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205682", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207890", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208178", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208349", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1372.0, "maximum": 1901.2, "gross_charge": 1960.0, "discounted_cash": 2940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1901.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 5*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206367", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207450", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208241", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209258", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202506", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4563.46, "maximum": 6323.66, "gross_charge": 6519.24, "discounted_cash": 9778.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5541.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4889.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4563.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6323.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4563.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4889.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5541.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5215.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206206", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206480", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207243", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207484", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 6*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209092", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205943", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208052", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208171", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208346", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208647", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 7*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208946", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206964", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207072", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207898", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208740", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ 9*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208444", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ1 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ1 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ1*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ2 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207445", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ2* 5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ2*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ2*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208239", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ2*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1906.98, "maximum": 2642.53, "gross_charge": 2724.26, "discounted_cash": 4086.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2315.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2043.19, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1906.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2642.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1906.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2043.19, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2315.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2179.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3 13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206541", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207207", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205797", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207765", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ3*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209057", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208192", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208951", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209162", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205981", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1909.82, "maximum": 2646.47, "gross_charge": 2728.32, "discounted_cash": 4092.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2646.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2182.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1909.82, "maximum": 2646.47, "gross_charge": 2728.32, "discounted_cash": 4092.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2646.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2182.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204832", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4022.01, "maximum": 5573.36, "gross_charge": 5745.74, "discounted_cash": 8618.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4883.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4309.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4022.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5573.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4022.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4309.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4883.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4596.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 19", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 9M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205733", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4022.01, "maximum": 5573.36, "gross_charge": 5745.74, "discounted_cash": 8618.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4883.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4309.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4022.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5573.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4022.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4309.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4883.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4596.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4 9M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206540", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205841", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206670", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207248", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ4*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5 11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204649", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5 13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202978", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3500.77, "maximum": 4851.06, "gross_charge": 5001.1, "discounted_cash": 7501.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4250.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3750.82, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3500.77, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4851.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3500.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3750.82, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4250.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4000.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5 25", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4022.01, "maximum": 5573.36, "gross_charge": 5745.74, "discounted_cash": 8618.61, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4883.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4309.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4022.01, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5573.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4022.01, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4309.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4883.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4596.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208721", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207851", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209836", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1909.82, "maximum": 2646.47, "gross_charge": 2728.32, "discounted_cash": 4092.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2646.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2182.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6 10", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1909.82, "maximum": 2646.47, "gross_charge": 2728.32, "discounted_cash": 4092.48, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2646.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1909.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2046.24, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2319.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2182.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6 28", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202431", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4563.46, "maximum": 6323.66, "gross_charge": 6519.24, "discounted_cash": 9778.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5541.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4889.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4563.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6323.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4563.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4889.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5541.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5215.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207074", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ6*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7 13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206159", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7 16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7 9M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7 9M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ7*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ8 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4027.29, "maximum": 5580.68, "gross_charge": 5753.28, "discounted_cash": 8629.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5580.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4027.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4314.96, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4890.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4602.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ8 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ8 *5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ8 12", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209790", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT SZ8*18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206391", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERT TOT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4957.4, "maximum": 6869.54, "gross_charge": 7082.0, "discounted_cash": 10623.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6019.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5311.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4957.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6869.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4957.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5311.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6019.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5665.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERTPS S4 *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERTPS S6 *", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206182", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERTPS S8 1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206133", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL INSERTSZ 5*55", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206614", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1874.25, "maximum": 2597.17, "gross_charge": 2677.5, "discounted_cash": 4016.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2597.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1874.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2008.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2275.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL LFT MED/RT LA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101983", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL LT MED LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101984", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL LT MED/RT LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101985", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL MOD CEMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3416.0, "maximum": 4733.6, "gross_charge": 4880.0, "discounted_cash": 7320.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4148.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3660.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3416.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4733.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3416.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3660.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4148.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL PKR SZ3 10MM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1809.86, "maximum": 2507.95, "gross_charge": 2585.52, "discounted_cash": 3878.28, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2197.69, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1939.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1809.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2507.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1809.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1939.14, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2197.69, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2068.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL RT MED/LT LAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100101986", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SEGMENT 60*TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209164", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 916.1, "maximum": 1269.45, "gross_charge": 1308.72, "discounted_cash": 1963.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1112.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 981.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 916.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1269.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 916.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 981.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1112.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1046.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SLEEVE 29*151", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4808.44, "maximum": 6663.12, "gross_charge": 6869.2, "discounted_cash": 10303.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6663.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5495.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SLEEVE 29*151", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206815", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4808.44, "maximum": 6663.12, "gross_charge": 6869.2, "discounted_cash": 10303.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6663.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5495.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SLEEVE 37*151", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6011.46, "maximum": 8330.16, "gross_charge": 8587.8, "discounted_cash": 12881.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7299.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6440.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6011.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8330.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6011.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6440.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7299.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6870.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SLEEVE 37*151", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4808.44, "maximum": 6663.12, "gross_charge": 6869.2, "discounted_cash": 10303.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6663.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5495.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SLEEVE 45*151", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4808.44, "maximum": 6663.12, "gross_charge": 6869.2, "discounted_cash": 10303.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6663.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4808.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5151.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5838.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5495.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL SLEEVE 53*151", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6011.46, "maximum": 8330.16, "gross_charge": 8587.8, "discounted_cash": 12881.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7299.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6440.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6011.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8330.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6011.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6440.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7299.63, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6870.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL STEM 10X 50*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2093.0, "maximum": 2900.3, "gross_charge": 2990.0, "discounted_cash": 4485.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2900.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2093.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2242.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2541.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL STEMMED SZ6*0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2774.8, "maximum": 3845.08, "gross_charge": 3964.0, "discounted_cash": 5946.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3369.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2973.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2774.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3845.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2774.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2973.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3369.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3171.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY 360 71MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5369.0, "maximum": 7439.9, "gross_charge": 7670.0, "discounted_cash": 11505.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7439.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5369.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5752.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6519.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6136.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY 360 79MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203678", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6442.8, "maximum": 8927.88, "gross_charge": 9204.0, "discounted_cash": 13806.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7823.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6903.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6442.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8927.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6442.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6903.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7823.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7363.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY FIXED BE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3052.0, "maximum": 4229.2, "gross_charge": 4360.0, "discounted_cash": 6540.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3706.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3270.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3052.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4229.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3052.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3270.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3706.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3488.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ 2*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206173", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ 3*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.04, "maximum": 2348.84, "gross_charge": 2421.49, "discounted_cash": 3632.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.04, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.04, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ 4*336", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208156", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9086.0, "maximum": 12590.6, "gross_charge": 12980.0, "discounted_cash": 19470.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11033.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9086.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12590.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9086.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9735.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11033.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10384.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ 4*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ 5*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205993", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ 6*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ10*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ5 CEM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202856", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1155.0, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 2475.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ7*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ8*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRAY SZ9*AR-5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207143", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1695.05, "maximum": 2348.85, "gross_charge": 2421.5, "discounted_cash": 3632.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2348.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1695.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1816.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2058.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1937.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRIAL", "code_information": [{"code": "3100102285", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104221", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1831.2, "maximum": 2537.52, "gross_charge": 2616.0, "discounted_cash": 3924.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2223.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1962.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1831.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2537.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1831.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1962.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2223.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2092.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TRIATHLON", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1383.2, "maximum": 1916.72, "gross_charge": 1976.0, "discounted_cash": 2964.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1679.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1482.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1383.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1916.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1383.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1482.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1679.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1580.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBIAL TUNNEL BX", "code_information": [{"code": "3100101987", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 114.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIBIAL VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3964.1, "maximum": 5493.11, "gross_charge": 5663.0, "discounted_cash": 8494.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4813.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4247.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3964.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5493.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3964.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4247.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4813.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4530.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIBPER REVASC W/ATHER ADD-ON", "code_information": [{"code": "37233", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.25ML IM", "code_information": [{"code": "90626", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIC-BRN ENCEPH VAC 0.5ML IM", "code_information": [{"code": "90627", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIGECYCLINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3243", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.67, "maximum": 0.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGERLOOP", "code_information": [{"code": "3100101988", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGERSTICK", "code_information": [{"code": "3100101989", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.0, "discounted_cash": 276.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGERTAPE", "code_information": [{"code": "3100101990", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGERTAPE CERCLAGE*A", "code_information": [{"code": "3100203963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 2025.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 386.4, "maximum": 535.44, "gross_charge": 552.0, "discounted_cash": 828.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 469.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 414.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 535.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 386.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 414.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 469.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 441.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 1666.0, "maximum": 2308.6, "gross_charge": 2380.0, "discounted_cash": 3570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2308.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1666.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2023.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 388.5, "maximum": 538.35, "gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 538.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 388.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 416.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 471.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 444.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103574", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 493.92, "maximum": 684.43, "gross_charge": 705.6, "discounted_cash": 1058.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 599.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 493.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 684.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 493.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 599.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 564.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103575", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103576", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1841.91, "maximum": 2552.36, "gross_charge": 2631.3, "discounted_cash": 3946.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2236.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1973.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1841.91, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2552.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1841.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1973.47, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2236.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2105.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104639", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 493.92, "maximum": 684.43, "gross_charge": 705.6, "discounted_cash": 1058.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 599.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 493.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 684.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 493.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 599.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 564.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE 20MM BUTTO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 493.92, "maximum": 684.43, "gross_charge": 705.6, "discounted_cash": 1058.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 599.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 493.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 684.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 493.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 529.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 599.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 564.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104567", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 650.47, "maximum": 901.37, "gross_charge": 929.25, "discounted_cash": 1393.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 901.37, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 650.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 696.93, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 789.86, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 743.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE ABS*AR-158", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207094", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 606.37, "maximum": 840.26, "gross_charge": 866.25, "discounted_cash": 1299.38, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 736.31, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 649.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 840.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 606.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 649.68, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 736.31, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 693.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE ACL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102359", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 840.0, "maximum": 1164.0, "gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1164.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 840.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1020.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 960.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE ACL IMPLAN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203780", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE ACL RT *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1245.82, "maximum": 1726.35, "gross_charge": 1779.75, "discounted_cash": 2669.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1512.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1334.81, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1245.82, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1726.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1245.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1334.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1512.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1423.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE BONE-TENDO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100101992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 787.5, "maximum": 1091.25, "gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1091.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 787.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 843.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 956.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 900.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE DBL LD*AR-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204745", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 934.5, "maximum": 1294.95, "gross_charge": 1335.0, "discounted_cash": 2002.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1134.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1001.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 934.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1294.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 934.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1001.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1134.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1068.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE FIBTAG*AR1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1939.66, "maximum": 2687.82, "gross_charge": 2770.95, "discounted_cash": 4156.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2355.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2078.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1939.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2687.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1939.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2078.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2355.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2216.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE FLIP*AR128", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2168.98, "maximum": 3005.59, "gross_charge": 3098.55, "discounted_cash": 4647.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2633.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2323.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2168.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3005.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2168.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2323.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2633.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2478.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE FLIP*AR128", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208414", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2016.1, "maximum": 2793.74, "gross_charge": 2880.15, "discounted_cash": 4320.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2448.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2160.11, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2016.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2793.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2016.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2160.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2448.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2304.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE MINI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1039.5, "maximum": 1440.45, "gross_charge": 1485.0, "discounted_cash": 2227.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1440.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1039.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1113.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1262.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1188.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE MINI 2.7*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209865", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3621.34, "maximum": 5018.14, "gross_charge": 5173.35, "discounted_cash": 7760.03, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4397.34, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3880.01, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3621.34, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5018.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3621.34, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3880.01, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4397.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4138.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE MINI*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1102.5, "maximum": 1527.75, "gross_charge": 1575.0, "discounted_cash": 2362.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1527.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1102.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1181.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1338.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1260.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE REPAIR SYN", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2720.9, "maximum": 3770.39, "gross_charge": 3887.0, "discounted_cash": 5830.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3770.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2720.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2915.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3303.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3109.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE SUTURE", "code_information": [{"code": "3100103992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2310.0, "discounted_cash": 3465.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIGHTROPE W/FIBERTAG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207313", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 850.5, "maximum": 1178.55, "gross_charge": 1215.0, "discounted_cash": 1822.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1178.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 850.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 911.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1032.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 972.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIGHTROPE W/FIBERTAG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207314", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1522.5, "maximum": 2109.75, "gross_charge": 2175.0, "discounted_cash": 3262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2109.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1522.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1631.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1848.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1740.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TILT TABLE EVALUATION", "code_information": [{"code": "93660", "type": "CPT"}], "standard_charges": [{"minimum": 249.65, "maximum": 249.65, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIMELINE TUBE REFILL", "code_information": [{"code": "3100102256", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 328.0, "discounted_cash": 492.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TINED LEAD KIT*1201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205457", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5629.26, "maximum": 7800.54, "gross_charge": 8041.8, "discounted_cash": 12062.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6835.53, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6031.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5629.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7800.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5629.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6031.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6835.53, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6433.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINED LEAD*2201", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205276", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5962.32, "maximum": 8262.07, "gross_charge": 8517.6, "discounted_cash": 12776.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7239.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6388.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5962.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8262.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5962.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6388.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7239.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6814.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TINNITUS ASSESSMENT", "code_information": [{"code": "92625", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TINZAPARIN SODIUM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1655", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIP DISTAL SIZER", "code_information": [{"code": "3100101993", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP ISOCOOL", "code_information": [{"code": "3100103975", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1344.0, "discounted_cash": 2016.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPS PRE-BENT", "code_information": [{"code": "3100101994", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPS PRE-BENT", "code_information": [{"code": "3100102257", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.0, "discounted_cash": 79.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIROFIBAN HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3246", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.1, "maximum": 4.1, "discounted_cash": 6.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ADDL 30 SQ CM", "code_information": [{"code": "14302", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR ANY 30.1-60 SQ CM", "code_information": [{"code": "14301", "type": "CPT"}], "standard_charges": [{"minimum": 2188.07, "maximum": 2188.07, "discounted_cash": 5491.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR E/N/E/L10.1-30SQCM", "code_information": [{"code": "14061", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TIS TRNFR S/A/L 10.1-30 SQCM", "code_information": [{"code": "14021", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISAGENLECLEUCEL CAR-POS T", "code_information": [{"code": "Q2042", "type": "HCPCS"}], "standard_charges": [{"minimum": 518240.68, "maximum": 518240.68, "discounted_cash": 821037.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 518240.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS CUL NEO DIS BON", "code_information": [{"code": "88237", "type": "CPT"}, {"code": "3440101218", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 112.14, "maximum": 1100.95, "gross_charge": 1135.0, "discounted_cash": 230.94, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 964.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 851.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 794.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1100.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 157.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 794.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 158.58, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 851.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 153.96, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 183.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 964.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 153.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 908.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 143.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 153.96, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 157.04, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISS EX MOLECUL STUDY ADD-ON", "code_information": [{"code": "88388", "type": "CPT"}], "standard_charges": [{"minimum": 60.52, "maximum": 60.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 60.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISS TRNSGLTMNASE EA IG CLAS", "code_information": [{"code": "86364", "type": "CPT"}], "standard_charges": [{"minimum": 11.53, "maximum": 30.26, "discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSEEL 2ML*1506078", "code_information": [{"code": "3100205986", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 358.52, "discounted_cash": 537.78, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL APPLICATOR*0", "code_information": [{"code": "3100205987", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 209.92, "discounted_cash": 314.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE ALLODERM", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100104053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 1902.0, "discounted_cash": 2853.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE ALLODERM 2X4C", "code_information": [{"code": "Q4116", "type": "HCPCS"}, {"code": "3100202237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 35.24, "maximum": 1725.27, "gross_charge": 538.0, "discounted_cash": 807.0, "setting": "both", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE COLLECTOR*ABS", "code_information": [{"code": "3100204773", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 1732.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE CULTURE LYMPH", "code_information": [{"code": "88230", "type": "CPT"}, {"code": "3440103033", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 112.14, "maximum": 987.46, "gross_charge": 1018.0, "discounted_cash": 187.14, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 865.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 129.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 763.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 987.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 712.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 128.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 763.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 124.76, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 148.46, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 865.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 124.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 814.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 116.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 124.76, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 127.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE PLACENTA", "code_information": [{"code": "88235", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 150.3, "discounted_cash": 241.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 150.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE SKIN/BIOPSY", "code_information": [{"code": "88233", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 140.73, "discounted_cash": 226.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 140.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE TUMOR", "code_information": [{"code": "88239", "type": "CPT"}], "standard_charges": [{"minimum": 112.14, "maximum": 147.52, "discounted_cash": 236.99, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 147.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM FOR FUNGI", "code_information": [{"code": "87220", "type": "CPT"}], "standard_charges": [{"minimum": 4.27, "maximum": 24.03, "discounted_cash": 6.86, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPAN 450*361", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203934", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPAND 550*36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100101996", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2457.0, "maximum": 3404.7, "gross_charge": 3510.0, "discounted_cash": 5265.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2457.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2632.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2983.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2808.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100103577", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2538.9, "maximum": 3518.19, "gross_charge": 3627.0, "discounted_cash": 5440.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3082.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2720.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2538.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3518.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2538.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2720.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3082.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2901.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100103578", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2584.4, "maximum": 3581.24, "gross_charge": 3692.0, "discounted_cash": 5538.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3138.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2769.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2584.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3581.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2584.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2769.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3138.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2953.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100103579", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2811.9, "maximum": 3896.49, "gross_charge": 4017.0, "discounted_cash": 6025.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3414.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3896.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3414.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3213.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100104307", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2366.0, "maximum": 3278.6, "gross_charge": 3380.0, "discounted_cash": 5070.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3278.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2366.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2535.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2873.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2704.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 250C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202849", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 275C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203884", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2475.2, "maximum": 3429.92, "gross_charge": 3536.0, "discounted_cash": 5304.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3429.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2828.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 350C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202821", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 350C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203885", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2475.2, "maximum": 3429.92, "gross_charge": 3536.0, "discounted_cash": 5304.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3429.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2475.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3005.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2828.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 400C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 500C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 535*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3712.8, "maximum": 5144.88, "gross_charge": 5304.0, "discounted_cash": 7956.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5144.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4508.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4243.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXPANDER 650C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2902.9, "maximum": 4022.59, "gross_charge": 4147.0, "discounted_cash": 6220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4022.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2902.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3524.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE IN-SITU HYBRIDIZATION", "code_information": [{"code": "D0479", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TISSUE REINFORCEMENT", "code_information": [{"code": "3100101997", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1425.0, "discounted_cash": 2137.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE STRATTICE", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100101998", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6131.3, "maximum": 8496.23, "gross_charge": 8759.0, "discounted_cash": 13138.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7445.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6569.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6131.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8496.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6131.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6569.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7445.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7007.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE STRATTICE", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100103581", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3374.0, "maximum": 4675.4, "gross_charge": 4820.0, "discounted_cash": 7230.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4097.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3615.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3374.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4675.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3374.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3615.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4097.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3856.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE STRATTICE", "code_information": [{"code": "C1789", "type": "HCPCS"}, {"code": "3100103582", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8160.6, "maximum": 11308.26, "gross_charge": 11658.0, "discounted_cash": 17487.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9909.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8743.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8160.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11308.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8160.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8743.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9909.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9326.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TITAN NARROW CYLINDE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10500.0, "maximum": 14550.0, "gross_charge": 15000.0, "discounted_cash": 22500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14550.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TITAN PATIENT KIT*51", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209280", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1560.3, "maximum": 2162.13, "gross_charge": 2229.0, "discounted_cash": 3343.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2162.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1560.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1671.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1894.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1783.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV INJ HM", "code_information": [{"code": "M0221", "type": "HCPCS"}], "standard_charges": [{"minimum": 250.5, "maximum": 250.5, "discounted_cash": 402.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 250.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV, 300MG", "code_information": [{"code": "Q0220", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TIXAGEV AND CILGAV, 600MG", "code_information": [{"code": "Q0221", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TKA FEM CEMENT SZ 7*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1975.44, "maximum": 2737.4, "gross_charge": 2822.07, "discounted_cash": 4233.11, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2737.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1975.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2116.55, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2398.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2257.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TKR SUPPORT", "code_information": [{"code": "3100101999", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.0, "discounted_cash": 1593.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TL IMPLANT 10MM*7107", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 10MM*7107", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205738", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 12MM*7107", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 18X50X9*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 18X55X9*7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 5MM*7107-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 8MM*7107-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205617", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL IMPLANT 8MM*7107-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8304.66, "maximum": 11507.88, "gross_charge": 11863.8, "discounted_cash": 17795.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11507.88, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8304.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8897.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10084.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9491.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL INTERBODY*6101-21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202550", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL INTERBODY*6101-21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL INTERBODY*6101-21", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206864", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4004.0, "maximum": 5548.4, "gross_charge": 5720.0, "discounted_cash": 8580.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5548.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4004.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4290.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4862.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4576.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TL201 THALLIUM", "code_information": [{"code": "A9505", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.53, "maximum": 35.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH UTERUS OVER 250", "code_information": [{"code": "58572", "type": "CPT"}, {"code": "3480103147", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 8510.18, "maximum": 12499.89, "gross_charge": 12770.0, "discounted_cash": 15756.17, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10854.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10861.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9577.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8939.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12386.9, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8939.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10819.23, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9577.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 12499.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10854.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10216.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 10504.11, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 10714.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 15756.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TLSO DUAL", "code_information": [{"code": "L0460", "type": "HCPCS"}, {"code": "3100102000", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 672.0, "maximum": 931.2, "gross_charge": 960.0, "discounted_cash": 1440.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 931.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 672.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 720.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 816.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 768.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLSO DUAL", "code_information": [{"code": "L0460", "type": "HCPCS"}, {"code": "3100103583", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 678.3, "maximum": 939.93, "gross_charge": 969.0, "discounted_cash": 1453.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 823.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 678.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 939.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 678.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 726.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 823.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 775.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLSO DUAL", "code_information": [{"code": "L0460", "type": "HCPCS"}, {"code": "3100103584", "type": "CDM"}, {"code": "274", "type": "RC"}], "standard_charges": [{"minimum": 711.9, "maximum": 986.49, "gross_charge": 1017.0, "discounted_cash": 1525.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 864.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 762.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 711.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 986.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 711.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 762.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 864.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 813.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TM STEM W/CER HEAD*4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6304.48, "maximum": 8736.2, "gross_charge": 9006.4, "discounted_cash": 13509.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8736.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7205.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMA/TMAO PRFL MS/MS UR ALG", "code_information": [{"code": "256U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 256.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DEBRIDEMENT", "code_information": [{"code": "D7877", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISC REPOSIT", "code_information": [{"code": "D7874", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISCECTOMY", "code_information": [{"code": "D7876", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY LYSIS ADHESN", "code_information": [{"code": "D7873", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY SYNOVECTOMY", "code_information": [{"code": "D7875", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ ASPIRATION JOINT FLUID", "code_information": [{"code": "D7870", "type": "HCPCS"}], "standard_charges": [{"minimum": 456.57, "maximum": 456.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING INTO JOINT", "code_information": [{"code": "D7860", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING OF A MUSCLE", "code_information": [{"code": "D7856", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ DIAGNOSTIC ARTHROSCOPY", "code_information": [{"code": "D7872", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ EXCISN OF JOINT MEMBRANE", "code_information": [{"code": "D7854", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ MANIPULATION UNDER ANEST", "code_information": [{"code": "D7830", "type": "HCPCS"}], "standard_charges": [{"minimum": 1670.09, "maximum": 1670.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ MENISCECTOMY", "code_information": [{"code": "D7850", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ OPEN REDUCT-DISLOCATION", "code_information": [{"code": "D7810", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ RECONSTRUCTION", "code_information": [{"code": "D7858", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ REPAIR OF JOINT DISC", "code_information": [{"code": "D7852", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ RESHAPING COMPONENTS", "code_information": [{"code": "D7865", "type": "HCPCS"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMJ UNSPECIFIED THERAPY", "code_information": [{"code": "D7899", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TNOT ELBOW LATERAL/M", "code_information": [{"code": "24358", "type": "CPT"}, {"code": "3480101568", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2919.2, "maximum": 7831.78, "gross_charge": 8074.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7831.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5651.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6055.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6862.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6459.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBACCO COUNSELING", "code_information": [{"code": "D1320", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBACO USE CES CONSL", "code_information": [{"code": "99406", "type": "CPT"}, {"code": "3310100289", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 29.28, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 43.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBACO USE CES CONSL", "code_information": [{"code": "99407", "type": "CPT"}, {"code": "3310100290", "type": "CDM"}, {"code": "942", "type": "RC"}], "standard_charges": [{"minimum": 29.28, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 43.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.28, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.16, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 34.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 29.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 29.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN", "code_information": [{"code": "80200", "type": "CPT"}, {"code": "3440100831", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.13, "maximum": 140.65, "gross_charge": 145.0, "discounted_cash": 25.92, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 123.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 108.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 140.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 101.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 108.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 123.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 17.28, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7685", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7682", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.53, "maximum": 16.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN SULFATE", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300026", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 57.6, "discounted_cash": 86.4, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "TOBRAMYCIN SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3260", "type": "HCPCS"}, {"code": "3400300234", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.55, "maximum": 188.18, "gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 188.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3260", "type": "HCPCS"}, {"code": "3400300235", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.55, "maximum": 188.18, "gross_charge": 194.0, "discounted_cash": 291.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 188.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 135.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 164.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 155.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBRAMYCIN/DEXAMETHA", "code_information": [{"code": "3400300218", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 59.7, "discounted_cash": 89.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TOCILIZUMAB FOR COVID-19", "code_information": [{"code": "Q0249", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.57, "maximum": 6.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCILIZUMAB INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3262", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.04, "maximum": 6.04, "discounted_cash": 9.83, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOCOPHEROL ALPHA VIT", "code_information": [{"code": "84446", "type": "CPT"}, {"code": "3440101002", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.18, "maximum": 123.19, "gross_charge": 127.0, "discounted_cash": 22.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 123.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOE JOINT 14MM*16870", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209142", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5435.88, "maximum": 7532.58, "gross_charge": 7765.55, "discounted_cash": 11648.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7532.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5435.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5824.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6600.71, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6212.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 7559.22, "maximum": 7559.22, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOMCAT HYBRID 16X4*R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204343", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 2713.61, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH NECK SURGERY", "code_information": [{"code": "41153", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 6415.12, "maximum": 6415.12, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6415.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1869.0, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY AND AD", "code_information": [{"code": "42821", "type": "CPT"}, {"code": "3480101931", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY, PRIMA", "code_information": [{"code": "42825", "type": "CPT"}, {"code": "3480101932", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11131.72, "gross_charge": 11476.0, "discounted_cash": 8963.81, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6179.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11131.72, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8033.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6155.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8607.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7111.29, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9754.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9180.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5975.87, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6095.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TONSILLECTOMY, PRIMA", "code_information": [{"code": "42826", "type": "CPT"}, {"code": "3480101933", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6110.03, "gross_charge": 6299.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6110.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4409.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4724.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5354.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5039.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOL INSERTION*1803", "code_information": [{"code": "3100207952", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING", "code_information": [{"code": "3100102001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOTH PIN RETENTION", "code_information": [{"code": "D2951", "type": "HCPCS"}], "standard_charges": [{"minimum": 942.96, "maximum": 942.96, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 942.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOTH REIMPLANTATION", "code_information": [{"code": "D7270", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOTH ROOT REMOVAL", "code_information": [{"code": "D7250", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOTH SPLITTING", "code_information": [{"code": "D3920", "type": "HCPCS"}], "standard_charges": [{"minimum": 961.65, "maximum": 961.65, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 961.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOOTH TRANSPLANTATION", "code_information": [{"code": "D7272", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOPICAL APP FLUORID EX VRNSH", "code_information": [{"code": "D1208", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "D1206", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOPOGRAPHIC BRAIN MAPPING", "code_information": [{"code": "S8040", "type": "HCPCS"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOPOTECAN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.17, "maximum": 1.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOPOTECAN ORAL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J8705", "type": "HCPCS"}], "standard_charges": [{"minimum": 113.24, "maximum": 113.24, "discounted_cash": 182.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORCON ADVAN CATH 5X", "code_information": [{"code": "3100204894", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.36, "discounted_cash": 99.54, "setting": "both", "billing_class": "facility"}]}, {"description": "TORNIER HEMI SHOULDE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207293", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8680.0, "maximum": 12028.0, "gross_charge": 12400.0, "discounted_cash": 18600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12028.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8680.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10540.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9920.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORP CENTERED 6MM*14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207375", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1218.0, "maximum": 1687.8, "gross_charge": 1740.0, "discounted_cash": 2610.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1479.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1305.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1218.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1687.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1218.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1305.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1479.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1392.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TORPEDO", "code_information": [{"code": "3100102258", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 404.0, "discounted_cash": 606.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TORQUE DEVICE*TD01", "code_information": [{"code": "3100206641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.52, "discounted_cash": 39.78, "setting": "both", "billing_class": "facility"}]}, {"description": "TORQUE VISE", "code_information": [{"code": "3100102259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 96.0, "discounted_cash": 144.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TORQUE VISE", "code_information": [{"code": "3100103723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TORQUE WRENCH *48561", "code_information": [{"code": "3100208970", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.25, "discounted_cash": 772.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TOT ABD HYS W/COLPUR", "code_information": [{"code": "58152", "type": "CPT"}, {"code": "3480102097", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2201.5, "maximum": 8510.18, "gross_charge": 3145.0, "discounted_cash": 4717.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2673.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2358.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3050.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2201.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2358.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2673.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2516.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC CRV", "code_information": [{"code": "22856", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22857", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 2ND LVL CRV", "code_information": [{"code": "22858", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT ESTRADIOL RESPONSE PANEL", "code_information": [{"code": "80415", "type": "CPT"}], "standard_charges": [{"minimum": 55.89, "maximum": 68.09, "discounted_cash": 89.79, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 55.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOT SHLDR TITAN MODI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL ELBOW PIN KIT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1568.0, "maximum": 2172.8, "gross_charge": 2240.0, "discounted_cash": 3360.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2172.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1568.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1904.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL GLUE", "code_information": [{"code": "3100102002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1276.0, "discounted_cash": 1914.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL GLUE", "code_information": [{"code": "3100103585", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 315.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103586", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5733.0, "maximum": 7944.3, "gross_charge": 8190.0, "discounted_cash": 12285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7944.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7553.0, "maximum": 10466.3, "gross_charge": 10790.0, "discounted_cash": 16185.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9171.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8092.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7553.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10466.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7553.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8092.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9171.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8632.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103588", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7826.0, "maximum": 10844.6, "gross_charge": 11180.0, "discounted_cash": 16770.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9503.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8385.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7826.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10844.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7826.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8385.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9503.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8944.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103589", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8315.3, "maximum": 11522.63, "gross_charge": 11879.0, "discounted_cash": 17818.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10097.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8909.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8315.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11522.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8315.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8909.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10097.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9503.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103591", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8372.0, "maximum": 11601.2, "gross_charge": 11960.0, "discounted_cash": 17940.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11601.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8372.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8970.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10166.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9568.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103592", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8400.0, "maximum": 11640.0, "gross_charge": 12000.0, "discounted_cash": 18000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11640.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103593", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8736.0, "maximum": 12105.6, "gross_charge": 12480.0, "discounted_cash": 18720.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10608.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12105.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10608.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9984.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103594", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103595", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9800.0, "maximum": 13580.0, "gross_charge": 14000.0, "discounted_cash": 21000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13580.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP LOW ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5460.0, "maximum": 7566.0, "gross_charge": 7800.0, "discounted_cash": 11700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP MED ZIMMER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6643.0, "maximum": 9205.3, "gross_charge": 9490.0, "discounted_cash": 14235.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9205.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6643.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7117.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8066.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7592.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": [{"code": "S2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER *40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205161", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8483.3, "maximum": 11755.43, "gross_charge": 12119.0, "discounted_cash": 18178.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10301.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9089.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8483.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11755.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8483.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9089.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10301.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9695.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER *40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205262", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7929.74, "maximum": 10988.35, "gross_charge": 11328.2, "discounted_cash": 16992.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9628.97, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8496.15, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7929.74, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10988.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7929.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8496.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9628.97, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9062.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER *80", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7669.48, "maximum": 10627.7, "gross_charge": 10956.4, "discounted_cash": 16434.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9312.94, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7669.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10627.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7669.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8217.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9312.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8765.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER*400", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER*401", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7401.94, "maximum": 10256.97, "gross_charge": 10574.2, "discounted_cash": 15861.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8988.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7930.65, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7401.94, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10256.97, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7401.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7930.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8988.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8459.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER*402", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203257", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6304.48, "maximum": 8736.2, "gross_charge": 9006.4, "discounted_cash": 13509.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8736.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6304.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6754.8, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7655.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7205.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER*405", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7904.26, "maximum": 10953.04, "gross_charge": 11291.8, "discounted_cash": 16937.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9598.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8468.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7904.26, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10953.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7904.26, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8468.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9598.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9033.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP ZIMMER*405", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207641", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7168.98, "maximum": 9934.15, "gross_charge": 10241.4, "discounted_cash": 15362.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8705.19, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7681.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7168.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9934.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7168.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7681.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8705.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8193.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "27447", "type": "CPT"}, {"code": "3480101704", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 11069.1, "maximum": 15981.88, "gross_charge": 15813.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13441.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11859.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11069.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15338.61, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11069.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11859.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13441.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12650.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6279.0, "maximum": 8700.9, "gross_charge": 8970.0, "discounted_cash": 13455.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7624.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6727.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6279.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8700.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6279.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6727.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7624.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103596", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5187.0, "maximum": 7187.7, "gross_charge": 7410.0, "discounted_cash": 11115.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6298.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5557.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5187.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7187.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5187.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5557.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6298.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5928.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103597", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5642.0, "maximum": 7818.2, "gross_charge": 8060.0, "discounted_cash": 12090.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7818.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5642.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6045.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6851.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6448.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103598", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5733.0, "maximum": 7944.3, "gross_charge": 8190.0, "discounted_cash": 12285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7944.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5733.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6142.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6961.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6552.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103599", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5975.06, "maximum": 8279.72, "gross_charge": 8535.8, "discounted_cash": 12803.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7255.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6401.85, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5975.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8279.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5975.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6401.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7255.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6828.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6126.4, "maximum": 8489.44, "gross_charge": 8752.0, "discounted_cash": 13128.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7439.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6564.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6126.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8489.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6126.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6564.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7439.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7001.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6682.9, "maximum": 9260.59, "gross_charge": 9547.0, "discounted_cash": 14320.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8114.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7160.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6682.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9260.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6682.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7160.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8114.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7637.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6779.5, "maximum": 9394.45, "gross_charge": 9685.0, "discounted_cash": 14527.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8232.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7263.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6779.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9394.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6779.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7263.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8232.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7748.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7007.0, "maximum": 9709.7, "gross_charge": 10010.0, "discounted_cash": 15015.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8508.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7507.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7007.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9709.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7007.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7507.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8508.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8008.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7700.0, "maximum": 10670.0, "gross_charge": 11000.0, "discounted_cash": 16500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10670.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7700.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9350.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7786.1, "maximum": 10789.31, "gross_charge": 11123.0, "discounted_cash": 16684.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9454.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8342.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7786.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10789.31, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7786.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8342.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9454.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8898.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103607", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8190.0, "maximum": 11349.0, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11349.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8775.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9945.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9360.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8554.0, "maximum": 11853.4, "gross_charge": 12220.0, "discounted_cash": 18330.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11853.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8554.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9165.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10387.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9776.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104284", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6099.1, "maximum": 8451.61, "gross_charge": 8713.0, "discounted_cash": 13069.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7406.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6534.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6099.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8451.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6099.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6534.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7406.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6970.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE BIOMET*40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202681", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5978.7, "maximum": 8284.77, "gross_charge": 8541.0, "discounted_cash": 12811.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7259.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6405.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5978.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8284.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5978.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6405.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7259.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6832.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE DEPUY*302", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205263", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7462.0, "maximum": 10340.2, "gross_charge": 10660.0, "discounted_cash": 15990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9061.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7462.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10340.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7462.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9061.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8528.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER 40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205347", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8026.2, "maximum": 11122.02, "gross_charge": 11466.0, "discounted_cash": 17199.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9746.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8599.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8026.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11122.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8026.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8599.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9746.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9172.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER 40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205903", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6188.0, "maximum": 8574.8, "gross_charge": 8840.0, "discounted_cash": 13260.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8574.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6188.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6630.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7514.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7072.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER 40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206755", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7720.44, "maximum": 10698.32, "gross_charge": 11029.2, "discounted_cash": 16543.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9374.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8271.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7720.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10698.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7720.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8271.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9374.82, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8823.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER*40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6734.0, "maximum": 9331.4, "gross_charge": 9620.0, "discounted_cash": 14430.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9331.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6734.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7215.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8177.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7696.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER*40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7644.0, "maximum": 10592.4, "gross_charge": 10920.0, "discounted_cash": 16380.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10592.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8190.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9282.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8736.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER*80", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202408", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7847.7, "maximum": 10874.67, "gross_charge": 11211.0, "discounted_cash": 16816.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9529.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8408.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7847.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10874.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7847.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8408.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9529.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8968.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE ZIMMER*80", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8382.92, "maximum": 11616.33, "gross_charge": 11975.6, "discounted_cash": 17963.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10179.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8981.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8382.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11616.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8382.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8981.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10179.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9580.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL LUNG LAVAGE", "code_information": [{"code": "32997", "type": "CPT"}], "standard_charges": [{"minimum": 3179.97, "maximum": 3179.97, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3179.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13711.6, "maximum": 19000.36, "gross_charge": 19588.0, "discounted_cash": 29382.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16649.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14691.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13711.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19000.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13711.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14691.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16649.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15670.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8400.0, "maximum": 11640.0, "gross_charge": 12000.0, "discounted_cash": 18000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11640.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8400.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10200.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103611", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10400.6, "maximum": 14412.26, "gross_charge": 14858.0, "discounted_cash": 22287.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12629.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11143.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10400.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14412.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10400.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11143.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12629.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11886.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103612", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11760.0, "maximum": 16296.0, "gross_charge": 16800.0, "discounted_cash": 25200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12600.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11760.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16296.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11760.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12600.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER DEPUY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER STRYK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203564", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11900.0, "maximum": 16490.0, "gross_charge": 17000.0, "discounted_cash": 25500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16490.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14450.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13860.0, "maximum": 19206.0, "gross_charge": 19800.0, "discounted_cash": 29700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16830.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13860.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19206.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13860.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16830.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103795", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 13273.4, "maximum": 18393.14, "gross_charge": 18962.0, "discounted_cash": 28443.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16117.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14221.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13273.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18393.14, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13273.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14221.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16117.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15169.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14092.4, "maximum": 19528.04, "gross_charge": 20132.0, "discounted_cash": 30198.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17112.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15099.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14092.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19528.04, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14092.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15099.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17112.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16105.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15820.0, "maximum": 21922.0, "gross_charge": 22600.0, "discounted_cash": 33900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19210.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15820.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 21922.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15820.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19210.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18080.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 14077.0, "maximum": 19506.7, "gross_charge": 20110.0, "discounted_cash": 30165.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17093.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15082.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14077.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19506.7, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14077.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15082.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17093.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16088.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205939", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10080.0, "maximum": 13968.0, "gross_charge": 14400.0, "discounted_cash": 21600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12240.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10080.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13968.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10080.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12240.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11520.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207169", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9800.0, "maximum": 13580.0, "gross_charge": 14000.0, "discounted_cash": 21000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9800.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13580.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9800.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10500.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11900.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 15260.0, "maximum": 21146.0, "gross_charge": 21800.0, "discounted_cash": 32700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 18530.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 16350.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15260.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 21146.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15260.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 16350.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 18530.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 17440.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 16660.0, "maximum": 23086.0, "gross_charge": 23800.0, "discounted_cash": 35700.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20230.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17850.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 16660.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23086.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 16660.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17850.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20230.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19040.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209960", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7560.0, "maximum": 10476.0, "gross_charge": 10800.0, "discounted_cash": 16200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7560.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10476.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7560.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9180.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8640.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER TORNI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11200.0, "maximum": 15520.0, "gross_charge": 16000.0, "discounted_cash": 24000.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13600.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11200.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15520.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11200.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12000.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13600.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL SHOULDER ZIMM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203629", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7271.6, "maximum": 10076.36, "gross_charge": 10388.0, "discounted_cash": 15582.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8829.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7791.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7271.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10076.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7271.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7791.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8829.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8310.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL THYROID LOBECT", "code_information": [{"code": "60220", "type": "CPT"}, {"code": "3480102126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 14956.43, "gross_charge": 15419.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13106.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11564.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10793.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14956.43, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10793.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11564.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13106.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12335.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5635.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOTAZOLINE HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2670", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TOTL SHLDR TITANUM U", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210177", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOUCH QUANT SENSORY TEST", "code_information": [{"code": "106T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOURNIQUET", "code_information": [{"code": "3100102006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET", "code_information": [{"code": "3100103613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET", "code_information": [{"code": "3100103614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.96, "discounted_cash": 56.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET", "code_information": [{"code": "3100103615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.16, "discounted_cash": 52.74, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET", "code_information": [{"code": "3100103616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.96, "discounted_cash": 56.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET", "code_information": [{"code": "3100103617", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 12IN*5921", "code_information": [{"code": "3100210112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.8, "discounted_cash": 79.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 18IN ST*6", "code_information": [{"code": "3100207751", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 18IN*5921", "code_information": [{"code": "3100210113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.8, "discounted_cash": 79.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 24IN*5921", "code_information": [{"code": "3100210114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.8, "discounted_cash": 79.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 30IN ST*6", "code_information": [{"code": "3100206882", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 30IN*5921", "code_information": [{"code": "3100207372", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET 34IN*5921", "code_information": [{"code": "3100206988", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.0, "discounted_cash": 70.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUEL", "code_information": [{"code": "3100102362", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 244.0, "discounted_cash": 366.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUEL", "code_information": [{"code": "3100103793", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.0, "discounted_cash": 219.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOURNIQUET DUEL", "code_information": [{"code": "3100103794", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 198.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOWEL CLAMP", "code_information": [{"code": "3100102007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOXIN/ANTITOX TISSUE", "code_information": [{"code": "87230", "type": "CPT"}, {"code": "3440101188", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 19.74, "maximum": 205.64, "gross_charge": 212.0, "discounted_cash": 31.71, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 205.64, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 148.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 159.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 25.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 180.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 169.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 21.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 21.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB", "code_information": [{"code": "86777", "type": "CPT"}, {"code": "3440101125", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.39, "maximum": 125.13, "gross_charge": 129.0, "discounted_cash": 23.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 125.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 90.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 96.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 109.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 103.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TOXOPLASMA AB IGM", "code_information": [{"code": "86778", "type": "CPT"}, {"code": "3440101126", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.41, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 23.15, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TP53 GENE FULL GENE SEQUENCE", "code_information": [{"code": "81351", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 641.85, "discounted_cash": 1031.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 641.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TP53 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81353", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 308.0, "discounted_cash": 494.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 308.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TP53 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81352", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 329.51, "discounted_cash": 529.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 329.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPMT GENE COM VARIANTS", "code_information": [{"code": "81335", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPMT NUDT15 GENES", "code_information": [{"code": "34U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 748.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV ADJMT", "code_information": [{"code": "53454", "type": "CPT"}], "standard_charges": [{"minimum": 434.32, "maximum": 434.32, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV BI", "code_information": [{"code": "53451", "type": "CPT"}], "standard_charges": [{"minimum": 6427.58, "maximum": 6427.58, "discounted_cash": 19648.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV RMVL EA", "code_information": [{"code": "53453", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL BALO CNTNC DEV UNI", "code_information": [{"code": "53452", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL FOCAL ABLTJ MAL PRST8", "code_information": [{"code": "655T", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TPRNL PLMT BIODEGRDABL MATRL", "code_information": [{"code": "55874", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM INF", "code_information": [{"code": "67229", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAB CONE 36X31*0054", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204853", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9588.6, "maximum": 13287.06, "gross_charge": 13698.0, "discounted_cash": 20547.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11643.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10273.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9588.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13287.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9588.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10273.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11643.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10958.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAB CONE 60X36*0054", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9588.6, "maximum": 13287.06, "gross_charge": 13698.0, "discounted_cash": 20547.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11643.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10273.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9588.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 13287.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9588.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10273.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11643.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10958.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1367.49, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INT LSR W/SCP", "code_information": [{"code": "622T", "type": "CPT"}], "standard_charges": [{"minimum": 1367.49, "maximum": 1367.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRABECULOSTOMY INTERNO LASER", "code_information": [{"code": "621T", "type": "CPT"}], "standard_charges": [{"minimum": 1367.49, "maximum": 1367.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAC JT DISTRA*AR-89", "code_information": [{"code": "3100207417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 787.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACH EB ROBERTSHAW", "code_information": [{"code": "3100102008", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 224.0, "discounted_cash": 336.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACH TUBE NASAL", "code_information": [{"code": "3100102009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "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": 16043.48, "maximum": 16043.48, "discounted_cash": 44712.96, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16043.48, "methodology": "fee schedule"}], "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": 21694.42, "maximum": 21694.42, "discounted_cash": 57567.84, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 21694.42, "methodology": "fee schedule"}], "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": 14542.67, "maximum": 14542.67, "discounted_cash": 29984.67, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14542.67, "methodology": "fee schedule"}], "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": 62389.05, "maximum": 62389.05, "discounted_cash": 164119.1, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 62389.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACKER TRUDI NAV*TP", "code_information": [{"code": "3100209289", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 573.0, "discounted_cash": 859.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43332", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSAB ESOPH HIAT HERN RPR", "code_information": [{"code": "43333", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSABDOM AMNIOINFUS W/US", "code_information": [{"code": "59070", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2169.82, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF ASD", "code_information": [{"code": "93580", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH CLOSURE OF VSD", "code_information": [{"code": "93581", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH EMBOLIZ MICROSPHER", "code_information": [{"code": "S2095", "type": "HCPCS"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH INTRAOP MICROINF", "code_information": [{"code": "C9759", "type": "HCPCS"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", "code_information": [{"code": "345T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION CNS", "code_information": [{"code": "61624", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH OCCLUSION NON-CNS", "code_information": [{"code": "61626", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/EPS", "code_information": [{"code": "37215", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATH STENT CCA W/O EPS", "code_information": [{"code": "37216", "type": "CPT"}], "standard_charges": [{"minimum": 17023.92, "maximum": 17023.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17023.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": [{"code": "61596", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCONDYLAR APPROACH/SKULL", "code_information": [{"code": "61597", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCONNECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2184.0, "maximum": 3026.4, "gross_charge": 3120.0, "discounted_cash": 4680.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3026.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2340.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2652.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2496.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCONNECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1854.3, "maximum": 2569.53, "gross_charge": 2649.0, "discounted_cash": 3973.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2251.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1986.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1854.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2569.53, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1854.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1986.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2251.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2119.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCONNECT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCONNECT TOP LOA", "code_information": [{"code": "3100102364", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4064.0, "discounted_cash": 6096.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 9.37, "maximum": 20.92, "discounted_cash": 15.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", "code_information": [{"code": "88741", "type": "CPT"}], "standard_charges": [{"minimum": 9.37, "maximum": 20.92, "discounted_cash": 15.06, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.37, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSCYTE, PER SQ CENTIMETER", "code_information": [{"code": "Q4182", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MEASUREMENTS", "code_information": [{"code": "602T", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSDERMAL GFR MONITORING", "code_information": [{"code": "603T", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSDUCER", "code_information": [{"code": "3100102011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSDUCER COVER*610", "code_information": [{"code": "3100203089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSDUCER THBEAT", "code_information": [{"code": "3100102365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5850.0, "discounted_cash": 8775.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSECT ARTERY SINUS", "code_information": [{"code": "61611", "type": "CPT"}], "standard_charges": [{"minimum": 6756.88, "maximum": 6756.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6756.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSECT PULMONARY ARTERY", "code_information": [{"code": "33922", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSESOPH DOPPL CARDIAC MON", "code_information": [{"code": "G9157", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ABDOMINAL MUSCLE", "code_information": [{"code": "27100", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58974", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "discounted_cash": 1230.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF EMBRYO", "code_information": [{"code": "58976", "type": "CPT"}], "standard_charges": [{"minimum": 252.32, "maximum": 252.32, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 252.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27110", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF ILIOPSOAS MUSCLE", "code_information": [{"code": "27111", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OF SPINAL MUSCLE", "code_information": [{"code": "27105", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER OR TRANSPLA", "code_information": [{"code": "27691", "type": "CPT"}, {"code": "3480101727", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 11671.04, "gross_charge": 12032.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11671.04, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8422.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9024.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10227.2, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9625.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER SET", "code_information": [{"code": "3100102012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSFER SKIN PEDICLE FLAP", "code_information": [{"code": "15650", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2188.07, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2188.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFER TENDON TO PELVIS", "code_information": [{"code": "27098", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFERRIN", "code_information": [{"code": "84466", "type": "CPT"}, {"code": "3440101005", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.76, "maximum": 111.55, "gross_charge": 115.0, "discounted_cash": 20.51, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 111.55, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 86.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 97.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 92.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.67, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSFORMER WALL", "code_information": [{"code": "3100102013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.0, "discounted_cash": 1233.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSFR ASPART AMNO", "code_information": [{"code": "84450", "type": "CPT"}, {"code": "3440101003", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.18, "maximum": 43.65, "gross_charge": 45.0, "discounted_cash": 8.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 43.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 33.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6.6, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 38.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.55, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [{"code": "69", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3891.28, "maximum": 3891.28, "discounted_cash": 8917.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3891.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT HIGH F2F 7D", "code_information": [{"code": "99496", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSJ CARE MGMT MOD F2F 14D", "code_information": [{"code": "99495", "type": "CPT"}], "standard_charges": [{"minimum": 138.4, "maximum": 138.4, "discounted_cash": 202.34, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 138.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSORL LWR ESOPHGL MYOTOMY", "code_information": [{"code": "43497", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "discounted_cash": 8723.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPAC IV ARTL", "code_information": [{"code": "3100102014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSPAC IV ARTL", "code_information": [{"code": "3100103620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.96, "discounted_cash": 23.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSPAC IV ARTL", "code_information": [{"code": "3100104476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 63.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRANSPEDICULAR DECOM", "code_information": [{"code": "63055", "type": "CPT"}, {"code": "3480102152", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5178.02, "maximum": 12760.35, "gross_charge": 13155.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12760.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9208.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9866.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11181.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10524.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLA", "code_information": [{"code": "55875", "type": "CPT"}, {"code": "3480103197", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5280.12, "maximum": 8632.03, "gross_charge": 8899.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8632.03, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6229.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6674.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7564.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7119.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLA", "code_information": [{"code": "55875", "type": "CPT"}, {"code": "3480103271", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 5280.12, "maximum": 10615.68, "gross_charge": 10944.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10615.68, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7660.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8208.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9302.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8755.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPERI NEEDLE PLA", "code_information": [{"code": "55875", "type": "CPT"}, {"code": "3480103311", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 5280.12, "maximum": 16166.99, "gross_charge": 16667.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14166.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 12500.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11666.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 16166.99, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11666.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 12500.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14166.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13333.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPETROSAL APPROACH/SKULL", "code_information": [{"code": "61598", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPL ALLOGRAFT PANCREAS", "code_information": [{"code": "48554", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FEMUR RIDGE", "code_information": [{"code": "27140", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25310", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT FOREARM TENDON", "code_information": [{"code": "25312", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2919.2, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2919.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT HAND TEND", "code_information": [{"code": "26480", "type": "CPT"}, {"code": "3480101639", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7014.07, "gross_charge": 7231.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7014.07, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5061.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5423.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6146.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5784.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT OF THIGH TENDON", "code_information": [{"code": "27396", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT PALM TEND", "code_information": [{"code": "26485", "type": "CPT"}, {"code": "3480103094", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 7566.97, "gross_charge": 7801.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7566.97, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5460.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5850.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6630.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6240.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT URETER TO SKIN", "code_information": [{"code": "50860", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT HAND TENDON", "code_information": [{"code": "26483", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANT/GRAFT PALM TENDON", "code_information": [{"code": "26489", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION HEART/LUNG", "code_information": [{"code": "33935", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": "33945", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50360", "type": "CPT"}], "standard_charges": [{"minimum": 11018.2, "maximum": 11018.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11018.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF KIDNEY", "code_information": [{"code": "50365", "type": "CPT"}], "standard_charges": [{"minimum": 11018.2, "maximum": 11018.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11018.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF MULTIVISC", "code_information": [{"code": "S2054", "type": "HCPCS"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF SMALL INT", "code_information": [{"code": "S2053", "type": "HCPCS"}], "standard_charges": [{"minimum": 7559.66, "maximum": 7559.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 4985.78, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO HCT/DONOR", "code_information": [{"code": "38240", "type": "CPT"}], "standard_charges": [{"minimum": 3633.43, "maximum": 3633.43, "discounted_cash": 83644.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3633.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT ALLO LYMPHOCYTES", "code_information": [{"code": "38242", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPLT AUTOL HCT/DONOR", "code_information": [{"code": "38241", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 2348.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OF VEIN VALVE", "code_information": [{"code": "34510", "type": "CPT"}], "standard_charges": [{"minimum": 5457.93, "maximum": 5457.93, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5457.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSPOSITION OVARY(S)", "code_information": [{"code": "58825", "type": "CPT"}], "standard_charges": [{"minimum": 4828.25, "maximum": 4828.25, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4828.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSSEPTAL FIBEROTOMY", "code_information": [{"code": "D7291", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTEMPORAL APPROACH/SKULL", "code_information": [{"code": "61595", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR CATH FOR STENT", "code_information": [{"code": "33621", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43335", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL ELECTR", "code_information": [{"code": "52601", "type": "CPT"}, {"code": "3480102037", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6283.34, "gross_charge": 6158.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5234.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4618.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4310.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5973.26, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4310.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4618.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5234.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4926.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [{"code": "669", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8428.14, "maximum": 8428.14, "discounted_cash": 17133.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8428.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [{"code": "668", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9807.22, "maximum": 9807.22, "discounted_cash": 31461.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9807.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "670", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4964.78, "maximum": 4964.78, "discounted_cash": 10747.01, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4964.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITH CC/MCC", "code_information": [{"code": "713", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5915.32, "maximum": 5915.32, "discounted_cash": 16196.43, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5915.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC", "code_information": [{"code": "714", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4469.84, "maximum": 4469.84, "discounted_cash": 10701.24, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4469.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RESECT", "code_information": [{"code": "52500", "type": "CPT"}, {"code": "3480102036", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 6480.57, "gross_charge": 6681.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6480.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4676.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5010.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5678.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5344.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSURETHRAL RF TREATMENT", "code_information": [{"code": "53860", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "discounted_cash": 3117.68, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSVAGINAL US NON-OB", "code_information": [{"code": "76830", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSVAGINAL US OBSTETRIC", "code_information": [{"code": "76817", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRANSVRS A-ARCH GRF HYPTHRM", "code_information": [{"code": "33871", "type": "CPT"}], "standard_charges": [{"minimum": 16129.03, "maximum": 16129.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16129.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRAP TISSUE", "code_information": [{"code": "3100102262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAPEZIECT HANDLE*AR", "code_information": [{"code": "3100203893", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAPEZIECT HANDLE*AR", "code_information": [{"code": "3100205148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAPEZOID BASKET 1.5", "code_information": [{"code": "3100205088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAPEZOID BASKET 2.0", "code_information": [{"code": "3100203672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAPEZOID BASKET 3.0", "code_information": [{"code": "3100203673", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 1147.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [{"code": "604", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5459.73, "maximum": 5459.73, "discounted_cash": 16816.07, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5459.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [{"code": "605", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3856.85, "maximum": 3856.85, "discounted_cash": 10146.36, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3856.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITH MCC", "code_information": [{"code": "913", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10063.6, "maximum": 10063.6, "discounted_cash": 16685.45, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10063.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [{"code": "914", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3377.28, "maximum": 3377.28, "discounted_cash": 10134.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3377.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [{"code": "86", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4914.37, "maximum": 4914.37, "discounted_cash": 14704.85, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4914.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [{"code": "85", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8209.26, "maximum": 8209.26, "discounted_cash": 25374.83, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8209.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "87", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3033.59, "maximum": 3033.59, "discounted_cash": 9894.03, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3033.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [{"code": "83", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5481.25, "maximum": 5481.25, "discounted_cash": 15143.61, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5481.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [{"code": "82", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14726.5, "maximum": 14726.5, "discounted_cash": 25436.22, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14726.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC", "code_information": [{"code": "84", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3286.9, "maximum": 3286.9, "discounted_cash": 10268.06, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3286.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY 5FR PARACENT*SP", "code_information": [{"code": "3100206555", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.44, "discounted_cash": 180.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY ARTHROGRAM*28-4", "code_information": [{"code": "3100206873", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 71.72, "discounted_cash": 107.58, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY BONE MARROW", "code_information": [{"code": "3100102015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.0, "discounted_cash": 172.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CAPSTONE INS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1012.2, "maximum": 1402.62, "gross_charge": 1446.0, "discounted_cash": 2169.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1229.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1084.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1012.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1402.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1012.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1084.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1229.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY CATHETER ANES C", "code_information": [{"code": "3100102017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATHETER ANES C", "code_information": [{"code": "3100103621", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.0, "discounted_cash": 97.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CATHETER FOLEY", "code_information": [{"code": "3100102018", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CIDEX", "code_information": [{"code": "3100102019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 487.0, "discounted_cash": 730.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY CIDEX", "code_information": [{"code": "3100103622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 269.0, "discounted_cash": 403.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY COMBITUBE AIRWA", "code_information": [{"code": "3100102020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY COMP REV SHOULD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202761", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2922.92, "maximum": 4050.33, "gross_charge": 4175.6, "discounted_cash": 6263.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3549.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3131.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2922.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4050.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2922.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3131.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3549.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3340.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY COMP SHOULD SYS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2982.7, "maximum": 4133.17, "gross_charge": 4261.0, "discounted_cash": 6391.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3621.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3195.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2982.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4133.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2982.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3195.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3621.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3408.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL", "code_information": [{"code": "3100102022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 103.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL", "code_information": [{"code": "3100103623", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.0, "discounted_cash": 76.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL", "code_information": [{"code": "3100103624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.0, "discounted_cash": 96.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL", "code_information": [{"code": "3100103625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 130.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY EPIDURAL CONT*3", "code_information": [{"code": "3100208826", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 101.88, "discounted_cash": 152.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSERTER TIP TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 411.6, "maximum": 570.36, "gross_charge": 588.0, "discounted_cash": 882.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 570.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 411.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 441.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 470.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT", "code_information": [{"code": "3100102024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 792.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT", "code_information": [{"code": "3100103626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.0, "discounted_cash": 835.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT", "code_information": [{"code": "3100103627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 624.0, "discounted_cash": 936.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT MICR", "code_information": [{"code": "3100102025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.0, "discounted_cash": 255.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT MICR", "code_information": [{"code": "3100103628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 304.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT MICR", "code_information": [{"code": "3100103629", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 322.0, "discounted_cash": 483.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT MINC", "code_information": [{"code": "3100104410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "discounted_cash": 304.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY INSTRUMENT WITH", "code_information": [{"code": "3100102026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 684.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY IP JOINT COMPNT", "code_information": [{"code": "3100102027", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2750.0, "discounted_cash": 4125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LUMBAR PUCTRE*D", "code_information": [{"code": "3100207310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.68, "discounted_cash": 131.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LUMBAR PUNCTRE*", "code_information": [{"code": "3100207409", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.52, "discounted_cash": 51.78, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY LUMBAR PUNCTURE", "code_information": [{"code": "3100102028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.0, "discounted_cash": 85.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY OFFSET TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104360", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1742.3, "maximum": 2414.33, "gross_charge": 2489.0, "discounted_cash": 3733.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2115.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1866.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1742.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2414.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1742.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1866.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2115.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1991.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY OFFSET TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104361", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4879.7, "maximum": 6761.87, "gross_charge": 6971.0, "discounted_cash": 10456.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5925.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5228.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4879.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6761.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4879.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5228.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5925.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5576.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY OFFSET TIBIAL 7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3882.06, "maximum": 5379.42, "gross_charge": 5545.8, "discounted_cash": 8318.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4713.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4159.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3882.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5379.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3882.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4159.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4713.93, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4436.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY PLATE REVERSED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY PLATE REVERSED*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5141.5, "maximum": 7124.65, "gross_charge": 7345.0, "discounted_cash": 11017.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6243.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5508.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5141.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7124.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5141.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5508.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6243.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5876.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY PLATE REVERSED*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202615", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 2580.2, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY REV CEMT SZ 1.5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202453", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8549.54, "maximum": 11847.22, "gross_charge": 12213.63, "discounted_cash": 18320.45, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10381.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9160.22, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8549.54, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11847.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8549.54, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9160.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10381.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9770.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY REVI CEMT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104184", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8716.4, "maximum": 12078.44, "gross_charge": 12452.0, "discounted_cash": 18678.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10584.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9339.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8716.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12078.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8716.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9339.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10584.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9961.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY REVI CEMT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104558", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6466.46, "maximum": 8960.66, "gross_charge": 9237.8, "discounted_cash": 13856.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7852.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6928.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6466.46, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8960.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6466.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6928.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7852.13, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7390.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY REVIS CEMT SZ3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10993.29, "maximum": 15233.55, "gross_charge": 15704.7, "discounted_cash": 23557.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13348.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11778.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10993.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15233.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10993.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11778.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13348.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12563.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY REVISION CEMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8715.7, "maximum": 12077.47, "gross_charge": 12451.0, "discounted_cash": 18676.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10583.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9338.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8715.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12077.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8715.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9338.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10583.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9960.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY SAFE-T-CENTES C", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3100102030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 147.7, "maximum": 204.67, "gross_charge": 211.0, "discounted_cash": 316.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 179.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 158.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 147.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 204.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 147.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 158.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 179.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 168.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY SPINAL", "code_information": [{"code": "3100102031", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPINAL *NEPINLD", "code_information": [{"code": "3100203873", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.64, "discounted_cash": 185.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPINAL*186A012", "code_information": [{"code": "3100205144", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 105.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPINAL*186A017", "code_information": [{"code": "3100204708", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SPINAL*333211", "code_information": [{"code": "3100207425", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.76, "discounted_cash": 73.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY STERILIZATION P", "code_information": [{"code": "3100102032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 702.0, "discounted_cash": 1053.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY STERILIZATN SMA", "code_information": [{"code": "3100102033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1131.0, "discounted_cash": 1696.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRAY SUPRAPUBIC", "code_information": [{"code": "C2627", "type": "HCPCS"}, {"code": "3100102034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 127.4, "maximum": 176.54, "gross_charge": 182.0, "discounted_cash": 273.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 154.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 136.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 127.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 176.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 127.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 136.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 154.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 145.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY THORACENTESIS W", "code_information": [{"code": "C1729", "type": "HCPCS"}, {"code": "3100102035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 84.0, "maximum": 116.4, "gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3000.9, "maximum": 4158.39, "gross_charge": 4287.0, "discounted_cash": 6430.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3643.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3215.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3000.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4158.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3000.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3215.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3643.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3429.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL FIXED CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1824.76, "maximum": 2528.59, "gross_charge": 2606.8, "discounted_cash": 3910.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2528.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1824.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1955.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2215.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2085.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL FIXED CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2709.7, "maximum": 3754.87, "gross_charge": 3871.0, "discounted_cash": 5806.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3290.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2903.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2709.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3754.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2709.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2903.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3290.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3096.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL ILOK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1829.1, "maximum": 2534.61, "gross_charge": 2613.0, "discounted_cash": 3919.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2534.61, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1829.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1959.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2221.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2090.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL INTER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104616", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1480.5, "maximum": 2051.55, "gross_charge": 2115.0, "discounted_cash": 3172.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2051.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1480.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1586.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1797.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1692.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL INTER 75", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205290", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL INTER 83", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204954", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL OXF SZD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203055", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL ROTAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8716.4, "maximum": 12078.44, "gross_charge": 12452.0, "discounted_cash": 18678.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10584.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9339.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8716.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12078.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8716.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9339.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10584.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9961.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL ROTAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100103631", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5384.4, "maximum": 7461.24, "gross_charge": 7692.0, "discounted_cash": 11538.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6538.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5769.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5384.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7461.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5384.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5769.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6538.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRAY TIBIAL ROTAT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104279", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 8630.3, "maximum": 11959.13, "gross_charge": 12329.0, "discounted_cash": 18493.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10479.65, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9246.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8630.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11959.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8630.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9246.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10479.65, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9863.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE ANALY EVAL", "code_information": [{"code": "81342", "type": "CPT"}, {"code": "3440103068", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 1600.5, "gross_charge": 1650.0, "discounted_cash": 323.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1600.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 220.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1155.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 222.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1237.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 215.81, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 256.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1402.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 215.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1320.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 201.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 215.81, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 220.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE ANALY MISC", "code_information": [{"code": "81340", "type": "CPT"}, {"code": "3440103067", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 95.68, "maximum": 1659.67, "gross_charge": 1711.0, "discounted_cash": 335.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1454.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 231.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1283.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1197.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1659.67, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 228.23, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1197.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 230.46, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1283.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.75, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 266.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1454.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 223.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1368.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 208.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 223.75, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 228.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRB@ GENE REARRANGE DIRPROBE", "code_information": [{"code": "81341", "type": "CPT"}], "standard_charges": [{"minimum": 49.59, "maximum": 79.66, "discounted_cash": 79.67, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 49.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRCATH REPLACE AORTIC VALVE", "code_information": [{"code": "33366", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27840", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27842", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27846", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE DISLOCATION", "code_information": [{"code": "27848", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ANKLE FRACTURE", "code_information": [{"code": "28445", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28490", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28496", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT BIG TOE FRACTURE", "code_information": [{"code": "28505", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CHEST LINING", "code_information": [{"code": "32215", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21432", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21433", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21435", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21436", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21440", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT DENTAL RIDGE FRACTURE", "code_information": [{"code": "21445", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT EACH ADD SPINE FX", "code_information": [{"code": "22328", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59120", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59121", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59130", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59136", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59140", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59150", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ECTOPIC PREGNANCY", "code_information": [{"code": "59151", "type": "CPT"}], "standard_charges": [{"minimum": 5342.67, "maximum": 5342.67, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5342.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24605", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24615", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW DISLOCATION", "code_information": [{"code": "24640", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24586", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24587", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24620", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ELBOW FRACTURE", "code_information": [{"code": "24635", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT EYELID BY INJECTION", "code_information": [{"code": "68200", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 277.43, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26770", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER DISLOCATION", "code_information": [{"code": "26775", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26720", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26740", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26742", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26750", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26755", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT BONE LESION", "code_information": [{"code": "28005", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7559.22, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7559.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28540", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28545", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28546", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28575", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28576", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28606", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FOREARM BONE LESION", "code_information": [{"code": "25035", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6065.8, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6065.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25505", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25520", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25525", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25526", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25530", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF ULNA", "code_information": [{"code": "25535", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE RADIUS/ULNA", "code_information": [{"code": "25575", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT FX GR TOE", "code_information": [{"code": "28495", "type": "CPT"}, {"code": "3340102332", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 607.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 588.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 485.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND BONE LESION", "code_information": [{"code": "26034", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 1856.1, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1856.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26670", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26675", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26685", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HAND DISLOCATION", "code_information": [{"code": "26686", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HEEL FRACTURE", "code_information": [{"code": "28415", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27250", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27253", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27254", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27258", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27265", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27227", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP FRACTURE(S)", "code_information": [{"code": "27228", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27220", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP SOCKET FRACTURE", "code_information": [{"code": "27222", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": "27226", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTU", "code_information": [{"code": "23630", "type": "CPT"}, {"code": "3480103081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 18277.71, "gross_charge": 18843.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 16016.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 14132.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 13190.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 18277.71, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 13190.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 14132.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 16016.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 15074.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24530", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24538", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24546", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24565", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24566", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24576", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24577", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24582", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FX W/I", "code_information": [{"code": "24516", "type": "CPT"}, {"code": "3480101572", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 20533.93, "gross_charge": 21169.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17993.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15876.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14818.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20533.93, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14818.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15876.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17993.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16935.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FX W/M", "code_information": [{"code": "24505", "type": "CPT"}, {"code": "3480101570", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 468.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27550", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27552", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27557", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 5894.92, "maximum": 5894.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5894.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27530", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27532", "type": "CPT"}, {"code": "3480103061", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 4251.51, "gross_charge": 4383.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3725.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3287.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3068.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4251.51, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3068.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3287.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3725.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3506.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE", "code_information": [{"code": "27536", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE FRACTURE(S)", "code_information": [{"code": "27538", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27562", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27566", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", "code_information": [{"code": "27520", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOC", "code_information": [{"code": "26705", "type": "CPT"}, {"code": "3480103084", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 607.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 588.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 485.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26715", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRAC", "code_information": [{"code": "21451", "type": "CPT"}, {"code": "3480103093", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 4134.14, "gross_charge": 4262.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4134.14, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2983.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3196.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3622.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3409.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21450", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21453", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21454", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21461", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG BONE LESION", "code_information": [{"code": "27607", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4111.8, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4111.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27830", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27831", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27824", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG FRACTURE", "code_information": [{"code": "27826", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26600", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26605", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METACARPAL FRACTURE", "code_information": [{"code": "26607", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28470", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28475", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT METATARSAL FRACTURE", "code_information": [{"code": "28476", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE", "code_information": [{"code": "28456", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28450", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28455", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE EACH", "code_information": [{"code": "28465", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3105.66, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21422", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6211.31, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21423", "type": "CPT"}], "standard_charges": [{"minimum": 6211.31, "maximum": 6211.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6211.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT NECK SPINE FRACTURE", "code_information": [{"code": "22326", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC FRACTURE(S)", "code_information": [{"code": "27215", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27216", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27217", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PELVIC RING FRACTURE", "code_information": [{"code": "27218", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54111", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5158.0, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 5158.0, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT PLEURODESIS W/AGENT", "code_information": [{"code": "32560", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTUR", "code_information": [{"code": "24655", "type": "CPT"}, {"code": "3340102394", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 607.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 588.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 485.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTUR", "code_information": [{"code": "24665", "type": "CPT"}, {"code": "3340102378", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 14003.89, "gross_charge": 14437.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14003.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11549.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT RADIUS FRACTURE", "code_information": [{"code": "24650", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28530", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SESAMOID BONE FRACTURE", "code_information": [{"code": "28531", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SHLD DISLOC W/", "code_information": [{"code": "23655", "type": "CPT"}, {"code": "3480101551", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3527.89, "gross_charge": 3637.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3527.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2909.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62000", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27175", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27177", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27178", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SLIPPED EPIPHYSIS", "code_information": [{"code": "27181", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62280", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINAL CORD LESION", "code_information": [{"code": "62281", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 985.68, "discounted_cash": 1395.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 985.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FRACTURE", "code_information": [{"code": "22325", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FX W/MAN", "code_information": [{"code": "22315", "type": "CPT"}, {"code": "3480101490", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 3930.57, "gross_charge": 2924.0, "discounted_cash": 4954.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2485.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3415.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2193.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2836.28, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2046.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3402.09, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2193.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3930.57, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2485.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2339.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3303.0, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3369.06, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21820", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT T-SPINE FX OPE", "code_information": [{"code": "22327", "type": "CPT"}, {"code": "3480101491", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 7959.27, "gross_charge": 4382.0, "discounted_cash": 6573.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3724.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3286.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3067.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4250.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3067.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3286.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3724.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3505.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27200", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27230", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27232", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27235", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27238", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27240", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27244", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27246", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FRACTURE", "code_information": [{"code": "27248", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27516", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27517", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB DISLOCATION", "code_information": [{"code": "26641", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26645", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT THUMB FRACTURE", "code_information": [{"code": "26665", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28630", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28635", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28660", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28665", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1670.09, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE DISLOCATION", "code_information": [{"code": "28666", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TOE FRACTURE", "code_information": [{"code": "28525", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL NERVE", "code_information": [{"code": "61790", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 5831.73, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL TRACT", "code_information": [{"code": "61791", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 5831.73, "discounted_cash": 2955.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5831.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24670", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT ULNAR FRACTURE", "code_information": [{"code": "24675", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"minimum": 2187.18, "maximum": 2187.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 167.32, "maximum": 277.43, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 167.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINAL BLEEDING", "code_information": [{"code": "57180", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 551.8, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25622", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25624", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25645", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25650", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCAT", "code_information": [{"code": "25675", "type": "CPT"}, {"code": "3340102387", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 607.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 588.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 424.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 455.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 515.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 485.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25660", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25670", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25676", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25690", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST DISLOCATION", "code_information": [{"code": "25695", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25680", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25685", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREAT/GRAFT HEEL FRACTURE", "code_information": [{"code": "28420", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT MOUTH ROOF LESION", "code_information": [{"code": "42160", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2713.61, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46940", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 4297.77, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANAL FISSURE", "code_information": [{"code": "46942", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27786", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27808", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27810", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27816", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "27818", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28430", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28436", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CHOROID LESION", "code_information": [{"code": "67220", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF COMPLICATIONS", "code_information": [{"code": "D9930", "type": "HCPCS"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF CORNEAL LESION", "code_information": [{"code": "65450", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 708.89, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 708.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF EYELID LESIONS", "code_information": [{"code": "68040", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27780", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27781", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FIBULA FRACTURE", "code_information": [{"code": "27784", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28002", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3498.15, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3498.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF FOOT INFECTION", "code_information": [{"code": "28003", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 2542.29, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2542.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF GUM LESION", "code_information": [{"code": "41850", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 3522.18, "discounted_cash": 2334.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEAD INJURY", "code_information": [{"code": "62010", "type": "CPT"}], "standard_charges": [{"minimum": 4954.63, "maximum": 4954.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4954.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28400", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28405", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF HEEL FRACTURE", "code_information": [{"code": "28406", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF INCOMPL", "code_information": [{"code": "59812", "type": "CPT"}, {"code": "3480102122", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 4938.27, "gross_charge": 5091.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4938.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3563.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3818.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4327.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4072.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF INTERTR", "code_information": [{"code": "27245", "type": "CPT"}, {"code": "3480101676", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2156.7, "maximum": 4985.78, "gross_charge": 3081.0, "discounted_cash": 4621.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2988.57, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2156.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2310.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2618.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2464.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF INTERTR", "code_information": [{"code": "27252", "type": "CPT"}, {"code": "3480101677", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3527.89, "gross_charge": 3637.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3527.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2909.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF INTERTR", "code_information": [{"code": "27266", "type": "CPT"}, {"code": "3480101678", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3527.89, "gross_charge": 3637.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3527.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2545.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2727.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3091.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2909.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1670.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISCARRIAGE", "code_information": [{"code": "59821", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 2187.18, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MISS AB", "code_information": [{"code": "59820", "type": "CPT"}, {"code": "3480102123", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 5925.73, "gross_charge": 6109.0, "discounted_cash": 4785.39, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5192.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3298.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4581.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4276.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5925.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4276.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.97, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4581.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3796.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5192.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4887.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3190.26, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3254.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2187.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF MOUTH LESION", "code_information": [{"code": "40820", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 3522.18, "discounted_cash": 4928.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3522.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54110", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2109.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54115", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2109.3, "discounted_cash": 4349.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2109.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54200", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54205", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 5158.0, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5158.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF PENIS LESION", "code_information": [{"code": "54220", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 378.3, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67208", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67218", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 5918.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21812", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RIB FRACTURE", "code_information": [{"code": "21813", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF SLIPPPE", "code_information": [{"code": "27176", "type": "CPT"}, {"code": "3480101674", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1607.9, "maximum": 4985.78, "gross_charge": 2297.0, "discounted_cash": 3445.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1952.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1722.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1607.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2228.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1607.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1722.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1952.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1837.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH F", "code_information": [{"code": "27511", "type": "CPT"}, {"code": "3480103085", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "gross_charge": 3373.0, "discounted_cash": 5059.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2867.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2529.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2361.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3271.81, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2361.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2529.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2867.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2698.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27500", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27501", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27502", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27503", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27506", "type": "CPT"}], "standard_charges": [{"minimum": 4985.78, "maximum": 4985.78, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4985.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27507", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27508", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27509", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 6155.24, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27510", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 2460.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27513", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF THIGH FRACTURE", "code_information": [{"code": "27514", "type": "CPT"}], "standard_charges": [{"minimum": 6155.24, "maximum": 6155.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA F", "code_information": [{"code": "27758", "type": "CPT"}, {"code": "3480103079", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 15981.88, "gross_charge": 14437.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14003.89, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10105.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10827.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12271.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11549.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TIBIA FRACTURE", "code_information": [{"code": "27750", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28510", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF TOE FRACTURE", "code_information": [{"code": "28515", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53220", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF URETHRA LESION", "code_information": [{"code": "53260", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT PLAN DEVELOPMENT", "code_information": [{"code": "T1007", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.61, "maximum": 128.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 128.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREATMENT X10SV RETINOPATHY", "code_information": [{"code": "67228", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 902.02, "discounted_cash": 889.73, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREPHINE 15MM*233-20", "code_information": [{"code": "3100208464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPHINE MRI NONST", "code_information": [{"code": "3100102038", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 1687.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM", "code_information": [{"code": "86780", "type": "CPT"}], "standard_charges": [{"minimum": 13.24, "maximum": 30.26, "discounted_cash": 21.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREPONEMA PALLIDUM AG IF", "code_information": [{"code": "87285", "type": "CPT"}], "standard_charges": [{"minimum": 12.18, "maximum": 24.03, "discounted_cash": 19.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TREPROSTINIL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3285", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.55, "maximum": 54.55, "discounted_cash": 90.59, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 54.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREPROSTINIL, NON-COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7686", "type": "HCPCS"}], "standard_charges": [{"minimum": 725.27, "maximum": 725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 725.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 311+", "code_information": [{"code": "239U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 5622.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL 55-74", "code_information": [{"code": "242U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 8032.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ ALYS PNL DNA 23", "code_information": [{"code": "171U", "type": "CPT"}], "standard_charges": [{"minimum": 218.94, "maximum": 218.94, "discounted_cash": 2440.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 218.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 194 GENES", "code_information": [{"code": "50U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4685.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRGT GEN SEQ DNA 324 GENES", "code_information": [{"code": "37U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5622.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRH PANEL 1 HOUR", "code_information": [{"code": "80438", "type": "CPT"}, {"code": "3440100833", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 50.41, "maximum": 439.41, "gross_charge": 453.0, "discounted_cash": 80.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 439.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 317.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.61, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 339.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 64.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 385.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 53.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 362.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 50.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 53.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 55.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRH PANEL 2 HOUR", "code_information": [{"code": "80439", "type": "CPT"}, {"code": "3440100834", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 67.21, "maximum": 586.85, "gross_charge": 605.0, "discounted_cash": 107.97, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.43, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 423.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 586.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 423.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 74.14, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 85.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 67.21, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 71.98, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 73.42, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIA SOFT 6FX24CM*M0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.15, "maximum": 471.36, "gross_charge": 485.94, "discounted_cash": 728.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.15, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIA SOFT 6X26CM*M00", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207402", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 839.87, "maximum": 1163.82, "gross_charge": 1199.82, "discounted_cash": 1799.73, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1019.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 899.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 839.87, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1163.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 839.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 899.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1019.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 959.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIA SOFT 7FX24CM*M0", "code_information": [{"code": "V2632", "type": "HCPCS"}, {"code": "3100207623", "type": "CDM"}, {"code": "276", "type": "RC"}], "standard_charges": [{"minimum": 1552.32, "maximum": 2151.07, "gross_charge": 2217.6, "discounted_cash": 3326.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2151.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1552.32, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1663.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1884.96, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1774.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIA SOFT 8FX20CM*M0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 340.15, "maximum": 471.36, "gross_charge": 485.94, "discounted_cash": 728.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.45, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.15, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.36, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.15, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.45, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIAL 16 LEAD KIT*SC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209878", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1960.0, "maximum": 2716.0, "gross_charge": 2800.0, "discounted_cash": 4200.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2716.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1960.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2100.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2380.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIAL PUNCH/BROACH*1", "code_information": [{"code": "3100209143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1023.75, "discounted_cash": 1535.63, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE A INJ PRS-FREE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3300", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.27, "maximum": 4.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE ACETON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3301", "type": "HCPCS"}, {"code": "3400300005", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 1.08, "maximum": 169.75, "gross_charge": 175.0, "discounted_cash": 262.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 169.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 122.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 131.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 148.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE COMP CON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7683", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE COMP UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7684", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE DIACETATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3302", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "TRIAMCINOLONE HEXACETONL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3303", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.57, "maximum": 9.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRICHINELLA ANTIBODY", "code_information": [{"code": "86784", "type": "CPT"}], "standard_charges": [{"minimum": 12.56, "maximum": 30.26, "discounted_cash": 20.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRICHOGRAM", "code_information": [{"code": "96902", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS ASSAY W/OPTIC", "code_information": [{"code": "87808", "type": "CPT"}], "standard_charges": [{"minimum": 15.29, "maximum": 24.03, "discounted_cash": 24.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGIN DIR PROBE", "code_information": [{"code": "87660", "type": "CPT"}], "standard_charges": [{"minimum": 20.05, "maximum": 24.03, "discounted_cash": 32.21, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRICHOMONAS VAGINALIS AMPLIF", "code_information": [{"code": "87661", "type": "CPT"}], "standard_charges": [{"minimum": 35.09, "maximum": 41.83, "discounted_cash": 56.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 35.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRICYCLIC & CYCLICALS 6/MORE", "code_information": [{"code": "80337", "type": "CPT"}], "standard_charges": [{"minimum": 44.95, "maximum": 44.95, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 44.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIDENT ACET SHELL*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3772.86, "maximum": 5228.1, "gross_charge": 5389.8, "discounted_cash": 8084.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4581.33, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4042.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3772.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5228.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3772.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4042.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4581.33, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4311.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT ACET SHELL*5", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203437", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3357.35, "maximum": 4652.33, "gross_charge": 4796.22, "discounted_cash": 7194.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4076.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3597.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3357.35, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4652.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3357.35, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3597.16, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4076.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3836.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT INSER 10DEGX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203843", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3167.89, "maximum": 4389.79, "gross_charge": 4525.56, "discounted_cash": 6788.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3846.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3394.17, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3167.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4389.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3167.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3394.17, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3846.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3620.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT INSER 10DEGX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT INSERT 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206723", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT INSERT X3*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206383", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT INSERT X3*64", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 ECCENTRIC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2990.98, "maximum": 4144.65, "gross_charge": 4272.84, "discounted_cash": 6409.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3631.91, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3204.63, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2990.98, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4144.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2990.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3204.63, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3631.91, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3418.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT 36", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202490", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1292.76, "maximum": 1791.39, "gross_charge": 1846.8, "discounted_cash": 2770.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1569.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1385.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1292.76, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1791.39, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1292.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1385.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1569.78, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1477.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT32*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207109", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1470.0, "maximum": 2037.0, "gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2037.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1470.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT32*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207187", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT32*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208135", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206416", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206417", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206433", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206440", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206979", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206994", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1365.0, "maximum": 1891.5, "gross_charge": 1950.0, "discounted_cash": 2925.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1891.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1657.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIDENT X3 INSERT36*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207565", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1575.0, "maximum": 2182.5, "gross_charge": 2250.0, "discounted_cash": 3375.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2182.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1687.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1912.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIFLUPROMAZINE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3400", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.39, "maximum": 8.39, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIGEMINAL BLOCK ANESTHESIA", "code_information": [{"code": "D9212", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.35, "maximum": 9.35, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIGGER PNT INJ 1- 2", "code_information": [{"code": "20552", "type": "CPT"}, {"code": "3480101432", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 926.35, "gross_charge": 955.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 811.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 716.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 668.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 926.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 668.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 716.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 811.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 764.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 456.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIGGER-FLEX*DTF-31", "code_information": [{"code": "3100204977", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1695.0, "discounted_cash": 2542.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIGGER-FLEX*DTF-38", "code_information": [{"code": "3100205929", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1968.0, "discounted_cash": 2952.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIGLYCERIDES", "code_information": [{"code": "84478", "type": "CPT"}, {"code": "3440101006", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.74, "maximum": 47.53, "gross_charge": 49.0, "discounted_cash": 9.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 47.53, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.27, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 36.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 41.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 39.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 6.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIIODOTHYRONIINE T3", "code_information": [{"code": "84481", "type": "CPT"}, {"code": "3440101009", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 16.94, "maximum": 148.41, "gross_charge": 153.0, "discounted_cash": 27.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.76, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 148.41, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.68, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.59, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 130.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 122.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.14, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIIODOTHYRONIINE T3", "code_information": [{"code": "84482", "type": "CPT"}, {"code": "3440101010", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 15.76, "maximum": 137.74, "gross_charge": 142.0, "discounted_cash": 25.32, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.45, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 137.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 20.09, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 16.88, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 17.22, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIIODOTHYRONINE T3", "code_information": [{"code": "84480", "type": "CPT"}, {"code": "3440101008", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 14.18, "maximum": 123.19, "gross_charge": 127.0, "discounted_cash": 22.79, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.71, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 123.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 95.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 101.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S)", "code_information": [{"code": "G0127", "type": "HCPCS"}], "standard_charges": [{"minimum": 226.95, "maximum": 226.95, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIM NAIL(S) ANY NUMBER", "code_information": [{"code": "11719", "type": "CPT"}], "standard_charges": [{"minimum": 226.95, "maximum": 226.95, "discounted_cash": 93.63, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 226.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRIMANO KNEE KIT*AR-", "code_information": [{"code": "3100206906", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 160.0, "discounted_cash": 240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL 250MG", "code_information": [{"code": "Q0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.95, "maximum": 0.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 0.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIMETHOBENZAMIDE HCL INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3250", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.57, "maximum": 48.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 48.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRIPLE ANTIBIOTIC OI", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3400300264", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 12.6, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "TRIPTORELIN PAMOATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3315", "type": "HCPCS"}], "standard_charges": [{"minimum": 416.69, "maximum": 416.69, "discounted_cash": 664.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 416.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRISMUS APPLIANCE", "code_information": [{"code": "D5937", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1", "code_information": [{"code": "37246", "type": "CPT"}, {"code": "3480103163", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5001.8, "maximum": 6940.66, "gross_charge": 0.01, "discounted_cash": 8748.74, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6030.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6007.46, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6940.66, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1", "code_information": [{"code": "37248", "type": "CPT"}, {"code": "3480103165", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5001.8, "maximum": 6940.66, "gross_charge": 0.01, "discounted_cash": 8748.74, "setting": "both", "payers_information": [{"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6030.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6007.46, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6940.66, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5832.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5949.14, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP A", "code_information": [{"code": "37247", "type": "CPT"}, {"code": "3480103164", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP A", "code_information": [{"code": "37249", "type": "CPT"}, {"code": "3480103166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "gross_charge": 0.01, "discounted_cash": 0.02, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/O ST", "code_information": [{"code": "66174", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML DIL AQ O/F CAN W/ST", "code_information": [{"code": "66175", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ABD AORTA", "code_information": [{"code": "236T", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC BRCHIOCPH", "code_information": [{"code": "237T", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC ILIAC ART", "code_information": [{"code": "238T", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC RENAL ART", "code_information": [{"code": "234T", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRLUML PERIP ATHRC VISCERAL", "code_information": [{"code": "235T", "type": "CPT"}], "standard_charges": [{"minimum": 7310.46, "maximum": 7310.46, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7310.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN 1ST 2 L/S", "code_information": [{"code": "64628", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRML DSTRJ IOS BVN EA ADDL", "code_information": [{"code": "64629", "type": "CPT"}], "standard_charges": [{"minimum": 7959.27, "maximum": 7959.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV BIL", "code_information": [{"code": "339T", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSCTH RENAL SYMP DENRV UNL", "code_information": [{"code": "338T", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "discounted_cash": 8748.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ DON-DRV CLL-FR DNA", "code_information": [{"code": "118U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 4423.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ KDN ALGRFT REJ 1494", "code_information": [{"code": "88U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 5075.61, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ PD LVR&BWL CD154+CLL", "code_information": [{"code": "81560", "type": "CPT"}], "standard_charges": [{"minimum": 88.56, "maximum": 640.73, "discounted_cash": 1029.33, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 640.73, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 88.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSPLJ RNL MEAS CD154+CLL", "code_information": [{"code": "18M", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 1029.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRNSXJ/REPOS ABRRNT RNL VSLS", "code_information": [{"code": "50100", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TROCAR", "code_information": [{"code": "3100102039", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 1/8\"X49\" *007", "code_information": [{"code": "3100203380", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.31, "discounted_cash": 30.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR 5MM LAP*B5LT", "code_information": [{"code": "3100207324", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR CONE", "code_information": [{"code": "3100103861", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR DAVINC 12MM*T", "code_information": [{"code": "3100209028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.76, "discounted_cash": 385.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100102040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 95.0, "discounted_cash": 142.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100102041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 385.0, "discounted_cash": 577.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103632", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 350.0, "discounted_cash": 525.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103633", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103634", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103636", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.0, "discounted_cash": 621.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103638", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 509.0, "discounted_cash": 763.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO", "code_information": [{"code": "3100103639", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.0, "discounted_cash": 334.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ERCP*CFR39", "code_information": [{"code": "3100206006", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR LAP", "code_information": [{"code": "3100102042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 478.0, "discounted_cash": 717.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR NEEDLE 18GA*G", "code_information": [{"code": "3100206335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.2, "discounted_cash": 85.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SLEEVE 5MM*CB", "code_information": [{"code": "3100208111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.96, "discounted_cash": 106.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SPIKE", "code_information": [{"code": "3100102043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 461.0, "discounted_cash": 691.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR SPIKE", "code_information": [{"code": "3100104656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 630.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR TUBE HIGH FLO", "code_information": [{"code": "3100102044", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2464.0, "discounted_cash": 3696.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCHLEOPLASTY KIT*A", "code_information": [{"code": "3100207895", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TROPONIN QUANTITATIV", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "3440101011", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.47, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 20.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TROPONIN QUANTITATIV", "code_information": [{"code": "84484", "type": "CPT"}, {"code": "3440101012", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 12.47, "maximum": 58.2, "gross_charge": 60.0, "discounted_cash": 20.04, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 58.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 42.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.36, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRTMNT SIMULATION 3D IMAGE", "code_information": [{"code": "D0393", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRUDI CURETTE*TDC000", "code_information": [{"code": "3100207185", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUDI NAV CABLE*TDNC", "code_information": [{"code": "3100204466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 555.0, "discounted_cash": 832.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUDI SHAVER 40 DEGR", "code_information": [{"code": "3100209303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUDI SHAVER STRAIGH", "code_information": [{"code": "3100209302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRURL DSTRJ PRST8 TISS RF WV", "code_information": [{"code": "53854", "type": "CPT"}], "standard_charges": [{"minimum": 2013.63, "maximum": 2013.63, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2013.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TRUSKIN, PER SQ CENTIMETER", "code_information": [{"code": "Q4167", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O CONTR, CONT ECG", "code_information": [{"code": "C8930", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CON,STRES", "code_information": [{"code": "C8928", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, COM", "code_information": [{"code": "C8921", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTE W OR W/O FOL W/CONT, F/U", "code_information": [{"code": "C8922", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTE W OR WO FOL WCON,DOPPLER", "code_information": [{"code": "C8929", "type": "HCPCS"}], "standard_charges": [{"minimum": 513.09, "maximum": 513.09, "discounted_cash": 1225.56, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 513.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTVI/RPLCMT W/PRSTC VLV PERQ", "code_information": [{"code": "646T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ APPR 1ST PROSTH", "code_information": [{"code": "569T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TTVR PERQ EA ADDL PROSTH", "code_information": [{"code": "570T", "type": "CPT"}], "standard_charges": [{"minimum": 11364.86, "maximum": 11364.86, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11364.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUBE 36F BARIATRIC C", "code_information": [{"code": "3100207578", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.8, "discounted_cash": 1024.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 36FR SHORT W/BU", "code_information": [{"code": "3100209866", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.88, "discounted_cash": 935.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE BUTTON VENT*240", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208792", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 77.56, "maximum": 107.47, "gross_charge": 110.8, "discounted_cash": 166.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 94.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 107.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 77.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 83.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 94.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 88.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE CALIBRATION GAS", "code_information": [{"code": "3100102414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 750.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE EAR TRIUNE", "code_information": [{"code": "3100103924", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 141.04, "discounted_cash": 211.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET EXCHANGE 14*", "code_information": [{"code": "3100210229", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.2, "discounted_cash": 487.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ET EXCHANGE 19*", "code_information": [{"code": "3100210230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 325.2, "discounted_cash": 487.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE GAS", "code_information": [{"code": "3100102047", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 496.0, "discounted_cash": 744.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE GASROSTOMY 18F*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206623", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 157.5, "maximum": 218.25, "gross_charge": 225.0, "discounted_cash": 337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 218.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE GASROSTOMY 22F*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 157.5, "maximum": 218.25, "gross_charge": 225.0, "discounted_cash": 337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 218.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE GASROSTOMY 24F*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206624", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 157.5, "maximum": 218.25, "gross_charge": 225.0, "discounted_cash": 337.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 218.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 157.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 168.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 191.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE GASTROJEJUNOSTO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206621", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 457.8, "maximum": 634.38, "gross_charge": 654.0, "discounted_cash": 981.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 555.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 490.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 457.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 634.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 457.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 490.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 555.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 523.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE GASTROJEJUNOSTO", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 457.8, "maximum": 634.38, "gross_charge": 654.0, "discounted_cash": 981.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 555.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 490.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 457.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 634.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 457.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 490.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 555.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 523.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE IRRIGATION SET", "code_information": [{"code": "3100104034", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE NEPHROSTOMY 10*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE NEPHROSTOMY 8F*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 210.0, "maximum": 291.0, "gross_charge": 300.0, "discounted_cash": 450.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 291.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 225.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 255.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE OUTER INSULATED", "code_information": [{"code": "3100102048", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 1611.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE PACKING", "code_information": [{"code": "3100104143", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1116.0, "discounted_cash": 1674.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE REDUCTION SA*KI", "code_information": [{"code": "3100204322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 720.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE REUTTER BOBBIN*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209472", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 29.0, "maximum": 40.19, "gross_charge": 41.44, "discounted_cash": 62.16, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE SALEM SUMP", "code_information": [{"code": "3100102049", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 7.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SET IN/OUT Y*AQ", "code_information": [{"code": "3100203078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 388.0, "discounted_cash": 582.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCT SHORT", "code_information": [{"code": "3100104087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 377.0, "discounted_cash": 565.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION", "code_information": [{"code": "3100104013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1301.0, "discounted_cash": 1951.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION SINUS", "code_information": [{"code": "3100102050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.0, "discounted_cash": 306.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION SINUS", "code_information": [{"code": "3100103640", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 342.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUCTION SINUS", "code_information": [{"code": "3100103641", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 261.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE SUPPORT 320MM*1", "code_information": [{"code": "3100205931", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE T/TUBE*VT-0401-", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210075", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 134.4, "maximum": 186.24, "gross_charge": 192.0, "discounted_cash": 288.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 186.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 134.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 144.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 163.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 153.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUBE VENT", "code_information": [{"code": "3100103848", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE VENT REUTER BOB", "code_information": [{"code": "3100104577", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING", "code_information": [{"code": "3100102052", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING", "code_information": [{"code": "3100103642", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING", "code_information": [{"code": "3100103643", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.0, "discounted_cash": 33.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING", "code_information": [{"code": "3100103644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING", "code_information": [{"code": "3100103645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.0, "discounted_cash": 84.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ARGYLE UNIVER", "code_information": [{"code": "3100102053", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 62.8, "discounted_cash": 94.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ARTHRO", "code_information": [{"code": "3100102054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.0, "discounted_cash": 330.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ARTHROSCOPY", "code_information": [{"code": "3100102055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 139.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING CONNECTOR", "code_information": [{"code": "3100102056", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING CONNECTOR", "code_information": [{"code": "3100103646", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 126.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING CONNECTOR*G02", "code_information": [{"code": "3100205718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.52, "discounted_cash": 50.28, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING DUAL PEEL", "code_information": [{"code": "3100102057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.0, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ENDO SMARTCAP", "code_information": [{"code": "3100202636", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ENDO-SCRUB*19", "code_information": [{"code": "3100204566", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.4, "discounted_cash": 333.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING ENDOGATOR", "code_information": [{"code": "3100102058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.0, "discounted_cash": 67.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING FLEX", "code_information": [{"code": "3100102059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING INFILTRATION", "code_information": [{"code": "3100202595", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 570.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING INFILTRATION*", "code_information": [{"code": "3100207449", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 78.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING INSUFFLATION", "code_information": [{"code": "3100102060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 27.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING INTEGRATED", "code_information": [{"code": "3100102061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 345.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IRRIG", "code_information": [{"code": "3100102062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 166.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV", "code_information": [{"code": "3100102063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.0, "discounted_cash": 19.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV", "code_information": [{"code": "3100104470", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV EXT", "code_information": [{"code": "3100102064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 4.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV EXT ACCLAR", "code_information": [{"code": "3100102366", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 90.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING IV STOPCOCK", "code_information": [{"code": "3100102065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.8, "discounted_cash": 10.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING LIPOSUCT", "code_information": [{"code": "3100102066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING LIPOSUCTION", "code_information": [{"code": "3100102263", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.0, "discounted_cash": 87.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING LS PLUM", "code_information": [{"code": "3100102067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.0, "discounted_cash": 31.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING S/C COLLECTIO", "code_information": [{"code": "3100102070", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING S/C COLLECTIO", "code_information": [{"code": "3100206340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SET", "code_information": [{"code": "3100102071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 21.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SET COMP SYST", "code_information": [{"code": "3100102051", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 280.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION", "code_information": [{"code": "3100102072", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 164.0, "discounted_cash": 246.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION", "code_information": [{"code": "3100103647", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.0, "discounted_cash": 25.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION", "code_information": [{"code": "3100103648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.0, "discounted_cash": 82.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION", "code_information": [{"code": "3100103649", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 91.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SUCTION KIT*S", "code_information": [{"code": "3100205661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SURGICAL", "code_information": [{"code": "3100102073", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.64, "discounted_cash": 146.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING SURGICAL 1/4I", "code_information": [{"code": "3100210261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.16, "discounted_cash": 66.24, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING TUR", "code_information": [{"code": "3100102074", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING VINYL CONNECT", "code_information": [{"code": "3100206648", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 37.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBING Y TANDEM", "code_information": [{"code": "3100102075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.0, "discounted_cash": 55.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBLR PLATE 2HOLE/23", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 758.1, "maximum": 1050.51, "gross_charge": 1083.0, "discounted_cash": 1624.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 920.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 812.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 758.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1050.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 758.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 812.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 920.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 866.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUMOR ANTIGN QUANT C", "code_information": [{"code": "86300", "type": "CPT"}, {"code": "3440101075", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 20.81, "maximum": 181.39, "gross_charge": 187.0, "discounted_cash": 33.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUMOR ANTIGN QUANT C", "code_information": [{"code": "86304", "type": "CPT"}, {"code": "3440101076", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 20.81, "maximum": 181.39, "gross_charge": 187.0, "discounted_cash": 33.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUMOR ANTIGN QUANT O", "code_information": [{"code": "86316", "type": "CPT"}, {"code": "3440101078", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 20.81, "maximum": 181.39, "gross_charge": 187.0, "discounted_cash": 33.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 181.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 130.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.96, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 140.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 26.53, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 158.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 149.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.81, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 22.74, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUMOR CELL DEPLETE OF HARVST", "code_information": [{"code": "38211", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUNNELER DEEP BRAIN", "code_information": [{"code": "3100102076", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 840.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELER INSPIRE*484", "code_information": [{"code": "3100209271", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.24, "discounted_cash": 781.86, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL", "code_information": [{"code": "3100104597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 720.0, "discounted_cash": 1080.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 12\"*1", "code_information": [{"code": "3100202731", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 28CM*", "code_information": [{"code": "3100206442", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELING TOOL 30\"*M", "code_information": [{"code": "3100204310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 1350.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNELPRO LATERAL", "code_information": [{"code": "3100102077", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 750.0, "discounted_cash": 1125.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TUNNING TOOL KIT*MN1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 378.0, "maximum": 523.8, "gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 523.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 378.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 405.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 459.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TUOHY BORST ADAPTER*", "code_information": [{"code": "3100204266", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.12, "discounted_cash": 84.18, "setting": "both", "billing_class": "facility"}]}, {"description": "TURBINATOR", "code_information": [{"code": "3100102078", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TURNOVER KIT*DYKC184", "code_information": [{"code": "3100209087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.6, "discounted_cash": 57.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TUTOPLAST FASCIA LAT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100102079", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1071.0, "maximum": 1725.27, "gross_charge": 1530.0, "discounted_cash": 2295.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1300.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1484.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1071.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1147.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1300.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1224.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TUTOPLAST FASCIA LAT", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "3100103650", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1474.2, "maximum": 2042.82, "gross_charge": 2106.0, "discounted_cash": 3159.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1790.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1474.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2042.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1474.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1790.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1684.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TWIST DRILL HOLE", "code_information": [{"code": "61105", "type": "CPT"}], "standard_charges": [{"minimum": 8883.54, "maximum": 8883.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8883.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TWN ZYG GEN SEQ ALYS CHRMS2", "code_information": [{"code": "60U", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 348.44, "discounted_cash": 1219.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX AMBLYOPIA ASSMT W/REPORT", "code_information": [{"code": "688T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX AMBLYOPIA DEV SETUP 1ST", "code_information": [{"code": "687T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CLSD FS RAD/ULNA", "code_information": [{"code": "25560", "type": "CPT"}, {"code": "3480101603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 468.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CLSD FX DIST RAD", "code_information": [{"code": "25605", "type": "CPT"}, {"code": "3480101607", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 1396.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1186.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1047.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 977.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1354.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 977.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1047.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1186.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1116.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CLSD FX RAD/ULNA", "code_information": [{"code": "25565", "type": "CPT"}, {"code": "3480101604", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1951.66, "gross_charge": 1396.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1186.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1047.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 977.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1354.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 977.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1047.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1186.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1116.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CLSD FX RAD/ULNA", "code_information": [{"code": "25600", "type": "CPT"}, {"code": "3480101606", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 468.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1 CC/<", "code_information": [{"code": "11950", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 1.1-5.0CC", "code_information": [{"code": "11951", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS 5.1-10CC", "code_information": [{"code": "11952", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 595.41, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 595.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX CONTOUR DEFECTS >10.0 CC", "code_information": [{"code": "11954", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1988.71, "discounted_cash": 961.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1988.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX FOR OPIOID USE DEMO PROJ", "code_information": [{"code": "G2172", "type": "HCPCS"}], "standard_charges": [{"minimum": 205.59, "maximum": 205.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 205.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX L/R ATRIAL FIB ADDL", "code_information": [{"code": "93657", "type": "CPT"}], "standard_charges": [{"minimum": 19622.28, "maximum": 19622.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19622.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OF SUPERFICIAL WO", "code_information": [{"code": "12020", "type": "CPT"}, {"code": "3480103040", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1643.18, "gross_charge": 1694.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1439.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1643.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1185.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1270.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1439.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1355.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OF SUPERFICIAL WO", "code_information": [{"code": "12020", "type": "CPT"}, {"code": "3480103210", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 1892.47, "gross_charge": 1951.0, "discounted_cash": 961.34, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1658.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1463.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1365.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1892.47, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1365.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1463.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1658.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1560.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 640.89, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.71, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OF URETHRA LESION", "code_information": [{"code": "53265", "type": "CPT"}, {"code": "3480103190", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5583.32, "gross_charge": 5756.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5583.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4029.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4317.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4892.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4604.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OF URETHRA LESION", "code_information": [{"code": "53265", "type": "CPT"}, {"code": "3480103253", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OPEN FX RAD/ULNA", "code_information": [{"code": "25574", "type": "CPT"}, {"code": "3480101605", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OPEN FX RADIUS W/", "code_information": [{"code": "25515", "type": "CPT"}, {"code": "3480101601", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15334.73, "gross_charge": 15809.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15334.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OPEN RADIAL HEAD/", "code_information": [{"code": "24666", "type": "CPT"}, {"code": "3480101577", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 17111.77, "gross_charge": 17641.0, "discounted_cash": 20145.23, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13886.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 17111.77, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 12348.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13833.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 13230.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 15981.88, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 14994.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 14112.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13430.15, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13698.75, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OPEN ULNA W/WO FI", "code_information": [{"code": "25545", "type": "CPT"}, {"code": "3480101602", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 15334.73, "gross_charge": 15809.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15334.73, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11066.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11856.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13437.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12647.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX OPEN ULNAR FX WW/", "code_information": [{"code": "24685", "type": "CPT"}, {"code": "3480101578", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 12778.78, "gross_charge": 13174.0, "discounted_cash": 10950.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7548.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12778.78, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9221.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7519.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9880.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 8687.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11197.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10539.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 7300.29, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 7446.3, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6155.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TX SUPFC WND DEHSN W/PACKING", "code_information": [{"code": "12021", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 736.48, "discounted_cash": 610.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY", "code_information": [{"code": "92567", "type": "CPT"}], "standard_charges": [{"minimum": 200.25, "maximum": 200.25, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYMPANOMETRY & REFLEX THRESH", "code_information": [{"code": "92550", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYMPANOSTMY LOCAL AN", "code_information": [{"code": "69436", "type": "CPT"}, {"code": "3480102231", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 426.56, "maximum": 3895.52, "gross_charge": 4016.0, "discounted_cash": 2334.33, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1609.13, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1602.91, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1851.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1556.22, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1587.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYMS GENE COM VARIANTS", "code_information": [{"code": "81346", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 280.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE IM", "code_information": [{"code": "90691", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 114.89, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 114.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYPHOID VACCINE ORAL", "code_information": [{"code": "90690", "type": "CPT"}], "standard_charges": [{"minimum": 46.66, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 46.66, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "TYPHON ENT", "code_information": [{"code": "3100102082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 429.0, "discounted_cash": 643.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TYRX ANTIBAC POUCH*N", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TYRX ANTIBAC POUCH*N", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1950.2, "maximum": 2702.42, "gross_charge": 2786.0, "discounted_cash": 4179.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2702.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1950.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2089.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2368.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2228.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Tendon, Muscle And Other Soft Tissue Procedures, Major", "code_information": [{"code": "317.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 29530.89, "maximum": 29530.89, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 29530.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tendon, Muscle And Other Soft Tissue Procedures, Minor", "code_information": [{"code": "317.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12659.94, "maximum": 12659.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12659.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tendon, Muscle And Other Soft Tissue Procedures, Moderate", "code_information": [{"code": "317.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16736.39, "maximum": 16736.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16736.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tendon, Muscle And Other Soft Tissue Procedures, Severe", "code_information": [{"code": "317.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 48174.15, "maximum": 48174.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 48174.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Test For Detection Of Gastrointestinal Disease-Causing Organism Using Amplified Probe", "code_information": [{"code": "97U", "type": "CPT"}], "standard_charges": [{"minimum": 82.77, "maximum": 82.77, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 82.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Test For Detection Of Respiratory Disease-Causing Organisms In Sputum Or Respiratory Tract Specimen, 33 Target Organismal And Antibiotic Resistance Genes", "code_information": [{"code": "151U", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 41.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Testing Of Autonomic (Parasympathetic And Sympathetic) Nervous System Function", "code_information": [{"code": "95943", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid Disorders, Major", "code_information": [{"code": "427.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13272.5, "maximum": 13272.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 13272.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid Disorders, Minor", "code_information": [{"code": "427.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6189.65, "maximum": 6189.65, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6189.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid Disorders, Moderate", "code_information": [{"code": "427.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7528.81, "maximum": 7528.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7528.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid Disorders, Severe", "code_information": [{"code": "427.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26304.07, "maximum": 26304.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26304.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid, Parathyroid And Thyroglossal Procedures, Major", "code_information": [{"code": "404.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34137.88, "maximum": 34137.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34137.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid, Parathyroid And Thyroglossal Procedures, Minor", "code_information": [{"code": "404.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7080.29, "maximum": 7080.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7080.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid, Parathyroid And Thyroglossal Procedures, Moderate", "code_information": [{"code": "404.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20388.67, "maximum": 20388.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20388.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Thyroid, Parathyroid And Thyroglossal Procedures, Severe", "code_information": [{"code": "404.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 66054.92, "maximum": 66054.92, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 66054.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tobacco-use counsel 3-10 min", "code_information": [{"code": "G0436", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tobacco-use counsel>10min", "code_information": [{"code": "G0437", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.72, "maximum": 38.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 38.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tonsil And Adenoid Procedures, Major", "code_information": [{"code": "97.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 21761.15, "maximum": 21761.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 21761.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tonsil And Adenoid Procedures, Minor", "code_information": [{"code": "97.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8637.31, "maximum": 8637.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8637.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tonsil And Adenoid Procedures, Moderate", "code_information": [{"code": "97.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11273.36, "maximum": 11273.36, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11273.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tonsil And Adenoid Procedures, Severe", "code_information": [{"code": "97.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40504.37, "maximum": 40504.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40504.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Toxic Effects Of Non-Medicinal Substances, Major", "code_information": [{"code": "816.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11949.99, "maximum": 11949.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11949.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Toxic Effects Of Non-Medicinal Substances, Minor", "code_information": [{"code": "816.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5514.29, "maximum": 5514.29, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5514.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Toxic Effects Of Non-Medicinal Substances, Moderate", "code_information": [{"code": "816.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11332.3, "maximum": 11332.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11332.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Toxic Effects Of Non-Medicinal Substances, Severe", "code_information": [{"code": "816.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42644.48, "maximum": 42644.48, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42644.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours With Extensive Procedure, Major", "code_information": [{"code": "4.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 143097.42, "maximum": 143097.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 143097.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours With Extensive Procedure, Minor", "code_information": [{"code": "4.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 65907.55, "maximum": 65907.55, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 65907.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours With Extensive Procedure, Moderate", "code_information": [{"code": "4.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 106722.04, "maximum": 106722.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 106722.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours With Extensive Procedure, Severe", "code_information": [{"code": "4.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 254161.18, "maximum": 254161.18, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 254161.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours Without Extensive Procedure, Major", "code_information": [{"code": "5.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 112866.83, "maximum": 112866.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 112866.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours Without Extensive Procedure, Minor", "code_information": [{"code": "5.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 66912.24, "maximum": 66912.24, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 66912.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours Without Extensive Procedure, Moderate", "code_information": [{"code": "5.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 72728.97, "maximum": 72728.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 72728.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Tracheostomy With Mv >96 Hours Without Extensive Procedure, Severe", "code_information": [{"code": "5.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 223612.78, "maximum": 223612.78, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 223612.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Trans imp balloon cont", "code_information": [{"code": "C9746", "type": "HCPCS"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transient Ischemia, Major", "code_information": [{"code": "47.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11348.96, "maximum": 11348.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11348.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transient Ischemia, Minor", "code_information": [{"code": "47.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6370.34, "maximum": 6370.34, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6370.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transient Ischemia, Moderate", "code_information": [{"code": "47.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9076.86, "maximum": 9076.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9076.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transient Ischemia, Severe", "code_information": [{"code": "47.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18131.94, "maximum": 18131.94, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18131.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transurethral Prostatectomy, Major", "code_information": [{"code": "482.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24290.83, "maximum": 24290.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24290.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transurethral Prostatectomy, Minor", "code_information": [{"code": "482.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8600.15, "maximum": 8600.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8600.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transurethral Prostatectomy, Moderate", "code_information": [{"code": "482.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10517.27, "maximum": 10517.27, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10517.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Transurethral Prostatectomy, Severe", "code_information": [{"code": "482.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40421.07, "maximum": 40421.07, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40421.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "U/S TRTMT, NOT LEIOMYOMATA", "code_information": [{"code": "C9734", "type": "HCPCS"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 20145.23, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "U2AF1 GENE COMMON VARIANTS", "code_information": [{"code": "81357", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 193.25, "discounted_cash": 310.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UA NONAUTO W/O SCOPE", "code_information": [{"code": "81002", "type": "CPT"}, {"code": "3440103018", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 3.48, "maximum": 25.22, "gross_charge": 26.0, "discounted_cash": 5.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 25.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 18.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 19.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.44, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 20.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.48, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UCL INTERNAL BRACE*A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202788", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2145.78, "maximum": 2973.44, "gross_charge": 3065.41, "discounted_cash": 4598.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2605.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2299.05, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2145.78, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2973.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2145.78, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2299.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2605.59, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2452.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UGI AIR CONTRST,WO K", "code_information": [{"code": "74246", "type": "CPT"}, {"code": "3390100671", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 660.57, "gross_charge": 681.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 578.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 510.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 476.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 660.57, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 476.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 510.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 578.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 544.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UGT1A1 GENE COMMON VARIANTS", "code_information": [{"code": "81350", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 234.0, "discounted_cash": 375.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 2*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206451", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2948.4, "maximum": 4085.64, "gross_charge": 4212.0, "discounted_cash": 6318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4085.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 2*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206991", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2948.4, "maximum": 4085.64, "gross_charge": 4212.0, "discounted_cash": 6318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4085.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3330.6, "maximum": 4615.26, "gross_charge": 4758.0, "discounted_cash": 7137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4615.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 3*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3330.6, "maximum": 4615.26, "gross_charge": 4758.0, "discounted_cash": 7137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4615.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 4*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3330.6, "maximum": 4615.26, "gross_charge": 4758.0, "discounted_cash": 7137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4615.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 4*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202911", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3330.6, "maximum": 4615.26, "gross_charge": 4758.0, "discounted_cash": 7137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4615.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2948.4, "maximum": 4085.64, "gross_charge": 4212.0, "discounted_cash": 6318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4085.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202742", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2948.4, "maximum": 4085.64, "gross_charge": 4212.0, "discounted_cash": 6318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4085.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 6*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203948", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3330.6, "maximum": 4615.26, "gross_charge": 4758.0, "discounted_cash": 7137.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4615.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3330.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3568.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4044.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3806.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA FEM CEMENT SZ 6*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206974", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2948.4, "maximum": 4085.64, "gross_charge": 4212.0, "discounted_cash": 6318.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4085.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2948.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3159.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3580.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3369.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 1 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 1 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208785", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1020.6, "maximum": 1414.26, "gross_charge": 1458.0, "discounted_cash": 2187.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1239.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1093.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1020.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1414.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1020.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1093.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1239.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 2 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 2 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203477", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 2 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 2 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206992", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1020.6, "maximum": 1414.26, "gross_charge": 1458.0, "discounted_cash": 2187.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1239.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1093.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1020.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1414.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1020.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1093.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1239.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 3*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 3*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203329", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1020.6, "maximum": 1414.26, "gross_charge": 1458.0, "discounted_cash": 2187.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1239.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1093.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1020.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1414.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1020.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1093.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1239.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1166.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205190", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 5 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 5 *A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202829", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEAR SZ 6*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204469", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB BEARING SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202789", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1152.9, "maximum": 1597.59, "gross_charge": 1647.0, "discounted_cash": 2470.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1597.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1152.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1235.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1399.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1317.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 1*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3276.0, "maximum": 4539.6, "gross_charge": 4680.0, "discounted_cash": 7020.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4539.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3510.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3978.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3744.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 1*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208784", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 2*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202699", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 2*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204278", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 2*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 2*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 3*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202771", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 3*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202910", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 3*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206392", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 3*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206896", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202715", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202741", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 4*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207019", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 5*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202704", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 5*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202828", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 5*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 5*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1905.12, "maximum": 2639.95, "gross_charge": 2721.6, "discounted_cash": 4082.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2639.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1905.12, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2041.2, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2313.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2177.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UKA TIB TRAY SZ 6*AR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204468", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.36, "maximum": 2769.15, "gross_charge": 2854.8, "discounted_cash": 4282.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2769.15, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1998.36, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2141.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2426.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2283.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULNAR CAP*DKY069", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205306", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1907.08, "maximum": 2642.66, "gross_charge": 2724.4, "discounted_cash": 4086.6, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2315.74, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2043.3, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1907.08, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2642.66, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1907.08, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2043.3, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2315.74, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2179.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULNAR STEM 52MM*0030", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7597.59, "maximum": 10528.08, "gross_charge": 10853.7, "discounted_cash": 16280.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9225.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8140.27, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7597.59, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10528.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7597.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8140.27, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9225.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8682.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULNAR STEM*0030211", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 6279.0, "maximum": 8700.9, "gross_charge": 8970.0, "discounted_cash": 13455.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7624.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6727.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6279.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8700.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6279.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6727.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7624.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7176.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ULTRASONIC GUIDANCE", "code_information": [{"code": "76998", "type": "CPT"}, {"code": "3480101310", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 172.2, "maximum": 238.62, "gross_charge": 246.0, "discounted_cash": 369.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 209.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 184.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 172.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 238.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 172.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 184.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 209.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 196.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND BREAST COMPLETE", "code_information": [{"code": "76641", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND BREAST LIMITED", "code_information": [{"code": "76642", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND HEAD AND", "code_information": [{"code": "76536", "type": "CPT"}, {"code": "3270102317", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "gross_charge": 110.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRASOUND MED PROBE", "code_information": [{"code": "3100209411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3975.4, "discounted_cash": 5963.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRASOUND PROBE BK5", "code_information": [{"code": "3100209723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3975.4, "discounted_cash": 5963.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRASOUND SM PROBE*", "code_information": [{"code": "3100209412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3975.4, "discounted_cash": 5963.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ULTRASOUND, TRANSREC", "code_information": [{"code": "76873", "type": "CPT"}, {"code": "3480103339", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 385.09, "gross_charge": 397.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 337.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 297.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 277.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 385.09, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 277.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 297.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 337.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 317.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRAVIOLET LIGHT THERAPY", "code_information": [{"code": "96900", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ULTRAVIOLET THERAPY", "code_information": [{"code": "97028", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UMBILICAL ARTERY ECHO", "code_information": [{"code": "76820", "type": "CPT"}], "standard_charges": [{"minimum": 177.56, "maximum": 177.56, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 177.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UMBILICAL CORD OCCLUD W/US", "code_information": [{"code": "59072", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1526.8, "discounted_cash": 491.04, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNCLASSIFIED BIOLOGICS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3590", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [{"code": "383", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8061.7, "maximum": 8061.7, "discounted_cash": 15610.29, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8061.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [{"code": "384", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5467.1, "maximum": 5467.1, "discounted_cash": 9776.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5467.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNI CUTTING KIT*ABS-", "code_information": [{"code": "3100207466", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNI CUTTING KIT*ABS-", "code_information": [{"code": "3100207614", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNI CUTTING KIT*ABS-", "code_information": [{"code": "3100208418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2646.0, "discounted_cash": 3969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNI CUTTING KIT*ABS-", "code_information": [{"code": "3100208421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2646.0, "discounted_cash": 3969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNI CUTTING KIT*ABS-", "code_information": [{"code": "3100208549", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2646.0, "discounted_cash": 3969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNI CUTTING KIT*ABS-", "code_information": [{"code": "3100208667", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2646.0, "discounted_cash": 3969.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UNICEM 2 AUTOMIX", "code_information": [{"code": "3100104721", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 22.5, "setting": "both", "billing_class": "facility"}]}, {"description": "UNL THER/PROP/DIAG INJ/INF", "code_information": [{"code": "96379", "type": "CPT"}], "standard_charges": [{"minimum": 23.14, "maximum": 23.14, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 23.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLIST PROC ANT SEG", "code_information": [{"code": "66999", "type": "CPT"}, {"code": "3410100703", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 354.9, "maximum": 2829.81, "gross_charge": 507.0, "discounted_cash": 3566.99, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2458.84, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 491.79, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 354.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2449.33, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 380.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2829.81, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 430.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 405.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2377.99, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2425.55, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1367.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLIST PROC PELVIS/H", "code_information": [{"code": "27299", "type": "CPT"}, {"code": "3480101679", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 468.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTD NONINVAS VASC DX STD", "code_information": [{"code": "93998", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTD PX HEMIC/LYMPHTC SYS", "code_information": [{"code": "38999", "type": "CPT"}], "standard_charges": [{"minimum": 3504.82, "maximum": 3504.82, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED ALL/IMMLG SVC/PX", "code_information": [{"code": "95199", "type": "CPT"}], "standard_charges": [{"minimum": 574.94, "maximum": 574.94, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 574.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED ANES PROCEDURE", "code_information": [{"code": "1999", "type": "CPT"}], "standard_charges": [{"minimum": 33.38, "maximum": 33.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMISTRY PROCEDURE", "code_information": [{"code": "84999", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CHEMOTHERAPY PX", "code_information": [{"code": "96549", "type": "CPT"}], "standard_charges": [{"minimum": 447.23, "maximum": 447.23, "discounted_cash": 72.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 447.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CRANFCL&MAXLFCL PX", "code_information": [{"code": "21299", "type": "CPT"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CT PROCEDURE", "code_information": [{"code": "76497", "type": "CPT"}], "standard_charges": [{"minimum": 227.4, "maximum": 227.4, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 227.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV PX DX NUC MED", "code_information": [{"code": "78499", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CV SVC/PROCEDURE", "code_information": [{"code": "93799", "type": "CPT"}], "standard_charges": [{"minimum": 56.52, "maximum": 56.52, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOGENETIC STUDY", "code_information": [{"code": "88299", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED CYTOPATHOLOGY PX", "code_information": [{"code": "88199", "type": "CPT"}], "standard_charges": [{"minimum": 37.39, "maximum": 43.61, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 37.39, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED DIAGNOSTIC", "code_information": [{"code": "91299", "type": "CPT"}, {"code": "3390100676", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 159.4, "maximum": 932.72, "gross_charge": 480.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 465.6, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 360.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 408.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 384.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 932.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED DIALYSIS PROCEDURE", "code_information": [{"code": "90999", "type": "CPT"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED DX RADIOGRAPHIC PX", "code_information": [{"code": "76499", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED ENDOCRINE PX DX NUC", "code_information": [{"code": "78099", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED FETAL INVAS PX W/US", "code_information": [{"code": "59897", "type": "CPT"}], "standard_charges": [{"minimum": 303.94, "maximum": 303.94, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 303.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED FLUORO PROC", "code_information": [{"code": "76496", "type": "CPT"}, {"code": "3480102237", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 510.22, "gross_charge": 526.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 510.22, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 368.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 394.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 447.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 420.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED GI PX DX NUC MED", "code_information": [{"code": "78299", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED GU PX DX NUC MED", "code_information": [{"code": "78799", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED HEMATOLOGY&COAGJ PX", "code_information": [{"code": "85999", "type": "CPT"}], "standard_charges": [{"minimum": 8.89, "maximum": 20.92, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED HYSTEROSCOP", "code_information": [{"code": "58579", "type": "CPT"}, {"code": "3480102114", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 203.34, "maximum": 5710.39, "gross_charge": 5887.0, "discounted_cash": 305.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5003.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4415.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4120.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5710.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4120.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4415.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 241.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5003.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4709.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED IMMUNE GLOBULIN", "code_information": [{"code": "90399", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNLISTED IN VIVO LAB SERVICE", "code_information": [{"code": "88749", "type": "CPT"}], "standard_charges": [{"minimum": 35.16, "maximum": 35.16, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED INTESTINE P", "code_information": [{"code": "44799", "type": "CPT"}, {"code": "3340102414", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 925.01, "maximum": 6234.19, "gross_charge": 6427.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5462.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4820.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4498.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6234.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4498.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4820.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5462.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5141.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAP OVIDUC", "code_information": [{"code": "58679", "type": "CPT"}, {"code": "3480102119", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3553.77, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY", "code_information": [{"code": "49329", "type": "CPT"}, {"code": "3480101994", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4404.17, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY", "code_information": [{"code": "50549", "type": "CPT"}, {"code": "3480102016", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1571.3, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPAROSCOPY", "code_information": [{"code": "58578", "type": "CPT"}, {"code": "3480103036", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3553.77, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3553.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPROSCOPY", "code_information": [{"code": "55559", "type": "CPT"}, {"code": "3480102082", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1927.74, "maximum": 9268.35, "gross_charge": 9555.0, "discounted_cash": 8831.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6088.11, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9268.35, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6688.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6064.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7166.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7006.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8121.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7644.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5887.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6005.68, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX APPENDIX", "code_information": [{"code": "44979", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BILIARY TRC", "code_information": [{"code": "47579", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX BLADDER", "code_information": [{"code": "51999", "type": "CPT"}], "standard_charges": [{"minimum": 1767.1, "maximum": 1767.1, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1767.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX ENDOC SYS", "code_information": [{"code": "60659", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX LYMPHTC SYS", "code_information": [{"code": "38589", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"minimum": 4404.17, "maximum": 4404.17, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4404.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX STOMACH", "code_information": [{"code": "43659", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX TESTIS", "code_information": [{"code": "54699", "type": "CPT"}], "standard_charges": [{"minimum": 1927.74, "maximum": 1927.74, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"minimum": 1571.3, "maximum": 1571.3, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAXLFCL PROSTH PX", "code_information": [{"code": "21089", "type": "CPT"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 9.27, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.27, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 43.61, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MODALITY", "code_information": [{"code": "97039", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLCLR PATH", "code_information": [{"code": "81479", "type": "CPT"}, {"code": "3440100839", "type": "CDM"}, {"code": "310", "type": "RC"}], "standard_charges": [{"minimum": 79.66, "maximum": 737.56, "gross_charge": 279.0, "discounted_cash": 418.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 237.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 209.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 195.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 270.63, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 195.3, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 209.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 237.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 223.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 737.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX DX NUC", "code_information": [{"code": "78399", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX HEAD", "code_information": [{"code": "21499", "type": "CPT"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED NERVOUS SYS", "code_information": [{"code": "64999", "type": "CPT"}, {"code": "3480102199", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 302.24, "maximum": 770.18, "gross_charge": 794.0, "discounted_cash": 453.36, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 674.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 312.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 595.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 555.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 770.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 555.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 311.31, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 595.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 359.67, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 674.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 635.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 302.24, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 448.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED NEUROLOGICAL DX PX", "code_information": [{"code": "95999", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED NRVS SYS PX DX NUC", "code_information": [{"code": "78699", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED OPH SVC/PROCEDURE", "code_information": [{"code": "92499", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED ORL SERVICE/PX", "code_information": [{"code": "92700", "type": "CPT"}], "standard_charges": [{"minimum": 200.7, "maximum": 200.7, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 200.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PHYSCL MED/REHAB PX", "code_information": [{"code": "97799", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE", "code_information": [{"code": "29999", "type": "CPT"}, {"code": "3480101825", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE", "code_information": [{"code": "30999", "type": "CPT"}, {"code": "3480101841", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 191.1, "maximum": 1869.0, "gross_charge": 273.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 264.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE BREAST", "code_information": [{"code": "19499", "type": "CPT"}], "standard_charges": [{"minimum": 1551.72, "maximum": 1551.72, "discounted_cash": 5834.48, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1551.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE COLON", "code_information": [{"code": "45399", "type": "CPT"}], "standard_charges": [{"minimum": 1705.24, "maximum": 1705.24, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1705.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ESOPHAGUS", "code_information": [{"code": "43499", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE EYELIDS", "code_information": [{"code": "67999", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LARYNX", "code_information": [{"code": "31599", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIPS", "code_information": [{"code": "40799", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE LIVER", "code_information": [{"code": "47399", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE ORBIT", "code_information": [{"code": "67599", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE PANCREAS", "code_information": [{"code": "48999", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE RECTUM", "code_information": [{"code": "45999", "type": "CPT"}], "standard_charges": [{"minimum": 2670.89, "maximum": 2670.89, "discounted_cash": 1398.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE SHOULDER", "code_information": [{"code": "23929", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "27599", "type": "CPT"}, {"code": "3480101712", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 468.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "27899", "type": "CPT"}, {"code": "3480101740", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 240.64, "maximum": 1463.16, "gross_charge": 468.0, "discounted_cash": 360.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 248.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 453.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 327.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 247.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 351.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 286.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 397.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 374.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 240.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 245.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "37799", "type": "CPT"}, {"code": "3480101890", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 144.2, "maximum": 2718.95, "gross_charge": 206.0, "discounted_cash": 961.58, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 662.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 154.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 144.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 199.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 144.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 660.28, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 154.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 762.85, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 175.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 164.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 641.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 653.87, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "41899", "type": "CPT"}, {"code": "3480101914", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 191.1, "maximum": 2319.34, "gross_charge": 273.0, "discounted_cash": 373.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 264.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 191.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 256.73, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 204.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 296.61, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 232.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 218.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 249.25, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 254.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "46999", "type": "CPT"}, {"code": "3480101988", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 932.64, "maximum": 2670.89, "gross_charge": 1538.0, "discounted_cash": 1398.96, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1307.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 964.35, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1153.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1076.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1491.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1076.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 960.62, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1153.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1109.84, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1307.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1230.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 932.64, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 951.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2670.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "49999", "type": "CPT"}, {"code": "3480102015", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 925.01, "maximum": 6289.48, "gross_charge": 6484.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5511.4, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4863.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4538.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6289.48, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4538.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4863.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5511.4, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5187.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1083.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "53899", "type": "CPT"}, {"code": "3480102045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 252.2, "maximum": 1571.3, "gross_charge": 803.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 682.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 602.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 562.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 778.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 562.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 602.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 682.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 642.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "55899", "type": "CPT"}, {"code": "3480102083", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 200.9, "maximum": 1927.74, "gross_charge": 287.0, "discounted_cash": 378.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 243.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 260.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 215.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 200.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 278.39, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 200.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 259.77, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 215.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 300.12, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 243.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 229.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 252.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PROCEDURE,", "code_information": [{"code": "58999", "type": "CPT"}, {"code": "3480102121", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 24.29, "maximum": 551.8, "gross_charge": 34.7, "discounted_cash": 305.01, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 29.49, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 210.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 33.65, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24.29, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 209.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26.02, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 241.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 29.49, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 27.76, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 203.34, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 207.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 551.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PSYC SVC/THERAPY", "code_information": [{"code": "90899", "type": "CPT"}], "standard_charges": [{"minimum": 76.99, "maximum": 76.99, "discounted_cash": 43.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 76.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PULMONARY SVC/PX", "code_information": [{"code": "94799", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ABDOMEN MUSCSKEL", "code_information": [{"code": "22999", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ACCESSORY SINUS", "code_information": [{"code": "31299", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX BILIARY TRACT", "code_information": [{"code": "47999", "type": "CPT"}], "standard_charges": [{"minimum": 2301.1, "maximum": 2301.1, "discounted_cash": 1387.52, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2301.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CARDIAC SURGERY", "code_information": [{"code": "33999", "type": "CPT"}], "standard_charges": [{"minimum": 2718.95, "maximum": 2718.95, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2718.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CASTING/STRPG", "code_information": [{"code": "29799", "type": "CPT"}], "standard_charges": [{"minimum": 89.0, "maximum": 89.0, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 89.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CLIN BRACHYTX", "code_information": [{"code": "77799", "type": "CPT"}], "standard_charges": [{"minimum": 255.43, "maximum": 255.43, "discounted_cash": 183.54, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 255.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX CONJUNCTIVA", "code_information": [{"code": "68399", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 11601.6, "maximum": 11601.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11601.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX ENDOCRINE SYSTEM", "code_information": [{"code": "60699", "type": "CPT"}], "standard_charges": [{"minimum": 3504.82, "maximum": 3504.82, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3504.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXC PRESSURE ULC", "code_information": [{"code": "15999", "type": "CPT"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "discounted_cash": 1076.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX EXTRAOCULAR MUSC", "code_information": [{"code": "67399", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOOT/TOES", "code_information": [{"code": "28899", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX FOREARM/WRIST", "code_information": [{"code": "25999", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HANDS/FINGERS", "code_information": [{"code": "26989", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX HUMERUS/ELBOW", "code_information": [{"code": "24999", "type": "CPT"}], "standard_charges": [{"minimum": 1463.16, "maximum": 1463.16, "discounted_cash": 360.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1463.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX INNER EAR", "code_information": [{"code": "69949", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 450.34, "maximum": 450.34, "discounted_cash": 445.91, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 450.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LUNGS & PLEURA", "code_information": [{"code": "32999", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MAT CARE&DLVR", "code_information": [{"code": "59899", "type": "CPT"}], "standard_charges": [{"minimum": 2169.82, "maximum": 2169.82, "discounted_cash": 305.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2169.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MECKEL'S DVRTCLM", "code_information": [{"code": "44899", "type": "CPT"}], "standard_charges": [{"minimum": 2458.18, "maximum": 2458.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2458.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MEDIASTINUM", "code_information": [{"code": "39499", "type": "CPT"}], "standard_charges": [{"minimum": 1282.05, "maximum": 1282.05, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1282.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX NECK/THORAX", "code_information": [{"code": "21899", "type": "CPT"}], "standard_charges": [{"minimum": 2470.2, "maximum": 2470.2, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2470.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PALATE UVULA", "code_information": [{"code": "42299", "type": "CPT"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX PHRNX ADND/TNSL", "code_information": [{"code": "42999", "type": "CPT"}], "standard_charges": [{"minimum": 2399.89, "maximum": 2399.89, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2399.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], "standard_charges": [{"minimum": 902.02, "maximum": 902.02, "discounted_cash": 3566.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 902.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX SALIVRY GLND/DUX", "code_information": [{"code": "42699", "type": "CPT"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": "69979", "type": "CPT"}], "standard_charges": [{"minimum": 3105.66, "maximum": 3105.66, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3105.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX MGMT", "code_information": [{"code": "77499", "type": "CPT"}], "standard_charges": [{"minimum": 586.07, "maximum": 586.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 586.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX THER RAD TX PLNG", "code_information": [{"code": "77299", "type": "CPT"}], "standard_charges": [{"minimum": 196.25, "maximum": 196.25, "discounted_cash": 207.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 196.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TONGUE FLR MOUTH", "code_information": [{"code": "41599", "type": "CPT"}], "standard_charges": [{"minimum": 1869.0, "maximum": 1869.0, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1869.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TRACHEA BRONCHI", "code_information": [{"code": "31899", "type": "CPT"}], "standard_charges": [{"minimum": 1756.42, "maximum": 1756.42, "discounted_cash": 303.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VASCULAR NJX", "code_information": [{"code": "36299", "type": "CPT"}], "standard_charges": [{"minimum": 1369.71, "maximum": 1369.71, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1369.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX VESTIBULE MOUTH", "code_information": [{"code": "40899", "type": "CPT"}], "standard_charges": [{"minimum": 2319.34, "maximum": 2319.34, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2319.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED REPROD MED LAB PROC", "code_information": [{"code": "89398", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 43.61, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED RESP PX DX NUC MED", "code_information": [{"code": "78599", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED STOMACH SUR", "code_information": [{"code": "43999", "type": "CPT"}, {"code": "3480101951", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 925.01, "maximum": 4624.44, "gross_charge": 2182.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2116.54, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1527.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1636.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED SURGICAL PATH PX", "code_information": [{"code": "88399", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 43.61, "discounted_cash": 82.95, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED THERAPEUTIC PX", "code_information": [{"code": "97139", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED TRANSFUSION", "code_information": [{"code": "86999", "type": "CPT"}, {"code": "3440101158", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 15.99, "maximum": 113.49, "gross_charge": 117.0, "discounted_cash": 45.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.41, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 113.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 81.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 87.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 36.15, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 99.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15.99, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 30.38, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 30.99, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED URINALYSIS PX", "code_information": [{"code": "81099", "type": "CPT"}], "standard_charges": [{"minimum": 14.4, "maximum": 16.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED VACCINE/TOXOID", "code_information": [{"code": "90749", "type": "CPT"}], "standard_charges": [{"minimum": 11.2, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLISTED VASC ENDOSCOPY PX", "code_information": [{"code": "37501", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD HEMATOP RET/ENDO LYMP", "code_information": [{"code": "78199", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNLSTD LAPS PX MAT CARE&DLVR", "code_information": [{"code": "59898", "type": "CPT"}], "standard_charges": [{"minimum": 2385.2, "maximum": 2385.2, "discounted_cash": 8831.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2385.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNSCHED DIALYSIS ESRD PT HOS", "code_information": [{"code": "G0257", "type": "HCPCS"}], "standard_charges": [{"minimum": 887.33, "maximum": 887.33, "discounted_cash": 1069.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 887.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNSCHEDULED DRESSING CHANGE", "code_information": [{"code": "D4920", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED DIAGNOSTIC PROCE", "code_information": [{"code": "D0999", "type": "HCPCS"}], "standard_charges": [{"minimum": 161.09, "maximum": 161.09, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 161.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED ORAL ANTI-EMETIC", "code_information": [{"code": "Q0181", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED PERIODONTAL PROC", "code_information": [{"code": "D4999", "type": "HCPCS"}], "standard_charges": [{"minimum": 361.79, "maximum": 361.79, "discounted_cash": 373.88, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 361.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNSPECIFIED PREVENTIVE PROC", "code_information": [{"code": "D1999", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UNXPL CNST HRTBL DO GN XPRSN", "code_information": [{"code": "266U", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 5140.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPCHARGE E1 POLY*801", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202904", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 617.4, "maximum": 855.54, "gross_charge": 882.0, "discounted_cash": 1323.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 749.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 617.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 855.54, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 617.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 661.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 749.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 705.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPCHARGE REV AUGMENT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205735", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPCHARGE TIT GLEN SP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202637", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1967.42, "maximum": 2726.28, "gross_charge": 2810.6, "discounted_cash": 4215.9, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2389.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2107.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1967.42, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2726.28, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1967.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2107.95, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2389.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2248.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPCHARGE TIT SHOULDE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209857", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1050.0, "maximum": 1455.0, "gross_charge": 1500.0, "discounted_cash": 2250.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1455.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1050.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1125.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1275.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPGRADE OF PACEMAKER SYSTEM", "code_information": [{"code": "33214", "type": "CPT"}], "standard_charges": [{"minimum": 11831.66, "maximum": 11831.66, "discounted_cash": 16344.8, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11831.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY STUDY", "code_information": [{"code": "93930", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER EXTREMITY STUDY", "code_information": [{"code": "93931", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UPPER GASTROINTESTIN", "code_information": [{"code": "43236", "type": "CPT"}, {"code": "3480101941", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2539.46, "gross_charge": 2618.0, "discounted_cash": 1387.52, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2225.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 956.46, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2539.46, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1832.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 952.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1963.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1100.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2225.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2094.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 925.01, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 943.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1526.35, "methodology": "case rate"}], "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": 9207.75, "maximum": 9207.75, "discounted_cash": 18306.54, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9207.75, "methodology": "fee schedule"}], "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": 9400.2, "maximum": 9400.2, "discounted_cash": 30673.53, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9400.2, "methodology": "fee schedule"}], "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": 7140.07, "maximum": 7140.07, "discounted_cash": 11064.09, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7140.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UPR/L XTREMITY ART 2 LEVELS", "code_information": [{"code": "93922", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UR ALBUMIN SEMIQUANTITATIVE", "code_information": [{"code": "82044", "type": "CPT"}], "standard_charges": [{"minimum": 6.23, "maximum": 16.02, "discounted_cash": 10.01, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UREA INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3350", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN SEMI-QUANT", "code_information": [{"code": "84525", "type": "CPT"}], "standard_charges": [{"minimum": 5.13, "maximum": 20.92, "discounted_cash": 8.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UREA NITROGEN URINE", "code_information": [{"code": "84540", "type": "CPT"}, {"code": "3440101015", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 5.56, "maximum": 40.74, "gross_charge": 42.0, "discounted_cash": 8.93, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 40.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 29.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 31.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 7.08, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 35.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 33.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UREA-N CLEARANCE TEST", "code_information": [{"code": "84545", "type": "CPT"}], "standard_charges": [{"minimum": 7.2, "maximum": 20.92, "discounted_cash": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY", "code_information": [{"code": "50970", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50955", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & BIOPSY", "code_information": [{"code": "50974", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & CATHETER", "code_information": [{"code": "50972", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1571.3, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50957", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50961", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50976", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETER ENDOSCOPY & TREATMENT", "code_information": [{"code": "50980", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 4163.42, "discounted_cash": 7920.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4163.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL ACC CATH *A", "code_information": [{"code": "3100202990", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.32, "discounted_cash": 226.98, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL ACC SHEATH*", "code_information": [{"code": "3100208285", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL BX BRUSH*04", "code_information": [{"code": "3100202987", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 441.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL CATH DUAL*G", "code_information": [{"code": "3100204771", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.72, "discounted_cash": 190.08, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL EMBOLIZATION/OCCL", "code_information": [{"code": "50705", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL ENDO THRU E", "code_information": [{"code": "50951", "type": "CPT"}, {"code": "3480103331", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 11413.02, "gross_charge": 11766.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10001.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8824.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8236.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 11413.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8236.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8824.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10001.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9412.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1571.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL IRIS KIT*02", "code_information": [{"code": "3100209628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 727.29, "discounted_cash": 1090.94, "setting": "both", "billing_class": "facility"}]}, {"description": "URETERAL REFLUX STUDY", "code_information": [{"code": "78740", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT FIRM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203023", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 219.24, "maximum": 303.8, "gross_charge": 313.2, "discounted_cash": 469.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 219.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 303.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 219.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 250.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203026", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203027", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203029", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203033", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203034", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 219.24, "maximum": 303.8, "gross_charge": 313.2, "discounted_cash": 469.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 234.9, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 219.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 303.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 219.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 234.9, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 266.22, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 250.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203037", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETERAL STENT SOFT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 203.0, "maximum": 281.3, "gross_charge": 290.0, "discounted_cash": 435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 281.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 203.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 246.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 232.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETEROSCOPE 6.3 FR*", "code_information": [{"code": "3100210111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 3150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URETEROSCOPE 7.5*PU3", "code_information": [{"code": "3100209366", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1816.78, "discounted_cash": 2725.17, "setting": "both", "billing_class": "facility"}]}, {"description": "URETH BALLOON DILAT*", "code_information": [{"code": "3100203114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 697.5, "setting": "both", "billing_class": "facility"}]}, {"description": "URETH BALLOON DILAT*", "code_information": [{"code": "3100203236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 270.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITH CC/MCC", "code_information": [{"code": "671", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10926.83, "maximum": 10926.83, "discounted_cash": 19112.63, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10926.83, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHRAL PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "672", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5580.23, "maximum": 5580.23, "discounted_cash": 10301.55, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5580.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHRAL STRICTURE", "code_information": [{"code": "697", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3633.05, "maximum": 3633.05, "discounted_cash": 12427.28, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3633.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URETHRLYS TRANSVAG W/ SCOPE", "code_information": [{"code": "53500", "type": "CPT"}], "standard_charges": [{"minimum": 4354.77, "maximum": 4354.77, "discounted_cash": 5336.12, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHROMEATOPLASTY,", "code_information": [{"code": "53450", "type": "CPT"}, {"code": "3480102043", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 277.43, "maximum": 8056.82, "gross_charge": 8306.0, "discounted_cash": 5336.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7060.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3678.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6229.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5814.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8056.82, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5814.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3664.13, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6229.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4233.32, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7060.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6644.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3557.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3628.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4354.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URETHROPLASTY, ONE-S", "code_information": [{"code": "53410", "type": "CPT"}, {"code": "3480102040", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 9668.96, "gross_charge": 9968.0, "discounted_cash": 7920.18, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8472.8, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5459.64, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7476.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6977.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9668.96, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6977.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5438.52, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7476.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6283.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8472.8, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5280.12, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5385.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6427.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URIC ACID BLOOD", "code_information": [{"code": "84550", "type": "CPT"}, {"code": "3440101016", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 4.52, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 7.26, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.99, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4.84, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4.94, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINALYSIS", "code_information": [{"code": "81005", "type": "CPT"}], "standard_charges": [{"minimum": 2.17, "maximum": 16.02, "discounted_cash": 3.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.17, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINALYSIS GLASS TEST", "code_information": [{"code": "81020", "type": "CPT"}], "standard_charges": [{"minimum": 4.7, "maximum": 16.02, "discounted_cash": 7.55, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.7, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINALYSIS MICROSCOP", "code_information": [{"code": "81015", "type": "CPT"}, {"code": "3440100837", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 3.05, "maximum": 29.1, "gross_charge": 30.0, "discounted_cash": 4.91, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.38, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.37, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3.89, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.34, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINALYSIS NONAUTO W/SCOPE", "code_information": [{"code": "81000", "type": "CPT"}], "standard_charges": [{"minimum": 4.02, "maximum": 16.02, "discounted_cash": 6.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINALYSIS VOLUME MEASURE", "code_information": [{"code": "81050", "type": "CPT"}], "standard_charges": [{"minimum": 3.64, "maximum": 16.02, "discounted_cash": 5.85, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY BLADDER RETENTION", "code_information": [{"code": "78730", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITH MCC", "code_information": [{"code": "693", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5295.57, "maximum": 5295.57, "discounted_cash": 15812.37, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5295.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINARY STONES WITHOUT MCC", "code_information": [{"code": "694", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3526.07, "maximum": 3526.07, "discounted_cash": 8738.51, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3526.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "URINE FLOW MEASUREMENT", "code_information": [{"code": "51736", "type": "CPT"}], "standard_charges": [{"minimum": 189.13, "maximum": 277.43, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE SCREEN FOR BACTERIA", "code_information": [{"code": "81007", "type": "CPT"}], "standard_charges": [{"minimum": 16.02, "maximum": 29.98, "discounted_cash": 48.17, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.98, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE SHUNT TO INTESTINE", "code_information": [{"code": "50815", "type": "CPT"}], "standard_charges": [{"minimum": 8555.57, "maximum": 8555.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8555.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINE SPECIMEN COLLECT MULT", "code_information": [{"code": "P9615", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "discounted_cash": 14.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINLYSIS DIP/TAB AU", "code_information": [{"code": "81001", "type": "CPT"}, {"code": "3440100835", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 3.17, "maximum": 29.1, "gross_charge": 30.0, "discounted_cash": 5.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 29.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 22.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4.05, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 25.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 24.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3.17, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URINLYSIS DIP/TAB AU", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "3440100791", "type": "CDM"}, {"code": "307", "type": "RC"}], "standard_charges": [{"minimum": 2.25, "maximum": 20.37, "gross_charge": 21.0, "discounted_cash": 3.62, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.49, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.48, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2.46, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URO BALLOON DILATOR", "code_information": [{"code": "3100202986", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 605.13, "discounted_cash": 907.7, "setting": "both", "billing_class": "facility"}]}, {"description": "URO RING BAG*CF50750", "code_information": [{"code": "3100206963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.8, "discounted_cash": 85.2, "setting": "both", "billing_class": "facility"}]}, {"description": "URO STORZ COAG BALL*", "code_information": [{"code": "3100206379", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "URO SURGERY 1ST 30 M", "code_information": [{"code": "3480103131", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 1977.0, "discounted_cash": 2965.5, "setting": "both", "billing_class": "facility"}]}, {"description": "URO SURGERY EA ADDL", "code_information": [{"code": "3480103132", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 3293.0, "discounted_cash": 4939.5, "setting": "both", "billing_class": "facility"}]}, {"description": "URODYNAMIC STIM EVOK", "code_information": [{"code": "51792", "type": "CPT"}, {"code": "3480103280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 434.32, "gross_charge": 196.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 190.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 137.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 166.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "URODYNAMIC STIM EVOK", "code_information": [{"code": "51792", "type": "CPT"}, {"code": "3480103281", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 434.32, "gross_charge": 234.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 226.98, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 163.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 175.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 198.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 187.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 434.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UROFOLLITROPIN, 75 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3355", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY ANTEGRADE RS&I", "code_information": [{"code": "74425", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 588.66, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BLS W/NF", "code_information": [{"code": "74415", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UROGRAPHY NFS DRIP&/BOLUS", "code_information": [{"code": "74410", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "UROKINASE 250,000 IU INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3365", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROKINASE 5000 IU INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3364", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "UROLIFT CARTRIDGE*UL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1911.0, "maximum": 2648.1, "gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1911.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2047.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2320.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2184.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UROLIFT HANDLE KIT*U", "code_information": [{"code": "3100207414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2730.0, "discounted_cash": 4095.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UROLIFT INSERTION KI", "code_information": [{"code": "3100104037", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 1575.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UROLOK ADAPTOR*M0067", "code_information": [{"code": "3100203190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.36, "discounted_cash": 102.54, "setting": "both", "billing_class": "facility"}]}, {"description": "URONAV CLIPS*8808E", "code_information": [{"code": "3100209979", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.56, "discounted_cash": 81.84, "setting": "both", "billing_class": "facility"}]}, {"description": "URONAV CLIPS*8848", "code_information": [{"code": "3100209980", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.56, "discounted_cash": 81.84, "setting": "both", "billing_class": "facility"}]}, {"description": "UROVAC EVACUATOR", "code_information": [{"code": "3100102083", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 216.0, "setting": "both", "billing_class": "facility"}]}, {"description": "US ABDL AORTA SCREEN AAA", "code_information": [{"code": "76706", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US BONE DENSITY MEASURE", "code_information": [{"code": "76977", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US BONE STIMULATION", "code_information": [{"code": "20979", "type": "CPT"}], "standard_charges": [{"minimum": 453.46, "maximum": 453.46, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 453.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US COMPL JOINT R-T W/IMG", "code_information": [{"code": "76881", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US DUPLEX CAROTID BI", "code_information": [{"code": "93880", "type": "CPT"}, {"code": "3460101266", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 692.58, "gross_charge": 714.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 692.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US DUPLEX CAROTID UN", "code_information": [{"code": "93882", "type": "CPT"}, {"code": "3460101267", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 525.74, "gross_charge": 542.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 460.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 379.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 525.74, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 379.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 406.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 460.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 433.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US DUPLX ART LOWR EX", "code_information": [{"code": "93925", "type": "CPT"}, {"code": "3460101268", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 692.58, "gross_charge": 714.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 692.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US DUPLX ART LOWR EX", "code_information": [{"code": "93926", "type": "CPT"}, {"code": "3460101269", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 533.5, "gross_charge": 550.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 467.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 533.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 412.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 467.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 440.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US DUPLX VEIN LOWR E", "code_information": [{"code": "93970", "type": "CPT"}, {"code": "3460101270", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 250.05, "maximum": 692.58, "gross_charge": 714.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 692.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 499.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 535.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 606.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 571.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US DUPLX VEIN LOWR E", "code_information": [{"code": "93971", "type": "CPT"}, {"code": "3460101271", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 533.5, "gross_charge": 550.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 467.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 412.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 385.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 533.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 385.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 412.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 467.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 440.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL COMP", "code_information": [{"code": "76770", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDO BACK WALL LIM", "code_information": [{"code": "76775", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM ABDOM COMPLETE", "code_information": [{"code": "76700", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM CHEST", "code_information": [{"code": "76604", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS DYNAMIC", "code_information": [{"code": "76885", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM INFANT HIPS STATIC", "code_information": [{"code": "76886", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM K TRANSPL W/DOPPLER", "code_information": [{"code": "76776", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM PELVIC COMPLETE", "code_information": [{"code": "76856", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM PELVIC LIMITED", "code_information": [{"code": "76857", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US EXAM SPINAL CANAL", "code_information": [{"code": "76800", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US GUIDANCE FETAL REDUCT", "code_information": [{"code": "S8055", "type": "HCPCS"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US GUIDE TISSUE ABLATION", "code_information": [{"code": "76940", "type": "CPT"}], "standard_charges": [{"minimum": 221.17, "maximum": 221.17, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US GUIDE VASC ACCESS", "code_information": [{"code": "76937", "type": "CPT"}, {"code": "3340100571", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 221.17, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US GUIDE, NDL PLACEM", "code_information": [{"code": "76942", "type": "CPT"}, {"code": "3340100572", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 211.4, "maximum": 292.94, "gross_charge": 302.0, "discounted_cash": 453.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 256.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 226.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 211.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 292.94, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 211.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 226.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 256.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 241.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 221.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US LEIOMYOMATA ABLATE <200", "code_information": [{"code": "71T", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US LMTD JT/FCL EVL NVASC XTR", "code_information": [{"code": "76882", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US NONINV PHYS LOWR", "code_information": [{"code": "93923", "type": "CPT"}, {"code": "3460102283", "type": "CDM"}, {"code": "921", "type": "RC"}], "standard_charges": [{"minimum": 159.4, "maximum": 586.85, "gross_charge": 605.0, "discounted_cash": 239.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 423.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 586.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 423.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 164.18, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 453.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 189.69, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 514.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 484.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 159.4, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.59, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 249.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US POST VOID MEASURE", "code_information": [{"code": "51798", "type": "CPT"}, {"code": "3340100569", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 277.43, "gross_charge": 227.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 189.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US SCROTUM & CONTENT", "code_information": [{"code": "76870", "type": "CPT"}, {"code": "3480102238", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 445.23, "gross_charge": 459.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 390.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 445.23, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 321.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 344.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 390.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 367.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US TRANSRECTAL", "code_information": [{"code": "76872", "type": "CPT"}, {"code": "3340102486", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 112.19, "maximum": 471.42, "gross_charge": 486.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 471.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 340.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 364.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 413.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 388.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB 1ST LES", "code_information": [{"code": "76978", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US TRGT DYN MBUBB EA ADDL", "code_information": [{"code": "76979", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "US-E AXIS PIN2.5X40*", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 619.5, "maximum": 858.45, "gross_charge": 885.0, "discounted_cash": 1327.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 858.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 619.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 663.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 752.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 708.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US-E BASE PLATE*US-E", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203393", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7602.0, "maximum": 10534.2, "gross_charge": 10860.0, "discounted_cash": 16290.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9231.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8145.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7602.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10534.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7602.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8145.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9231.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8688.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USE 1ST TARGET LESION", "code_information": [{"code": "76982", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "USE EA ADDL TARGET LESION", "code_information": [{"code": "76983", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "USE OF SPEECH DEVICE SERVICE", "code_information": [{"code": "92609", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "USE PARENCHYMA", "code_information": [{"code": "76981", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "USTEKINUMAB SUB CU INJ, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3357", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.57, "maximum": 152.57, "discounted_cash": 247.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 152.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "USTEKINUMAB, IV INJECT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3358", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.49, "maximum": 12.49, "discounted_cash": 20.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.49, "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": 7035.55, "maximum": 7035.55, "discounted_cash": 19894.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7035.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "743", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5440.67, "maximum": 5440.67, "discounted_cash": 12973.23, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5440.67, "methodology": "fee schedule"}], "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": 9638.14, "maximum": 9638.14, "discounted_cash": 19951.08, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9638.14, "methodology": "fee schedule"}], "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": 23503.26, "maximum": 23503.26, "discounted_cash": 40374.42, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 23503.26, "methodology": "fee schedule"}], "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": 7860.65, "maximum": 7860.65, "discounted_cash": 14506.13, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7860.65, "methodology": "fee schedule"}], "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": 10924.99, "maximum": 10924.99, "discounted_cash": 22036.62, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10924.99, "methodology": "fee schedule"}], "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": 26187.62, "maximum": 26187.62, "discounted_cash": 43398.9, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26187.62, "methodology": "fee schedule"}], "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": 8777.99, "maximum": 8777.99, "discounted_cash": 15235.17, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8777.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UTERINE MANIPULATOR", "code_information": [{"code": "3100102084", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 123.0, "discounted_cash": 184.5, "setting": "both", "billing_class": "facility"}]}, {"description": "UTERINE SOUND SIMS", "code_information": [{"code": "3100102085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 333.0, "setting": "both", "billing_class": "facility"}]}, {"description": "UVULECTOMY, EXCISION", "code_information": [{"code": "42140", "type": "CPT"}, {"code": "3480101918", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 3909.65, "gross_charge": 4016.0, "discounted_cash": 4928.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3397.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3895.52, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2811.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3383.98, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3012.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 3909.65, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3413.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 3285.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3351.13, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2713.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ultrasound Follow-Up Study", "code_information": [{"code": "76970", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ultrasound Measurement Of Bone Density In Shin Bone", "code_information": [{"code": "508T", "type": "CPT"}], "standard_charges": [{"minimum": 154.42, "maximum": 154.42, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 154.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ultrasound exam aaa screen", "code_information": [{"code": "G0389", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Unite biomatrix", "code_information": [{"code": "Q4129", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urethral And Transurethral Procedures, Major", "code_information": [{"code": "446.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19888.88, "maximum": 19888.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19888.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urethral And Transurethral Procedures, Minor", "code_information": [{"code": "446.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2175.99, "maximum": 2175.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2175.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urethral And Transurethral Procedures, Moderate", "code_information": [{"code": "446.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10182.8, "maximum": 10182.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10182.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urethral And Transurethral Procedures, Severe", "code_information": [{"code": "446.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40729.91, "maximum": 40729.91, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40729.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urinary Stones And Acquired Upper Urinary Tract Obstruction, Major", "code_information": [{"code": "465.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12681.72, "maximum": 12681.72, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12681.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urinary Stones And Acquired Upper Urinary Tract Obstruction, Minor", "code_information": [{"code": "465.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6595.88, "maximum": 6595.88, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6595.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urinary Stones And Acquired Upper Urinary Tract Obstruction, Moderate", "code_information": [{"code": "465.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7613.39, "maximum": 7613.39, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7613.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Urinary Stones And Acquired Upper Urinary Tract Obstruction, Severe", "code_information": [{"code": "465.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26715.43, "maximum": 26715.43, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26715.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Leiomyoma, Major", "code_information": [{"code": "519.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 34704.3, "maximum": 34704.3, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 34704.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Leiomyoma, Minor", "code_information": [{"code": "519.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9575.37, "maximum": 9575.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9575.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Leiomyoma, Moderate", "code_information": [{"code": "519.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12287.02, "maximum": 12287.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12287.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Leiomyoma, Severe", "code_information": [{"code": "519.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 50929.37, "maximum": 50929.37, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 50929.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma, Major", "code_information": [{"code": "513.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26291.25, "maximum": 26291.25, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 26291.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma, Minor", "code_information": [{"code": "513.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10895.31, "maximum": 10895.31, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10895.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma, Moderate", "code_information": [{"code": "513.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12638.15, "maximum": 12638.15, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12638.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Malignancy Except Leiomyoma, Severe", "code_information": [{"code": "513.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 42808.51, "maximum": 42808.51, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 42808.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy, Major", "code_information": [{"code": "512.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 31143.01, "maximum": 31143.01, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 31143.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy, Minor", "code_information": [{"code": "512.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15124.26, "maximum": 15124.26, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15124.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy, Moderate", "code_information": [{"code": "512.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17894.87, "maximum": 17894.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17894.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy, Severe", "code_information": [{"code": "512.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 55755.5, "maximum": 55755.5, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55755.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy, Major", "code_information": [{"code": "511.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 32075.95, "maximum": 32075.95, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 32075.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy, Minor", "code_information": [{"code": "511.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18676.58, "maximum": 18676.58, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18676.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy, Moderate", "code_information": [{"code": "511.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 19132.8, "maximum": 19132.8, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 19132.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Uterine And Adnexa Procedures For Ovarian And Adnexal Malignancy, Severe", "code_information": [{"code": "511.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 62061.76, "maximum": 62061.76, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 62061.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "V", "code_information": [{"code": "3100203655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 474.0, "setting": "both", "billing_class": "facility"}]}, {"description": "V", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100202919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 11025.0, "maximum": 15277.5, "gross_charge": 15750.0, "discounted_cash": 23625.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 13387.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11812.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 11025.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 15277.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 11025.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11812.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 13387.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12600.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "V-BAND GASTROPLASTY", "code_information": [{"code": "43842", "type": "CPT"}], "standard_charges": [{"minimum": 8334.85, "maximum": 8334.85, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8334.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VACC AIIV4 NO PRSRV 0.5ML IM", "code_information": [{"code": "90694", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 77.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 77.36, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VACC IIV4 NO PRSRV 0.25ML IM", "code_information": [{"code": "90689", "type": "CPT"}], "standard_charges": [{"minimum": 55.18, "maximum": 55.18, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VACCINA IG IM", "code_information": [{"code": "90393", "type": "CPT"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VACCINIA VRS VAC 0.3 ML PERQ", "code_information": [{"code": "90622", "type": "CPT"}], "standard_charges": [{"discounted_cash": 0.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VACUUM LINE HARMONY", "code_information": [{"code": "3100103889", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 390.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VAG HYST COMPLEX", "code_information": [{"code": "58290", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST T/O & REPAIR COMPL", "code_information": [{"code": "58292", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 11566.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W TUBE REMO", "code_information": [{"code": "58291", "type": "CPT"}, {"code": "3480103148", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5075.58, "maximum": 12116.27, "gross_charge": 12491.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 10617.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9368.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 8743.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12116.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 8743.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9368.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10617.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 9992.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/ENTEROCELE COMPL", "code_information": [{"code": "58294", "type": "CPT"}], "standard_charges": [{"minimum": 8510.18, "maximum": 8510.18, "discounted_cash": 7613.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8510.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAG HYST W/URINARY REPAIR", "code_information": [{"code": "58267", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC", "code_information": [{"code": "746", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6128.67, "maximum": 6128.67, "discounted_cash": 18712.92, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6128.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "747", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5408.69, "maximum": 5408.69, "discounted_cash": 9905.21, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5408.69, "methodology": "fee schedule"}], "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": 4105.25, "maximum": 4105.25, "discounted_cash": 13599.56, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4105.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC", "code_information": [{"code": "797", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5274.05, "maximum": 5274.05, "discounted_cash": 11118.8, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5274.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC", "code_information": [{"code": "796", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5789.28, "maximum": 5789.28, "discounted_cash": 15835.82, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5789.28, "methodology": "fee schedule"}], "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": 5010.28, "maximum": 5010.28, "discounted_cash": 9056.7, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5010.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [{"code": "806", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3905.43, "maximum": 3905.43, "discounted_cash": 8336.58, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3905.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [{"code": "805", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4318.59, "maximum": 4318.59, "discounted_cash": 11256.12, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 4318.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC", "code_information": [{"code": "807", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3665.03, "maximum": 3665.03, "discounted_cash": 7304.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3665.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTEREC, WI", "code_information": [{"code": "58280", "type": "CPT"}, {"code": "3480102101", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1862.0, "maximum": 5460.6, "gross_charge": 2660.0, "discounted_cash": 3990.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2580.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1995.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2261.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2128.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY", "code_information": [{"code": "58260", "type": "CPT"}, {"code": "3480102098", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5075.58, "maximum": 8960.86, "gross_charge": 9238.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8960.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7390.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINAL HYSTERECTOMY", "code_information": [{"code": "58262", "type": "CPT"}, {"code": "3480102099", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5075.58, "maximum": 8960.86, "gross_charge": 9238.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 8960.86, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 6466.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 6928.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 7852.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 7390.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGINECTOMY PARTIAL W/NODES", "code_information": [{"code": "57109", "type": "CPT"}], "standard_charges": [{"minimum": 7423.94, "maximum": 7423.94, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7423.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGL HYSTER ENTEROCE", "code_information": [{"code": "58270", "type": "CPT"}, {"code": "3480102100", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5075.58, "maximum": 10753.42, "gross_charge": 11086.0, "discounted_cash": 7613.37, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 9423.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5248.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 8314.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7760.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10753.42, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7760.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5227.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 8314.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 6039.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 9423.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8868.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 5075.58, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5177.09, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43640", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VAGOTOMY & PYLORUS REPAIR", "code_information": [{"code": "43641", "type": "CPT"}], "standard_charges": [{"minimum": 4624.44, "maximum": 4624.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4624.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALRUBICIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 1347.69, "maximum": 1347.69, "discounted_cash": 2191.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1347.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VALVE 3/4 SPRING CHE", "code_information": [{"code": "3100102086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 188.0, "discounted_cash": 282.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE A/W F/140 EVIS", "code_information": [{"code": "3100104060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 424.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE DEFENDO", "code_information": [{"code": "3100104716", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE GAUGE W/PLASTI", "code_information": [{"code": "3100102088", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.0, "discounted_cash": 150.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE PEEP DISPOSABL", "code_information": [{"code": "3100102089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SAFETY RELIEF", "code_information": [{"code": "3100102090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 751.0, "discounted_cash": 1126.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SAFETY RELIEF", "code_information": [{"code": "3100103651", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 679.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVE SUCTION F/EVIS", "code_information": [{"code": "3100104061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 369.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33390", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY AORTIC VALVE", "code_information": [{"code": "33391", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33463", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VALVULOPLASTY TRICUSPID", "code_information": [{"code": "33464", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN", "code_information": [{"code": "80202", "type": "CPT"}, {"code": "3440100832", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 13.54, "maximum": 117.37, "gross_charge": 121.0, "discounted_cash": 21.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.99, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 117.37, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.94, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 17.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.54, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.79, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VANCOMYCIN HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "3400300115", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 6.7, "discounted_cash": 10.05, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN HCL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3373", "type": "HCPCS"}, {"code": "3400300129", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "discounted_cash": 18.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANCOMYCIN HCL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3370", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.58, "maximum": 2.58, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VANGUARD PINS*32-486", "code_information": [{"code": "3100206733", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VANTAS IMPLANT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9225", "type": "HCPCS"}], "standard_charges": [{"minimum": 5424.6, "maximum": 5424.6, "discounted_cash": 8299.65, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5424.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAR VACCINE LIVE SUBQ", "code_information": [{"code": "90716", "type": "CPT"}], "standard_charges": [{"minimum": 136.57, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 136.57, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER AB", "code_information": [{"code": "86787", "type": "CPT"}, {"code": "3440101127", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 12.88, "maximum": 91.18, "gross_charge": 94.0, "discounted_cash": 20.69, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.26, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 91.18, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 65.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 70.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 79.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 75.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.88, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 13.79, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VARICELLA-ZOSTER IG IM", "code_information": [{"code": "90396", "type": "CPT"}], "standard_charges": [{"minimum": 123.88, "maximum": 123.88, "discounted_cash": 3624.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 123.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ARTERY", "code_information": [{"code": "37242", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 26840.3, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE BLEED", "code_information": [{"code": "37244", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE ORGAN", "code_information": [{"code": "37243", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC EMBOLIZE/OCCLUDE VENOUS", "code_information": [{"code": "37241", "type": "CPT"}], "standard_charges": [{"minimum": 8133.27, "maximum": 8133.27, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8133.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASC GRAFT INTO CARPAL BONE", "code_information": [{"code": "25430", "type": "CPT"}], "standard_charges": [{"minimum": 3676.59, "maximum": 3676.59, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3676.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCU-GUARD 0.8 X8*V", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204914", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.01, "discounted_cash": 822.02, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR BIOPSY", "code_information": [{"code": "75970", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR FLOW IMAGING", "code_information": [{"code": "78445", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR GRAFT 45CM*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204434", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2935.66, "maximum": 4067.98, "gross_charge": 4193.8, "discounted_cash": 6290.7, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3564.73, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3145.35, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2935.66, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4067.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2935.66, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3145.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3564.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3355.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR GRAFT*H4700", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204426", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4426.24, "maximum": 6133.5, "gross_charge": 6323.2, "discounted_cash": 9484.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5374.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4742.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4426.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6133.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4426.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4742.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5374.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5058.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93975", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93976", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93978", "type": "CPT"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASCULAR STUDY", "code_information": [{"code": "93979", "type": "CPT"}], "standard_charges": [{"minimum": 169.1, "maximum": 169.1, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 169.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASECTOMY, UNILATERA", "code_information": [{"code": "55250", "type": "CPT"}, {"code": "3480102076", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 5760.83, "gross_charge": 5939.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5760.83, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4157.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4454.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5048.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4751.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASECTOMY, UNILATERA", "code_information": [{"code": "55250", "type": "CPT"}, {"code": "3480103269", "type": "CDM"}, {"code": "761", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 6866.63, "gross_charge": 7079.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6866.63, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4955.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5309.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6017.15, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5663.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1927.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASOPNEUMATIC DEVICE THERAPY", "code_information": [{"code": "97016", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VASOPRESSIN ADH", "code_information": [{"code": "84588", "type": "CPT"}, {"code": "3440101017", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 33.94, "maximum": 295.85, "gross_charge": 305.0, "discounted_cash": 54.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.59, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 295.85, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.08, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 213.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 228.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.35, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 43.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 259.25, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 36.35, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 244.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 33.94, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 36.35, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 37.08, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 68.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 3298.79, "maximum": 3298.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3298.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VBAC CLASS", "code_information": [{"code": "S9439", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY", "code_information": [{"code": "59610", "type": "CPT"}], "standard_charges": [{"minimum": 3298.79, "maximum": 3298.79, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3298.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VBAC DELIVERY ONLY", "code_information": [{"code": "59612", "type": "CPT"}], "standard_charges": [{"minimum": 3298.79, "maximum": 3298.79, "discounted_cash": 4785.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3298.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VCARE LARGE CERV CUP", "code_information": [{"code": "3100102091", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.0, "discounted_cash": 493.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR CONT MNTR", "code_information": [{"code": "95713", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR INTMT MNTR", "code_information": [{"code": "95712", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEEG 2-12 HR UNMONITORED", "code_information": [{"code": "95711", "type": "CPT"}], "standard_charges": [{"minimum": 358.67, "maximum": 358.67, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 358.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26 HR UNMNTR", "code_information": [{"code": "95714", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR CONT MNTR", "code_information": [{"code": "95716", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 1600.37, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEEG EA 12-26HR INTMT MNTR", "code_information": [{"code": "95715", "type": "CPT"}], "standard_charges": [{"minimum": 542.01, "maximum": 542.01, "discounted_cash": 820.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 542.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35583", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN BYP POP-TIBL PERONEAL", "code_information": [{"code": "35587", "type": "CPT"}], "standard_charges": [{"minimum": 7556.99, "maximum": 7556.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7556.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN LIGATION AND STRIPPING", "code_information": [{"code": "263", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14173.77, "maximum": 14173.77, "discounted_cash": 31542.14, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14173.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN SEALER", "code_information": [{"code": "3100102092", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2212.0, "discounted_cash": 3318.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VEIN STRIPPER DISP", "code_information": [{"code": "3100102093", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.0, "discounted_cash": 34.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLAND", "code_information": [{"code": "75840", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ADRENAL GLANDS", "code_information": [{"code": "75842", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARM/LEG", "code_information": [{"code": "75820", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARMS/LEGS", "code_information": [{"code": "75822", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY CHEST", "code_information": [{"code": "75827", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 2451.41, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY EYE SOCKET", "code_information": [{"code": "75880", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEY", "code_information": [{"code": "75831", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY KIDNEYS", "code_information": [{"code": "75833", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER", "code_information": [{"code": "75891", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75885", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75889", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/O HEMODYN", "code_information": [{"code": "75887", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY NECK", "code_information": [{"code": "75860", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL", "code_information": [{"code": "75870", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SKULL EPIDURAL", "code_information": [{"code": "75872", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 961.58, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 705.33, "maximum": 705.33, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 705.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY TRUNK", "code_information": [{"code": "75825", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VELAGLUCERASE ALFA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3385", "type": "HCPCS"}], "standard_charges": [{"minimum": 367.84, "maximum": 367.84, "discounted_cash": 590.24, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 367.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 199.36, "maximum": 199.36, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 199.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEN BLOOD COLL SNF/HHA", "code_information": [{"code": "G0471", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.83, "maximum": 11.57, "discounted_cash": 17.4, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.83, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 643.47, "maximum": 643.47, "discounted_cash": 631.31, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 643.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENDAJE AC, PER SQ CM", "code_information": [{"code": "Q4279", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VENDAJE, PER SQUARE CENTIMET", "code_information": [{"code": "Q4252", "type": "HCPCS"}], "standard_charges": [{"minimum": 127.45, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 127.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENEER REPAIR", "code_information": [{"code": "D2983", "type": "HCPCS"}], "standard_charges": [{"minimum": 684.86, "maximum": 684.86, "discounted_cash": 1347.69, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 684.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE COLLECT", "code_information": [{"code": "36415", "type": "CPT"}, {"code": "3440100790", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 8.83, "maximum": 19.4, "gross_charge": 20.0, "discounted_cash": 14.19, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 19.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 14.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.74, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 15.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 11.26, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 17.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 9.46, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 9.65, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 300.38, "discounted_cash": 609.87, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 300.38, "discounted_cash": 195.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 300.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE HOME/SNF", "code_information": [{"code": "S9529", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.57, "maximum": 11.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 11.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENOGRAM BILATERAL", "code_information": [{"code": "3270102318", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"gross_charge": 4660.32, "discounted_cash": 6990.48, "setting": "both", "billing_class": "facility"}]}, {"description": "VENOUS MECH THROMBECTOMY", "code_information": [{"code": "37187", "type": "CPT"}], "standard_charges": [{"minimum": 5001.8, "maximum": 5001.8, "discounted_cash": 16839.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5001.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING BY CATHETER", "code_information": [{"code": "75893", "type": "CPT"}], "standard_charges": [{"minimum": 4777.52, "maximum": 4777.52, "discounted_cash": 8411.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 4777.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENOUS THROMBOSIS IMAGING", "code_information": [{"code": "78457", "type": "CPT"}], "standard_charges": [{"minimum": 1372.83, "maximum": 1372.83, "discounted_cash": 827.33, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1372.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENT MGMT NF PER DAY", "code_information": [{"code": "94004", "type": "CPT"}], "standard_charges": [{"minimum": 1634.49, "maximum": 1634.49, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1634.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTILATOR MGMT FIRS", "code_information": [{"code": "94002", "type": "CPT"}, {"code": "3310100268", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 639.47, "maximum": 1634.49, "gross_charge": 1629.0, "discounted_cash": 959.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1384.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 661.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1221.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1140.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1580.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 652.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1140.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 658.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1221.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 639.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 760.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1384.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 639.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1303.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 639.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 652.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1634.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTILATOR MGMT SUBS", "code_information": [{"code": "94003", "type": "CPT"}, {"code": "3310100269", "type": "CDM"}, {"code": "410", "type": "RC"}], "standard_charges": [{"minimum": 639.47, "maximum": 1634.49, "gross_charge": 1629.0, "discounted_cash": 959.21, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1384.65, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 661.21, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1221.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1140.3, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1580.13, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 652.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1140.3, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 658.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1221.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 639.47, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 760.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1384.65, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 639.47, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1303.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 639.47, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 652.26, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1634.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [{"code": "32", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8399.86, "maximum": 8399.86, "discounted_cash": 24046.25, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8399.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [{"code": "31", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14549.43, "maximum": 14549.43, "discounted_cash": 45960.05, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14549.43, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "33", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7221.23, "maximum": 7221.23, "discounted_cash": 18118.97, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7221.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERAPAMIL HCL", "code_information": [{"code": "3400300145", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.7, "discounted_cash": 38.55, "setting": "both", "billing_class": "facility"}]}, {"description": "VERITAS COLLAGEN MATRIX, CM2", "code_information": [{"code": "C9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERSAGRAFT JRF*VRG-0", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2420.6, "maximum": 3354.26, "gross_charge": 3458.0, "discounted_cash": 5187.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2939.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2420.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2420.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2939.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2766.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERSAGRAFT TENDON 3.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206925", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2420.6, "maximum": 3354.26, "gross_charge": 3458.0, "discounted_cash": 5187.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2939.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2420.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3354.26, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2420.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2593.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2939.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2766.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERT BITEWINGS 7 TO 8 IMAGES", "code_information": [{"code": "D0277", "type": "HCPCS"}], "standard_charges": [{"minimum": 179.78, "maximum": 179.78, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 179.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL AXIAL DECOMPRESSIO", "code_information": [{"code": "S9090", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORP-CERVI", "code_information": [{"code": "63081", "type": "CPT"}, {"code": "3480102155", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 3005.8, "maximum": 7959.27, "gross_charge": 4294.0, "discounted_cash": 6441.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3649.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3220.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3005.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4165.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3005.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3220.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3649.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3435.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7959.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORP-CERVI", "code_information": [{"code": "63082", "type": "CPT"}, {"code": "3480102156", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 451.5, "maximum": 14462.5, "gross_charge": 645.0, "discounted_cash": 967.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 625.65, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 451.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 483.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 548.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 516.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY", "code_information": [{"code": "63101", "type": "CPT"}, {"code": "3480102157", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 4708.9, "maximum": 14462.5, "gross_charge": 6727.0, "discounted_cash": 10090.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5717.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5045.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4708.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6525.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4708.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5045.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5717.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5381.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBRAL CORPECTOMY", "code_information": [{"code": "63102", "type": "CPT"}, {"code": "3480103097", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 5224.1, "maximum": 14462.5, "gross_charge": 7463.0, "discounted_cash": 11194.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6343.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5597.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5224.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7239.11, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5224.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5597.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6343.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5970.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEBROPLASTY ADDL INJECT", "code_information": [{"code": "22512", "type": "CPT"}], "standard_charges": [{"minimum": 5178.02, "maximum": 5178.02, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5178.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VERTEPORFIN INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3396", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.44, "maximum": 11.44, "discounted_cash": 18.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEX LEVEL 1*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203518", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1233.75, "maximum": 1709.62, "gross_charge": 1762.5, "discounted_cash": 2643.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1709.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1233.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1321.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1498.12, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1410.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEX LEVEL 2*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203850", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5387.2, "maximum": 7465.12, "gross_charge": 7696.0, "discounted_cash": 11544.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6541.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5387.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7465.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5387.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5772.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6541.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 6156.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VERTEX LEVEL 3*M1000", "code_information": [{"code": "3100203218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10140.0, "discounted_cash": 15210.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERTEX LEVEL 4*M1000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203049", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7266.0, "maximum": 10068.6, "gross_charge": 10380.0, "discounted_cash": 15570.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8823.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7785.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10068.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7266.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7785.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8823.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8304.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VESICULOBULLOUS DISEASE CARR", "code_information": [{"code": "D5991", "type": "HCPCS"}], "standard_charges": [{"minimum": 157.53, "maximum": 157.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 157.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VESTIBULAR REHAB PER DIEM", "code_information": [{"code": "S9476", "type": "HCPCS"}], "standard_charges": [{"minimum": 130.83, "maximum": 130.83, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 130.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VESTIBULOPLASTY EXTEN GRAFT", "code_information": [{"code": "D7350", "type": "HCPCS"}], "standard_charges": [{"minimum": 3777.61, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VESTIBULOPLASTY RIDGE EXTENS", "code_information": [{"code": "D7340", "type": "HCPCS"}], "standard_charges": [{"minimum": 3777.61, "maximum": 3777.61, "discounted_cash": 8963.81, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3777.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIAGRAFT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 4914.0, "discounted_cash": 7371.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIAGRAFT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104251", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 8112.0, "discounted_cash": 12168.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIAGRAFT", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "3100104705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "gross_charge": 11700.0, "discounted_cash": 17550.0, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIAGRAFT 1CC*VCA0100", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.5, "maximum": 39.49, "gross_charge": 40.72, "discounted_cash": 61.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 39.49, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.54, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.61, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIBRATE QUANT SENSORY TEST", "code_information": [{"code": "107T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VICRYL KNIT MESH 12X", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205533", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1526.88, "maximum": 2115.82, "gross_charge": 2181.26, "discounted_cash": 3271.89, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1854.07, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1635.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1526.88, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2115.82, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1526.88, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1635.94, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1854.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1745.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIM, PER SQUARE CENTIMETER", "code_information": [{"code": "Q4251", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VINBLASTINE SULFATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9360", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.02, "maximum": 5.02, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VINCRISTINE SULFATE 1 MG INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9370", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.91, "maximum": 7.91, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 7.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VINORELBINE TARTRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9390", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.5, "maximum": 8.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIPER VENOM PROTHROMBIN TIME", "code_information": [{"code": "85612", "type": "CPT"}], "standard_charges": [{"minimum": 17.49, "maximum": 20.47, "discounted_cash": 28.1, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.49, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL CULTURE", "code_information": [{"code": "D0416", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.03, "maximum": 24.03, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITH MCC", "code_information": [{"code": "865", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5561.17, "maximum": 5561.17, "discounted_cash": 18308.78, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5561.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [{"code": "866", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3261.69, "maximum": 3261.69, "discounted_cash": 10245.72, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3261.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITH CC/MCC", "code_information": [{"code": "75", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5446.2, "maximum": 5446.2, "discounted_cash": 21366.75, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 5446.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRAL MENINGITIS WITHOUT CC/MCC", "code_information": [{"code": "76", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3481.19, "maximum": 3481.19, "discounted_cash": 10299.32, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 3481.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE EGGS/ANIMAL", "code_information": [{"code": "87250", "type": "CPT"}], "standard_charges": [{"minimum": 19.56, "maximum": 24.03, "discounted_cash": 31.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATE TISSUE ADDL", "code_information": [{"code": "87253", "type": "CPT"}], "standard_charges": [{"minimum": 20.2, "maximum": 24.03, "discounted_cash": 32.45, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION SHELL VIA", "code_information": [{"code": "87254", "type": "CPT"}], "standard_charges": [{"minimum": 19.56, "maximum": 24.03, "discounted_cash": 31.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 19.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIRUS ISO TISS CLTR", "code_information": [{"code": "87252", "type": "CPT"}, {"code": "3440101146", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 24.03, "maximum": 227.95, "gross_charge": 235.0, "discounted_cash": 41.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 199.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.87, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 176.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 227.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 164.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.76, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 176.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 33.22, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 199.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 188.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 27.92, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 28.48, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIS FIELD ASSMNT TECH SUPPT", "code_information": [{"code": "379T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 61.38, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 PROSTH", "code_information": [{"code": "34845", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"minimum": 25436.2, "maximum": 25436.2, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 25436.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISCOSTAT", "code_information": [{"code": "3100102094", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.0, "discounted_cash": 186.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VISCOSTAT", "code_information": [{"code": "3100103652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 204.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VISION ELITE LEV1*M1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2471.56, "maximum": 3424.87, "gross_charge": 3530.8, "discounted_cash": 5296.2, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3001.18, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2471.56, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3424.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2471.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2648.1, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3001.18, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2824.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISION ELITE LEV2*M1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203050", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3177.72, "maximum": 4403.41, "gross_charge": 4539.6, "discounted_cash": 6809.4, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3858.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3177.72, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4403.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3177.72, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3404.7, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3858.66, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3631.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISION ELITE LEV3*M1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203223", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3880.24, "maximum": 5376.9, "gross_charge": 5543.2, "discounted_cash": 8314.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4711.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4157.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3880.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5376.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3880.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4157.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4711.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4434.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISION ELITE LEV4*M1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4550.0, "maximum": 6305.0, "gross_charge": 6500.0, "discounted_cash": 9750.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6305.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4550.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4875.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5525.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5200.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE 56M OR LESS", "code_information": [{"code": "G2082", "type": "HCPCS"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 1848.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISIT ESKETAMINE, > 56M", "code_information": [{"code": "G2083", "type": "HCPCS"}], "standard_charges": [{"minimum": 429.43, "maximum": 429.43, "discounted_cash": 2972.84, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 429.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 147.3, "maximum": 147.3, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 147.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUAL EP SCR ACUITY AUTO", "code_information": [{"code": "333T", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST CNS W/I&R", "code_information": [{"code": "95930", "type": "CPT"}], "standard_charges": [{"minimum": 414.74, "maximum": 414.74, "discounted_cash": 480.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 414.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST FOR GLAUCOMA", "code_information": [{"code": "464T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUAL FIELD ASSMNT REV/RPRT", "code_information": [{"code": "378T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUAL FIELD EXAMINA", "code_information": [{"code": "92081", "type": "CPT"}, {"code": "3500102299", "type": "CDM"}, {"code": "510", "type": "RC"}], "standard_charges": [{"minimum": 62.42, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 93.63, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.54, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 64.29, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 74.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 62.42, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 63.67, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 277.43, "maximum": 1756.42, "discounted_cash": 842.18, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 277.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1756.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR HOLE", "code_information": [{"code": "67042", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR PUCKER", "code_information": [{"code": "67041", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 7184.53, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAL CAPACITY TEST", "code_information": [{"code": "94150", "type": "CPT"}], "standard_charges": [{"minimum": 126.38, "maximum": 126.38, "discounted_cash": 239.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 126.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAMIN B12 INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3420", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.42, "maximum": 1.42, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN D 1 25 DIHYD", "code_information": [{"code": "82652", "type": "CPT"}, {"code": "3440100899", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 38.5, "maximum": 336.59, "gross_charge": 347.0, "discounted_cash": 61.85, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 294.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.63, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 260.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 242.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 336.59, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 242.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 260.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.23, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 49.06, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 294.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 41.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 277.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 38.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 41.23, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 42.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAMIN D 25 HYDROXY", "code_information": [{"code": "82306", "type": "CPT"}, {"code": "3440100864", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 29.6, "maximum": 258.02, "gross_charge": 266.0, "discounted_cash": 47.55, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 186.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 258.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 186.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.65, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 199.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.7, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 37.72, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 226.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 31.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 212.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 29.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 31.7, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAMIN D SRM MICROSAMP QUAN", "code_information": [{"code": "38U", "type": "CPT"}], "standard_charges": [{"minimum": 53.85, "maximum": 53.85, "discounted_cash": 47.55, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 53.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAMIN K (PHYTONADI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3430", "type": "HCPCS"}, {"code": "3400300144", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 2.8, "maximum": 22.01, "gross_charge": 22.7, "discounted_cash": 34.05, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 22.01, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 19.29, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18.16, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAMIN, NOC", "code_information": [{"code": "84591", "type": "CPT"}, {"code": "3440103062", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 17.06, "maximum": 93.12, "gross_charge": 96.0, "discounted_cash": 27.41, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.89, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 93.12, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 67.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.82, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 72.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.27, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.74, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 81.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.27, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.27, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITAPEX CALCIUM REG", "code_information": [{"code": "3100103942", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.0, "discounted_cash": 256.5, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAPREP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100102264", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITOSS BA2", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100104584", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 2949.77, "gross_charge": 3041.0, "discounted_cash": 4561.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2584.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2280.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2128.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2949.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2128.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2280.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2584.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2432.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS BA2X", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100104529", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1143.8, "maximum": 1725.27, "gross_charge": 1634.0, "discounted_cash": 2451.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1388.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1225.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1143.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1584.98, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1143.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1225.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1388.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1307.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS FOAM", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100104018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 3036.1, "gross_charge": 3130.0, "discounted_cash": 4695.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2660.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2347.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2191.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3036.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2191.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2347.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2660.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2504.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS FOAM 1.2CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100104042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1474.9, "maximum": 2043.79, "gross_charge": 2107.0, "discounted_cash": 3160.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1790.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1580.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1474.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2043.79, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1474.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1580.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1790.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1685.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS FOAM 5CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100104150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5693.9, "gross_charge": 5870.0, "discounted_cash": 8805.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4989.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4402.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4109.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5693.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4109.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4402.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4989.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4696.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS STRIP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100102095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5523.18, "gross_charge": 5694.0, "discounted_cash": 8541.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4839.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4270.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3985.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5523.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3985.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4270.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4839.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4555.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS STRIP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100103653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1179.5, "maximum": 1725.27, "gross_charge": 1685.0, "discounted_cash": 2527.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1432.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1263.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1179.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1634.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1179.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1263.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1432.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1348.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITOSS STRIP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100103908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5127.42, "gross_charge": 5286.0, "discounted_cash": 7929.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4493.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3964.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3700.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5127.42, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3700.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3964.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4493.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4228.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITRCTMY MEC PARS PL", "code_information": [{"code": "67039", "type": "CPT"}, {"code": "3410100708", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY MEC PARS", "code_information": [{"code": "67036", "type": "CPT"}, {"code": "3410100707", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 522.5, "maximum": 9892.06, "gross_charge": 10198.0, "discounted_cash": 6223.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4290.01, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 9892.06, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7138.6, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4273.42, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7648.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 4937.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8668.3, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8158.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 4148.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4231.93, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VITRECTOMY PROBE*806", "code_information": [{"code": "3100209630", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 900.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VITROSS STRIP", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "3100103887", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1725.27, "maximum": 5044.0, "gross_charge": 5200.0, "discounted_cash": 7800.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5044.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3640.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3900.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4420.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4160.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VIVAGLOBIN, INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1562", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "VKORC1 GENE", "code_information": [{"code": "81355", "type": "CPT"}], "standard_charges": [{"minimum": 79.66, "maximum": 88.2, "discounted_cash": 141.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VLCAD LEUK NZM ACTV WHL BLD", "code_information": [{"code": "257U", "type": "CPT"}], "standard_charges": [{"minimum": 40.05, "maximum": 40.05, "discounted_cash": 1144.59, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VLVT PV CLSD HRT VIA P-ART", "code_information": [{"code": "33471", "type": "CPT"}], "standard_charges": [{"minimum": 18722.93, "maximum": 18722.93, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18722.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VNGD FEM PS 65MM LT*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 7280.0, "maximum": 10088.0, "gross_charge": 10400.0, "discounted_cash": 15600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 10088.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 7280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 7800.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8840.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 8320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGD TI FEM 60MMRT*C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204174", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10220.0, "maximum": 14162.0, "gross_charge": 14600.0, "discounted_cash": 21900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12410.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10220.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14162.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10220.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12410.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGD TI FEM 62.5MMLT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10220.0, "maximum": 14162.0, "gross_charge": 14600.0, "discounted_cash": 21900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12410.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10220.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14162.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10220.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12410.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGD TI FEM 72.5MMRT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204955", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10220.0, "maximum": 14162.0, "gross_charge": 14600.0, "discounted_cash": 21900.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12410.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 10950.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10220.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14162.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10220.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 10950.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12410.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 11680.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGD TI FEM PS 62.5*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205291", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 5110.0, "maximum": 7081.0, "gross_charge": 7300.0, "discounted_cash": 10950.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6205.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5475.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5110.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7081.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5110.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5475.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6205.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5840.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGD TI FEMPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104680", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 10530.8, "maximum": 14592.68, "gross_charge": 15044.0, "discounted_cash": 22566.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 12787.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 11283.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 10530.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 14592.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 10530.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 11283.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 12787.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12035.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOL REDUCTION OF BLOOD/PROD", "code_information": [{"code": "86960", "type": "CPT"}], "standard_charges": [{"minimum": 102.8, "maximum": 102.8, "discounted_cash": 261.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 102.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VOLAR PLATE*625214", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4639.39, "maximum": 6428.87, "gross_charge": 6627.71, "discounted_cash": 9941.57, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 5633.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4970.78, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4639.39, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 6428.87, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4639.39, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4970.78, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5633.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5302.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VOLTAGE-GTD CA CHNL ANTB EA", "code_information": [{"code": "86596", "type": "CPT"}], "standard_charges": [{"minimum": 12.05, "maximum": 30.26, "discounted_cash": 19.37, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VOLUME DEPLETE OF HARVEST", "code_information": [{"code": "38214", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VONVENDI INJ 1 IU VWF:RCO", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7179", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.87, "maximum": 1.87, "discounted_cash": 2.93, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRS BONE IMP MODEL*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 624.75, "maximum": 865.72, "gross_charge": 892.5, "discounted_cash": 1338.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 758.62, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 865.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 624.75, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 669.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 758.62, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 714.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRS IMP ADPTR*110027", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 17183.6, "maximum": 23811.56, "gross_charge": 24548.0, "discounted_cash": 36822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 20865.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 18411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 17183.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 23811.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 17183.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 18411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 20865.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19638.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT 8+ SEG", "code_information": [{"code": "657T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VRT BDY TETHERING ANT <7 SEG", "code_information": [{"code": "656T", "type": "CPT"}], "standard_charges": [{"minimum": 14462.5, "maximum": 14462.5, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14462.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2B EVAL PLSM", "code_information": [{"code": "283U", "type": "CPT"}], "standard_charges": [{"minimum": 20.47, "maximum": 20.47, "discounted_cash": 29.57, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VW FACTOR TYPE 2N EVAL PLSM", "code_information": [{"code": "284U", "type": "CPT"}], "standard_charges": [{"minimum": 20.47, "maximum": 20.47, "discounted_cash": 27.75, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "VYJUVEK 5X10^9PFU/ML, 0.1 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3401", "type": "HCPCS"}], "standard_charges": [{"minimum": 2519.09, "maximum": 2519.09, "discounted_cash": 4012.64, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 2519.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With O.R. Procedure Except Sterilization And/Or D&C, Major", "code_information": [{"code": "542.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9806.04, "maximum": 9806.04, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9806.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With O.R. Procedure Except Sterilization And/Or D&C, Minor", "code_information": [{"code": "542.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7067.47, "maximum": 7067.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7067.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With O.R. Procedure Except Sterilization And/Or D&C, Moderate", "code_information": [{"code": "542.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7809.46, "maximum": 7809.46, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7809.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With O.R. Procedure Except Sterilization And/Or D&C, Severe", "code_information": [{"code": "542.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 24768.83, "maximum": 24768.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 24768.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With Sterilization And/Or D&C, Major", "code_information": [{"code": "541.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12043.54, "maximum": 12043.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12043.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With Sterilization And/Or D&C, Minor", "code_information": [{"code": "541.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9131.97, "maximum": 9131.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9131.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With Sterilization And/Or D&C, Moderate", "code_information": [{"code": "541.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9554.86, "maximum": 9554.86, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 9554.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery With Sterilization And/Or D&C, Severe", "code_information": [{"code": "541.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16186.63, "maximum": 16186.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 16186.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery, Major", "code_information": [{"code": "560.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8430.99, "maximum": 8430.99, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 8430.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery, Minor", "code_information": [{"code": "560.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6090.97, "maximum": 6090.97, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6090.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery, Moderate", "code_information": [{"code": "560.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6717.62, "maximum": 6717.62, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6717.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Delivery, Severe", "code_information": [{"code": "560.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22323.73, "maximum": 22323.73, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22323.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vaginal Removal Of Uterus (Greater Than 250 Grams) With Repair For Stress Incontinence", "code_information": [{"code": "58293", "type": "CPT"}], "standard_charges": [{"minimum": 5460.6, "maximum": 5460.6, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5460.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ventricular Shunt Procedures, Major", "code_information": [{"code": "22.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 33198.54, "maximum": 33198.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 33198.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ventricular Shunt Procedures, Minor", "code_information": [{"code": "22.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 17797.47, "maximum": 17797.47, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 17797.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ventricular Shunt Procedures, Moderate", "code_information": [{"code": "22.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20688.54, "maximum": 20688.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20688.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Ventricular Shunt Procedures, Severe", "code_information": [{"code": "22.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 67815.7, "maximum": 67815.7, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 67815.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertebral And Intervertebral Spinal Procedures Including Disc Procedures, Major", "code_information": [{"code": "310.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 40178.87, "maximum": 40178.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40178.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertebral And Intervertebral Spinal Procedures Including Disc Procedures, Minor", "code_information": [{"code": "310.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 15026.87, "maximum": 15026.87, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 15026.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertebral And Intervertebral Spinal Procedures Including Disc Procedures, Moderate", "code_information": [{"code": "310.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 22357.05, "maximum": 22357.05, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 22357.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertebral And Intervertebral Spinal Procedures Including Disc Procedures, Severe", "code_information": [{"code": "310.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 56924.23, "maximum": 56924.23, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 56924.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertigo And Other Labyrinth Disorders, Major", "code_information": [{"code": "111.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10768.44, "maximum": 10768.44, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10768.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertigo And Other Labyrinth Disorders, Minor", "code_information": [{"code": "111.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6815.02, "maximum": 6815.02, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6815.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertigo And Other Labyrinth Disorders, Moderate", "code_information": [{"code": "111.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7005.96, "maximum": 7005.96, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7005.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vertigo And Other Labyrinth Disorders, Severe", "code_information": [{"code": "111.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 20183.63, "maximum": 20183.63, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20183.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vessel mapping hemo access", "code_information": [{"code": "G0365", "type": "HCPCS"}], "standard_charges": [{"minimum": 258.99, "maximum": 258.99, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 258.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Via matrix, per sq cm", "code_information": [{"code": "Q4309", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Viral Illness, Major", "code_information": [{"code": "723.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 12679.16, "maximum": 12679.16, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 12679.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Illness, Minor", "code_information": [{"code": "723.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5698.83, "maximum": 5698.83, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5698.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Illness, Moderate", "code_information": [{"code": "723.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7667.21, "maximum": 7667.21, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7667.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Illness, Severe", "code_information": [{"code": "723.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18949.54, "maximum": 18949.54, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18949.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Meningitis, Major", "code_information": [{"code": "51.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 18361.33, "maximum": 18361.33, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 18361.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Meningitis, Minor", "code_information": [{"code": "51.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6648.42, "maximum": 6648.42, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 6648.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Meningitis, Moderate", "code_information": [{"code": "51.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 10091.81, "maximum": 10091.81, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 10091.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Viral Meningitis, Severe", "code_information": [{"code": "51.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 35766.67, "maximum": 35766.67, "setting": "inpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35766.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Visual Axis Identification Using Patient Fixation During Operation", "code_information": [{"code": "514T", "type": "CPT"}], "standard_charges": [{"minimum": 109.47, "maximum": 109.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 109.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Vitrec/mech pars, subret inj", "code_information": [{"code": "C9770", "type": "HCPCS"}], "standard_charges": [{"minimum": 7184.53, "maximum": 7184.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7184.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WAND", "code_information": [{"code": "3100102096", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 1044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND", "code_information": [{"code": "3100103654", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND", "code_information": [{"code": "3100103655", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 1012.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND", "code_information": [{"code": "3100103656", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.0, "discounted_cash": 1102.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND EVAC 70 XTRA*EI", "code_information": [{"code": "3100207452", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 1044.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND EVAC HALO*72290", "code_information": [{"code": "3100207444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.0, "discounted_cash": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND HEAD & NECK", "code_information": [{"code": "3100102367", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 975.0, "discounted_cash": 1462.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND PLASMA*DS300-00", "code_information": [{"code": "3100208371", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 627.0, "discounted_cash": 940.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND PROCIS", "code_information": [{"code": "3100102368", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 2677.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WAND PROCIS", "code_information": [{"code": "3100103797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 1800.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WARFARIN RESPON GENETIC TEST", "code_information": [{"code": "G9143", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.66, "maximum": 79.66, "discounted_cash": 193.94, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 79.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WARMER STND W/EXTEN", "code_information": [{"code": "3100102265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.0, "discounted_cash": 66.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASH HARVEST STEM CELLS", "code_information": [{"code": "38209", "type": "CPT"}], "standard_charges": [{"minimum": 1695.45, "maximum": 1695.45, "discounted_cash": 664.47, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1695.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WASHED RED BLOOD CELLS UNIT", "code_information": [{"code": "P9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 424.98, "maximum": 424.98, "discounted_cash": 637.98, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 424.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 102.9, "maximum": 142.59, "gross_charge": 147.0, "discounted_cash": 220.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 142.59, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 102.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 110.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 124.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 117.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 63.86, "maximum": 88.5, "gross_charge": 91.24, "discounted_cash": 136.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 77.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 68.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 63.86, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 88.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 63.86, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 68.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 77.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 72.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103658", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 88.2, "maximum": 122.22, "gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 122.22, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 88.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 107.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 100.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 94.5, "maximum": 130.95, "gross_charge": 135.0, "discounted_cash": 202.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 130.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 94.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 101.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 114.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 108.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 99.4, "maximum": 137.74, "gross_charge": 142.0, "discounted_cash": 213.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 137.74, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 99.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 106.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 120.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 113.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103661", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 112.7, "maximum": 156.17, "gross_charge": 161.0, "discounted_cash": 241.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 156.17, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 112.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 120.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 136.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103662", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 128.1, "maximum": 177.51, "gross_charge": 183.0, "discounted_cash": 274.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 177.51, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 128.1, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 137.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 155.55, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 146.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103663", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 133.0, "maximum": 184.3, "gross_charge": 190.0, "discounted_cash": 285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 161.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 184.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 133.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 142.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 161.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 152.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103664", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 224.0, "maximum": 310.4, "gross_charge": 320.0, "discounted_cash": 480.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 310.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 224.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 240.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 272.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103665", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 238.7, "maximum": 330.77, "gross_charge": 341.0, "discounted_cash": 511.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 289.85, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 255.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 238.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 330.77, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 238.7, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 255.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 289.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 272.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 240.8, "maximum": 333.68, "gross_charge": 344.0, "discounted_cash": 516.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 333.68, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 240.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 258.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 292.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 275.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER 2.5*131220025", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 109.2, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 234.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER 4.0*04.353.90", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210095", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 326.44, "maximum": 452.35, "gross_charge": 466.35, "discounted_cash": 699.53, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 396.39, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 349.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 326.44, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 452.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 326.44, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 349.76, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 396.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 373.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER 7.0MM*AR-8740", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203324", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 84.0, "maximum": 116.4, "gross_charge": 120.0, "discounted_cash": 180.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 116.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 90.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 102.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 96.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER BUTTON", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104653", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 140.0, "maximum": 194.0, "gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 194.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 140.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 150.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 170.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 160.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER EXTRACTN DEVI", "code_information": [{"code": "3100102098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 546.0, "discounted_cash": 819.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WASHER FOR 4.0 SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209933", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER SPIKED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102369", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 280.0, "maximum": 388.0, "gross_charge": 400.0, "discounted_cash": 600.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 388.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 340.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 320.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER SPIKED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103798", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 322.0, "maximum": 446.2, "gross_charge": 460.0, "discounted_cash": 690.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 446.2, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 322.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 345.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 391.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 368.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WASHER SPIKED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 383.6, "maximum": 531.56, "gross_charge": 548.0, "discounted_cash": 822.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 531.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 383.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 411.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 465.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 438.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WATER CONTAINER SET", "code_information": [{"code": "3100102099", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 602.0, "discounted_cash": 903.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WATERBOOM FLOOR SUCT", "code_information": [{"code": "3100102100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 124.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WATERJET PROSTATE ABLTJ CMPL", "code_information": [{"code": "421T", "type": "CPT"}], "standard_charges": [{"minimum": 5791.23, "maximum": 5791.23, "discounted_cash": 14100.92, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5791.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WAVE WRITER TRIAL KI", "code_information": [{"code": "3100209879", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.0, "discounted_cash": 300.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WAVEWRITER 16 IPG*SC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207505", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 26976.6, "maximum": 37381.86, "gross_charge": 38538.0, "discounted_cash": 57807.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 32757.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 28903.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 26976.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 37381.86, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 26976.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 28903.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 32757.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 30830.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WBC ALKALINE PHOSPHATASE", "code_information": [{"code": "85540", "type": "CPT"}], "standard_charges": [{"minimum": 8.6, "maximum": 20.92, "discounted_cash": 13.82, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WCD DEVICE INTERROGATE", "code_information": [{"code": "93292", "type": "CPT"}], "standard_charges": [{"minimum": 51.18, "maximum": 51.18, "discounted_cash": 57.72, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 51.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WDG EVANS 18X18X8*AB", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210205", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2962.05, "maximum": 4104.55, "gross_charge": 4231.5, "discounted_cash": 6347.25, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3596.77, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3173.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2962.05, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4104.55, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2962.05, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3173.62, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3596.77, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3385.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE 4*WEDGE 4", "code_information": [{"code": "3100206224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE 6*WEDGE-6", "code_information": [{"code": "3100207599", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 296.0, "discounted_cash": 444.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WEDGE ACE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100104666", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4023.8, "maximum": 5575.84, "gross_charge": 5748.29, "discounted_cash": 8622.44, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4886.04, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4311.21, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4023.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5575.84, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4023.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4311.21, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4886.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4598.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE ARTH OSTE 12MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202686", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1091.47, "maximum": 1512.47, "gross_charge": 1559.25, "discounted_cash": 2338.88, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1325.36, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1169.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1091.47, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1512.47, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1091.47, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1169.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1325.36, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1247.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE BIOPSY OF LIVER", "code_information": [{"code": "47100", "type": "CPT"}], "standard_charges": [{"minimum": 7611.28, "maximum": 7611.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7611.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGE COTTON*ABS-280", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3200.92, "maximum": 4435.56, "gross_charge": 4572.75, "discounted_cash": 6859.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3886.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3429.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3200.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4435.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3200.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3429.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3886.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3658.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS 8MM*PLCL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3685.5, "maximum": 5107.05, "gross_charge": 5265.0, "discounted_cash": 7897.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3948.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3685.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5107.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3685.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3948.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4475.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4212.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2800", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209919", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3200.92, "maximum": 4435.56, "gross_charge": 4572.75, "discounted_cash": 6859.13, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3886.83, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3429.56, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3200.92, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4435.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3200.92, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3429.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3886.83, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3658.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100204659", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2821.0, "maximum": 3909.1, "gross_charge": 4030.0, "discounted_cash": 6045.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3909.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2821.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3022.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3425.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3224.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207975", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3003.0, "maximum": 4161.3, "gross_charge": 4290.0, "discounted_cash": 6435.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4161.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3003.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3217.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3646.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3432.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208494", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3152.24, "maximum": 4368.1, "gross_charge": 4503.2, "discounted_cash": 6754.8, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3827.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3377.4, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3152.24, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4368.1, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3152.24, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3377.4, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3827.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3602.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209327", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE EVANS*ABS-2810", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210175", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3057.6, "maximum": 4236.96, "gross_charge": 4368.0, "discounted_cash": 6552.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4236.96, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3057.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3276.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3712.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3494.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG ADD-ON", "code_information": [{"code": "32506", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG DIAG", "code_information": [{"code": "32507", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGE RESECT OF LUNG INITIAL", "code_information": [{"code": "32505", "type": "CPT"}], "standard_charges": [{"minimum": 7974.4, "maximum": 7974.4, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7974.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CAST", "code_information": [{"code": "29740", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEDGING OF CLUBFOOT CAST", "code_information": [{"code": "29750", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 411.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEHRS INCUS PRS*1408", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100210014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1533.0, "maximum": 2124.3, "gross_charge": 2190.0, "discounted_cash": 3285.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2124.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1642.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1861.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1752.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WEIGHT MGMT CLASS", "code_information": [{"code": "S9449", "type": "HCPCS"}], "standard_charges": [{"minimum": 139.73, "maximum": 139.73, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 139.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS AB", "code_information": [{"code": "86789", "type": "CPT"}, {"code": "3440101129", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 14.39, "maximum": 151.32, "gross_charge": 156.0, "discounted_cash": 23.12, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.93, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 151.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.87, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 117.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 18.34, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 124.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 15.41, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 15.72, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WEST NILE VIRUS AB I", "code_information": [{"code": "86788", "type": "CPT"}, {"code": "3440101128", "type": "CDM"}, {"code": "302", "type": "RC"}], "standard_charges": [{"minimum": 16.85, "maximum": 110.58, "gross_charge": 114.0, "discounted_cash": 27.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 96.9, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.66, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 110.58, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.59, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 85.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 96.9, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 91.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WESTERN BLOT TEST", "code_information": [{"code": "84181", "type": "CPT"}], "standard_charges": [{"minimum": 17.03, "maximum": 30.26, "discounted_cash": 27.36, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.03, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WET MOUNTS/ W PREPARATIONS", "code_information": [{"code": "Q0111", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.76, "maximum": 35.16, "discounted_cash": 28.53, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 17.76, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 35.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WHEELCHAIR MNGMENT TRAINING", "code_information": [{"code": "97542", "type": "CPT"}], "standard_charges": [{"minimum": 93.01, "maximum": 93.01, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 93.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WHIRLPOOL THERAPY", "code_information": [{"code": "97022", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WHISKER SLOT 5.0X13*", "code_information": [{"code": "3100205426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 264.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WHOLE BLOOD FOR TRANSFUSION", "code_information": [{"code": "P9010", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.68, "maximum": 188.68, "discounted_cash": 326.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 188.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81460", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 1287.0, "discounted_cash": 2067.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1287.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WHOLE MITOCHONDRIAL GENOME", "code_information": [{"code": "81465", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 936.0, "discounted_cash": 1503.69, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 936.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WIDE SAW BLADE*20013", "code_information": [{"code": "3100208105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 783.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WILATE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7183", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.26, "maximum": 1.26, "discounted_cash": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WINDOWING OF CAST", "code_information": [{"code": "29730", "type": "CPT"}], "standard_charges": [{"minimum": 323.96, "maximum": 323.96, "discounted_cash": 241.19, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 323.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102114", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE 0.9/120*WIRE-09", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207708", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE 1.1 CALIBRATED*", "code_information": [{"code": "3100208724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE 1.1/100*WIRE-1.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE 1.1/150*WIRE-1.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206886", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE 1.1/150D*WIRE-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207936", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 78.4, "maximum": 108.64, "gross_charge": 112.0, "discounted_cash": 168.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 108.64, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 78.4, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 84.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 95.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE 1.6/065*WIRE-1.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205868", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE BOLT OFFSET*03.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 201.06, "maximum": 278.62, "gross_charge": 287.24, "discounted_cash": 430.86, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 244.15, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 215.43, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 201.06, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 278.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 201.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 215.43, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.15, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 229.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE COMPRESSION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 193.2, "maximum": 267.72, "gross_charge": 276.0, "discounted_cash": 414.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 207.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 193.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 267.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 193.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 207.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 234.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 220.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE CUTTER", "code_information": [{"code": "3100102102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2593.0, "discounted_cash": 3889.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE FIX BOLT SLOTTE", "code_information": [{"code": "3100209123", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.0, "discounted_cash": 424.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE J DIAGNOSTIC/AN", "code_information": [{"code": "C1769", "type": "HCPCS"}, {"code": "3100102103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"minimum": 19.6, "maximum": 27.16, "gross_charge": 28.0, "discounted_cash": 42.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 27.16, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 21.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 22.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE K", "code_information": [{"code": "3100104488", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100102104", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 32.2, "maximum": 44.62, "gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103667", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 24.5, "maximum": 33.95, "gross_charge": 35.0, "discounted_cash": 52.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 26.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 33.95, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 24.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 26.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 29.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.0, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100103669", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 32.2, "maximum": 44.62, "gross_charge": 46.0, "discounted_cash": 69.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 44.62, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 32.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 34.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 39.1, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 36.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE K", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310103668", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 28.0, "maximum": 38.8, "gross_charge": 40.0, "discounted_cash": 60.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 28.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 30.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 34.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 32.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE LIGA", "code_information": [{"code": "3100102105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "discounted_cash": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE LIGA", "code_information": [{"code": "3100103670", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.0, "discounted_cash": 30.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE MEASUREMENT*AR-", "code_information": [{"code": "3100208517", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 168.0, "discounted_cash": 252.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE OLIVE TIP 1.8*1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209126", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 700.85, "maximum": 971.18, "gross_charge": 1001.22, "discounted_cash": 1501.83, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 851.03, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 750.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 700.85, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 971.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 700.85, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 750.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 851.03, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 800.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE POST SHORT*03.3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205131", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 586.95, "maximum": 813.34, "gross_charge": 838.5, "discounted_cash": 1257.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 712.72, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 628.87, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 586.95, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 813.34, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 586.95, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 628.87, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 712.72, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 670.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE SMOOTH TIP 1.8*", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209125", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 250.93, "maximum": 347.72, "gross_charge": 358.48, "discounted_cash": 537.72, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 304.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 268.86, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 250.93, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 347.72, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 250.93, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 268.86, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 304.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 286.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE SPRING GUID", "code_information": [{"code": "3100102106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 41.0, "discounted_cash": 61.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SPRING GUID", "code_information": [{"code": "3100103671", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.0, "discounted_cash": 43.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SPRING GUID", "code_information": [{"code": "3100103672", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.0, "discounted_cash": 57.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE SPRING GUID", "code_information": [{"code": "3100103673", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.0, "discounted_cash": 58.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE TITANIUM", "code_information": [{"code": "3100102107", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.72, "discounted_cash": 55.08, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE*2400-100-22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207498", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 318.5, "maximum": 441.35, "gross_charge": 455.0, "discounted_cash": 682.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 386.75, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 318.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 441.35, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 318.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 341.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 386.75, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 364.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE*WIRE-08/080", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207443", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE-0.7/080*WIRE-0.", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 56.0, "maximum": 77.6, "gross_charge": 80.0, "discounted_cash": 120.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 77.6, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 56.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 60.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 68.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 64.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WIRE/PIN CUTTER", "code_information": [{"code": "3100102108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2267.0, "discounted_cash": 3400.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WIRE/PIN STOPPER*710", "code_information": [{"code": "3100209140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 414.92, "discounted_cash": 622.38, "setting": "both", "billing_class": "facility"}]}, {"description": "WND PREP F/N/HF/G ADDL CM", "code_information": [{"code": "15005", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WNDEX FLW, BIOSKN FLW, 0.5CC", "code_information": [{"code": "Q4162", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING", "code_information": [{"code": "97545", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WORK HARDENING ADD-ON", "code_information": [{"code": "97546", "type": "CPT"}], "standard_charges": [{"minimum": 45.39, "maximum": 45.39, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 45.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WORKING ELEMENT WITH", "code_information": [{"code": "3100102109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5319.0, "discounted_cash": 7978.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WOUND CLOSURE BY ADHESIVE", "code_information": [{"code": "G0168", "type": "HCPCS"}], "standard_charges": [{"minimum": 402.28, "maximum": 402.28, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 402.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [{"code": "464", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15262.02, "maximum": 15262.02, "discounted_cash": 33509.33, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 15262.02, "methodology": "fee schedule"}], "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": 20600.63, "maximum": 20600.63, "discounted_cash": 63232.74, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 20600.63, "methodology": "fee schedule"}], "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": 8230.78, "maximum": 8230.78, "discounted_cash": 20886.66, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 8230.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [{"code": "902", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10324.91, "maximum": 10324.91, "discounted_cash": 21041.85, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10324.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [{"code": "901", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26212.22, "maximum": 26212.22, "discounted_cash": 48318.0, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 26212.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC", "code_information": [{"code": "903", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6576.26, "maximum": 6576.26, "discounted_cash": 13860.81, "setting": "inpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6576.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "WOUND EXPLOR EXTREM", "code_information": [{"code": "20103", "type": "CPT"}, {"code": "3340102330", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 372.23, "maximum": 2867.32, "gross_charge": 2956.0, "discounted_cash": 2481.65, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2512.6, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1710.68, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2217.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2069.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2867.32, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2069.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1704.06, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2217.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1968.77, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2512.6, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2364.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1654.43, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1687.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP ADDL 100 CM", "code_information": [{"code": "15003", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 736.48, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND PREP TRK/ARM/LEG", "code_information": [{"code": "15002", "type": "CPT"}], "standard_charges": [{"minimum": 372.23, "maximum": 2771.02, "discounted_cash": 2791.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 372.23, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2771.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUND(S) CARE NON-SELECTIVE", "code_information": [{"code": "97602", "type": "CPT"}], "standard_charges": [{"minimum": 736.48, "maximum": 736.48, "discounted_cash": 306.44, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 736.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUNDEX, BIOSKIN, PER SQ CM", "code_information": [{"code": "Q4163", "type": "HCPCS"}], "standard_charges": [{"minimum": 171.45, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 171.45, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUNDFIX BIOWOUND PLUS XPLUS", "code_information": [{"code": "Q4217", "type": "HCPCS"}], "standard_charges": [{"minimum": 525.18, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 525.18, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WOUNDPLUS E-GRAT, PER SQ CM", "code_information": [{"code": "Q4277", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "WRAP SHOULDER", "code_information": [{"code": "3100102266", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 189.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WRAP UNIVERSAL GEL*1", "code_information": [{"code": "3100207116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.84, "discounted_cash": 121.26, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH", "code_information": [{"code": "3100102110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 822.0, "discounted_cash": 1233.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WRENCH SCREW KIT", "code_information": [{"code": "3100103938", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 240.0, "discounted_cash": 360.0, "setting": "both", "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY", "code_information": [{"code": "29840", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29843", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 3461.21, "discounted_cash": 4954.5, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ARTHROSCOPY/SURGERY", "code_information": [{"code": "29847", "type": "CPT"}], "standard_charges": [{"minimum": 426.56, "maximum": 7500.92, "discounted_cash": 10950.44, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 426.56, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 7500.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST ENDOSCOPY", "code_information": [{"code": "29848", "type": "CPT"}, {"code": "3480101803", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1640.05, "maximum": 7169.27, "gross_charge": 7391.0, "discounted_cash": 2460.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1695.81, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 7169.27, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 5173.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1689.25, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 5543.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 1951.66, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6282.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5912.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 1640.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1672.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3461.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRIST INST DISP*8W00", "code_information": [{"code": "3100207682", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1857.0, "discounted_cash": 2785.5, "setting": "both", "billing_class": "facility"}]}, {"description": "WRIST REPLACEMENT", "code_information": [{"code": "25446", "type": "CPT"}], "standard_charges": [{"minimum": 522.5, "maximum": 14671.65, "discounted_cash": 28525.47, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 522.5, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 14671.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"minimum": 136.62, "maximum": 136.62, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 136.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Whole Genome Sequencing In Blood Or Bone Marrow For Acute Myelogenous Leukemia", "code_information": [{"code": "56U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81470", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 914.0, "discounted_cash": 1468.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 914.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81471", "type": "CPT"}], "standard_charges": [{"minimum": 348.44, "maximum": 914.0, "discounted_cash": 1468.34, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 914.0, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 348.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-PLATE SM 2.4*AR-89", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100207478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1459.5, "maximum": 2022.45, "gross_charge": 2085.0, "discounted_cash": 3127.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2022.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1459.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1563.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1772.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1668.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY ABDOMEN COMPLE", "code_information": [{"code": "74019", "type": "CPT"}, {"code": "3270100087", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 271.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY AORTA LEG ARTERIES", "code_information": [{"code": "75630", "type": "CPT"}], "standard_charges": [{"minimum": 2113.75, "maximum": 2113.75, "discounted_cash": 4878.96, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 2113.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY ASSAY CALCULUS", "code_information": [{"code": "82370", "type": "CPT"}], "standard_charges": [{"minimum": 12.52, "maximum": 40.05, "discounted_cash": 20.12, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.52, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE DUCT DILATION", "code_information": [{"code": "74363", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY BILE/PANC ENDOSCOPY", "code_information": [{"code": "74330", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ABDOMEN 3+ VIEWS", "code_information": [{"code": "74021", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM CHEST 3 VIEWS", "code_information": [{"code": "71047", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM CHEST 4+ VIEWS", "code_information": [{"code": "71048", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 2/3 VW", "code_information": [{"code": "72082", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 4/5 VW", "code_information": [{"code": "72083", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 6/> VW", "code_information": [{"code": "72084", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF BODY SECTION", "code_information": [{"code": "76100", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF EYE SOCKETS", "code_information": [{"code": "70190", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70328", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70332", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KIDNEY LESION", "code_information": [{"code": "74470", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF MIDDLE EAR", "code_information": [{"code": "70134", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PENIS", "code_information": [{"code": "74445", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERINEUM", "code_information": [{"code": "74775", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERITONEUM", "code_information": [{"code": "74190", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 844.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY DUCT", "code_information": [{"code": "70390", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY GLAND", "code_information": [{"code": "70380", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEAR DUCT", "code_information": [{"code": "70170", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70300", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEETH", "code_information": [{"code": "70310", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM PITUITARY SADDLE", "code_information": [{"code": "70240", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM THORACOLMB 2/> VW", "code_information": [{"code": "72080", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY FALLOPIAN TUBE", "code_information": [{"code": "74742", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY FEMALE GENITAL TRACT", "code_information": [{"code": "74740", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [{"code": "74329", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE FOR GI TUBE", "code_information": [{"code": "74340", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE GI DILATION", "code_information": [{"code": "74360", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE INTESTINAL TUBE", "code_information": [{"code": "74355", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY HEAD FOR ORTHODONTIA", "code_information": [{"code": "70350", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY MALE GENITAL TRACT", "code_information": [{"code": "74440", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY NOSE TO RECTUM", "code_information": [{"code": "76010", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 139.1, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCT", "code_information": [{"code": "77053", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCTS", "code_information": [{"code": "77054", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY URETHRA/BLADDER", "code_information": [{"code": "74450", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 375.08, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM COLON 1CNTRST STD", "code_information": [{"code": "74270", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM COLON 2CNTRST STD", "code_information": [{"code": "74280", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 1CNTRST", "code_information": [{"code": "74220", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM ESOPHAGUS 2CNTRST", "code_information": [{"code": "74221", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM PHRNX&/CRV ESOPH C+", "code_information": [{"code": "74210", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SM INT 1CNTRST STD", "code_information": [{"code": "74250", "type": "CPT"}], "standard_charges": [{"minimum": 187.49, "maximum": 223.11, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Cigna", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 97.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 80.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SM INT 2CNTRST STD", "code_information": [{"code": "74251", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM SWLNG FUNCJ C+", "code_information": [{"code": "74230", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAY XM UPR GI TRC 1CNTRST", "code_information": [{"code": "74240", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 281.24, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE LENGTH STUDIES", "code_information": [{"code": "77073", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY COMPLETE", "code_information": [{"code": "77075", "type": "CPT"}], "standard_charges": [{"minimum": 198.47, "maximum": 198.47, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY INFANT", "code_information": [{"code": "77076", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAYS BONE SURVEY LIMITED", "code_information": [{"code": "77074", "type": "CPT"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "discounted_cash": 168.29, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "X-RAYS TRANSCATH THERAPY", "code_information": [{"code": "75894", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL CPLX W/ECP", "code_information": [{"code": "66987", "type": "CPT"}], "standard_charges": [{"minimum": 3004.2, "maximum": 3004.2, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL INSJ 1+", "code_information": [{"code": "66991", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCAPSL CTRC RMVL W/ECP", "code_information": [{"code": "66988", "type": "CPT"}], "standard_charges": [{"minimum": 3004.2, "maximum": 3004.2, "discounted_cash": 6223.43, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 3004.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCELL AMNIO MATRIX PER SQ CM", "code_information": [{"code": "Q4280", "type": "HCPCS"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "XCELLERATE, PER SQ CM", "code_information": [{"code": "Q4234", "type": "HCPCS"}], "standard_charges": [{"minimum": 628.89, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 628.89, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCM BIOLOGIC TISS MATRIX 1CM", "code_information": [{"code": "Q4142", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XCPSL CTRC RMVL CPLX INSJ 1+", "code_information": [{"code": "66989", "type": "CPT"}], "standard_charges": [{"minimum": 5841.07, "maximum": 5841.07, "discounted_cash": 8000.06, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 5841.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XE133 XENON 10MCI", "code_information": [{"code": "A9558", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.56, "maximum": 41.56, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 41.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XK GNOTYP XK EXONS 1-3", "code_information": [{"code": "200U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 441.51, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XM ARCHIVE TISSUE MOLEC ANAL", "code_information": [{"code": "88363", "type": "CPT"}], "standard_charges": [{"minimum": 43.61, "maximum": 70.51, "discounted_cash": 45.57, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 70.51, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 43.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XOME TUM & NML SPEC SEQ ALYS", "code_information": [{"code": "36U", "type": "CPT"}], "standard_charges": [{"minimum": 493.51, "maximum": 493.51, "discounted_cash": 7679.07, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 493.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XPRESS MULTI-SINUS D", "code_information": [{"code": "C1726", "type": "HCPCS"}, {"code": "3100102111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2797.2, "maximum": 3876.12, "gross_charge": 3996.0, "discounted_cash": 5994.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3396.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2997.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2797.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3876.12, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2797.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2997.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3396.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3196.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XPS MOXY FIBER*10486", "code_information": [{"code": "3100209697", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2914.6, "discounted_cash": 4371.9, "setting": "both", "billing_class": "facility"}]}, {"description": "XR ABD ACUTE W UPRT", "code_information": [{"code": "74022", "type": "CPT"}, {"code": "3270100088", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ABDOMEN 1 VW AP", "code_information": [{"code": "74018", "type": "CPT"}, {"code": "3270100086", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ACROMIOCLAVICULAR", "code_information": [{"code": "73050", "type": "CPT"}, {"code": "3270100057", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ANKLE 2 VWS", "code_information": [{"code": "73600", "type": "CPT"}, {"code": "3270100080", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ANKLE COMPL 3 VWS", "code_information": [{"code": "73610", "type": "CPT"}, {"code": "3270100081", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR BONE AGE STUDIES", "code_information": [{"code": "77072", "type": "CPT"}, {"code": "3270100102", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CALCANEUS MIN 2VW", "code_information": [{"code": "73650", "type": "CPT"}, {"code": "3270100084", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CHEST 1 VW, FRONT", "code_information": [{"code": "71045", "type": "CPT"}, {"code": "3270100023", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CHEST 2 VWS, PA,", "code_information": [{"code": "71046", "type": "CPT"}, {"code": "3270100024", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 485.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CHEST 2VW W/APICA", "code_information": [{"code": "71021", "type": "CPT"}, {"code": "3270100025", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 340.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CHEST SPCL VW / D", "code_information": [{"code": "71035", "type": "CPT"}, {"code": "3270100026", "type": "CDM"}, {"code": "324", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 340.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CHOLANGIOGRAM INT", "code_information": [{"code": "74300", "type": "CPT"}, {"code": "3270100089", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 810.92, "gross_charge": 836.0, "discounted_cash": 1254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 710.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 585.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 810.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 585.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 710.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 668.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CHOLANGRM INTRAOP", "code_information": [{"code": "74301", "type": "CPT"}, {"code": "3270100090", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 405.46, "gross_charge": 418.0, "discounted_cash": 627.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 355.3, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 313.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 405.46, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 292.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 313.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 355.3, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 334.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CLAVICLE", "code_information": [{"code": "73000", "type": "CPT"}, {"code": "3270100053", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR CYSTOGRAPHY MIN 3", "code_information": [{"code": "74430", "type": "CPT"}, {"code": "3270100092", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 999.1, "gross_charge": 1030.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 824.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR DILATN NEPHRO/URE", "code_information": [{"code": "74485", "type": "CPT"}, {"code": "3270100094", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 5405.81, "gross_charge": 5573.0, "discounted_cash": 3117.68, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4737.05, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2149.12, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4179.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3901.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5405.81, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3901.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2140.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4179.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 2473.36, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4737.05, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4458.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 2078.45, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2120.02, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ELBOW 2VWS", "code_information": [{"code": "73070", "type": "CPT"}, {"code": "3270100059", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ELBOW MIN 3 VWS", "code_information": [{"code": "73080", "type": "CPT"}, {"code": "3270100060", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR EYE, FOREIGN BODY", "code_information": [{"code": "70030", "type": "CPT"}, {"code": "3270100008", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FACIAL BONES MIN", "code_information": [{"code": "70150", "type": "CPT"}, {"code": "3270100015", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FACIAL BONES<3 VW", "code_information": [{"code": "70140", "type": "CPT"}, {"code": "3270100014", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FEMUR MIN 2 VWS", "code_information": [{"code": "73551", "type": "CPT"}, {"code": "3270102293", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 210.49, "gross_charge": 217.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 184.45, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 162.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 151.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 210.49, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 151.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 162.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 184.45, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 173.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FEMUR MIN 2 VWS", "code_information": [{"code": "73552", "type": "CPT"}, {"code": "3270100073", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FINGER(S) MIN 2 V", "code_information": [{"code": "73140", "type": "CPT"}, {"code": "3270100067", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FISTULAGRM/SINUS", "code_information": [{"code": "76080", "type": "CPT"}, {"code": "3270100097", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 1223.17, "gross_charge": 1261.0, "discounted_cash": 844.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1071.85, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 582.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 882.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1223.17, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 882.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 579.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 945.75, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 669.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1071.85, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1008.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FLUOR GUIDE VENOU", "code_information": [{"code": "77001", "type": "CPT"}, {"code": "3270100099", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 205.8, "maximum": 285.18, "gross_charge": 294.0, "discounted_cash": 441.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 285.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 205.8, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 220.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 249.9, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 235.2, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FLUORO GUIDE NDL", "code_information": [{"code": "77002", "type": "CPT"}, {"code": "3270100100", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 810.92, "gross_charge": 836.0, "discounted_cash": 1254.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 710.6, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 585.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 810.92, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 585.2, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 627.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 710.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 668.8, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FLUORO GUIDE PLMN", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "3270102310", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 217.16, "maximum": 822.56, "gross_charge": 848.0, "discounted_cash": 1272.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 720.8, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 822.56, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 593.6, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 636.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 720.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 678.4, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FOOT 2 VWS", "code_information": [{"code": "73620", "type": "CPT"}, {"code": "3270100082", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FOOT COMPL MIN 3", "code_information": [{"code": "73630", "type": "CPT"}, {"code": "3270100083", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR FOREARM MIN 2 VWS", "code_information": [{"code": "73090", "type": "CPT"}, {"code": "3270100061", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HAND 2VWS", "code_information": [{"code": "73120", "type": "CPT"}, {"code": "3270100065", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HAND MIN 3 VWS", "code_information": [{"code": "73130", "type": "CPT"}, {"code": "3270100066", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIP IN OR", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "3270100071", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 562.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIP UNILAT 1VW", "code_information": [{"code": "73501", "type": "CPT"}, {"code": "3270100068", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIP UNILAT MIN 2", "code_information": [{"code": "73502", "type": "CPT"}, {"code": "3270100069", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 485.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIP UNILAT MIN 2", "code_information": [{"code": "73503", "type": "CPT"}, {"code": "3270102294", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 452.02, "gross_charge": 466.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 396.1, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 349.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 326.2, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 452.02, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 326.2, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 349.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 396.1, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 372.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIPS BIL 2VWS EA", "code_information": [{"code": "73521", "type": "CPT"}, {"code": "3270100043", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIPS BIL 2VWS EA", "code_information": [{"code": "73522", "type": "CPT"}, {"code": "3270102295", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 324.95, "gross_charge": 335.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 251.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 324.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 251.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HIPS BIL 2VWS EA", "code_information": [{"code": "73523", "type": "CPT"}, {"code": "3270102296", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 324.95, "gross_charge": 335.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 251.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 324.95, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 234.5, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 251.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 284.75, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 268.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR HUMERUS MIN 2 VW", "code_information": [{"code": "73060", "type": "CPT"}, {"code": "3270100058", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR IVP", "code_information": [{"code": "74400", "type": "CPT"}, {"code": "3270102287", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 187.49, "maximum": 999.1, "gross_charge": 1030.0, "discounted_cash": 281.24, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.86, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 193.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 223.11, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 824.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 187.49, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 191.24, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR KNEE 1 OR 2 VWS", "code_information": [{"code": "73560", "type": "CPT"}, {"code": "3270100074", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR KNEE 3 VWS", "code_information": [{"code": "73562", "type": "CPT"}, {"code": "3270100075", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR KNEE COMPL 4 VWS", "code_information": [{"code": "73564", "type": "CPT"}, {"code": "3270100076", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR KNEES BOTH STANDI", "code_information": [{"code": "73565", "type": "CPT"}, {"code": "3270100077", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR LOWER EXT INFANT", "code_information": [{"code": "73592", "type": "CPT"}, {"code": "3270100079", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MANDIBLE <4 VWS", "code_information": [{"code": "70100", "type": "CPT"}, {"code": "3270100010", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MANDIBLE MIN 4 VW", "code_information": [{"code": "70110", "type": "CPT"}, {"code": "3270100011", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MASTOIDS <3 VWS", "code_information": [{"code": "70120", "type": "CPT"}, {"code": "3270100012", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MASTOIDS MIN 3 VW", "code_information": [{"code": "70130", "type": "CPT"}, {"code": "3270100013", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MYELOGRAM 2< MORE", "code_information": [{"code": "72270", "type": "CPT"}, {"code": "3270100052", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 817.04, "maximum": 2426.94, "gross_charge": 2502.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2426.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2001.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MYELOGRAM CERV", "code_information": [{"code": "72240", "type": "CPT"}, {"code": "3270100049", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 817.04, "maximum": 2426.94, "gross_charge": 2502.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2426.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2001.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MYELOGRAM LUMBAR", "code_information": [{"code": "72265", "type": "CPT"}, {"code": "3270100051", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 817.04, "maximum": 2426.94, "gross_charge": 2502.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2426.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2001.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR MYELOGRAM THORACI", "code_information": [{"code": "72255", "type": "CPT"}, {"code": "3270100050", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 817.04, "maximum": 2426.94, "gross_charge": 2502.0, "discounted_cash": 1225.56, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 844.82, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2426.94, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1751.4, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 841.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1876.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 972.28, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2126.7, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2001.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 817.04, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 833.38, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 871.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR NASAL BONES COMP", "code_information": [{"code": "70160", "type": "CPT"}, {"code": "3270100016", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR NECK SOFT TISSUE", "code_information": [{"code": "70360", "type": "CPT"}, {"code": "3270100022", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR ORBITS COMPL 4 VW", "code_information": [{"code": "70200", "type": "CPT"}, {"code": "3270100017", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR PELVIS 1 OR 2 VWS", "code_information": [{"code": "72170", "type": "CPT"}, {"code": "3270100044", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR PELVIS MIN 3 VWS", "code_information": [{"code": "72190", "type": "CPT"}, {"code": "3270100045", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR PELVIS/HIPS INFAN", "code_information": [{"code": "73540", "type": "CPT"}, {"code": "3270100072", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 158.9, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 340.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR RAD SURGICAL SPEC", "code_information": [{"code": "76098", "type": "CPT"}, {"code": "3270100098", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 1028.2, "gross_charge": 1060.0, "discounted_cash": 844.43, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 901.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 582.09, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 742.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 1028.2, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 742.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 579.84, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 795.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 669.91, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 901.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 848.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 562.95, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 574.21, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR RIBS BIL W PA CHS", "code_information": [{"code": "71111", "type": "CPT"}, {"code": "3480102243", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR RIBS BILATERAL 3", "code_information": [{"code": "71110", "type": "CPT"}, {"code": "3270100029", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 407.4, "gross_charge": 420.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 407.4, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 294.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 315.0, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 357.0, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 336.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR RIBS UNI W PA CHE", "code_information": [{"code": "71101", "type": "CPT"}, {"code": "3270100028", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR RIBS UNILAT 2 VWS", "code_information": [{"code": "71100", "type": "CPT"}, {"code": "3270100027", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SACROILIAC JNTS 3", "code_information": [{"code": "72202", "type": "CPT"}, {"code": "3270100047", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SACROILIAC JNTS <", "code_information": [{"code": "72200", "type": "CPT"}, {"code": "3270100046", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SACRUM/COCCXY 2VW", "code_information": [{"code": "72220", "type": "CPT"}, {"code": "3270100048", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SCAPULA", "code_information": [{"code": "73010", "type": "CPT"}, {"code": "3270100054", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SHOULDER 1 VW", "code_information": [{"code": "73020", "type": "CPT"}, {"code": "3270100055", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SHOULDER MIN 2 VW", "code_information": [{"code": "73030", "type": "CPT"}, {"code": "3270100056", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SINUSES <3 VWS", "code_information": [{"code": "70210", "type": "CPT"}, {"code": "3270100018", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SINUSES,COMP,MIN", "code_information": [{"code": "70220", "type": "CPT"}, {"code": "3270100019", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SKULL <4 VWS", "code_information": [{"code": "70250", "type": "CPT"}, {"code": "3270100020", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SKULL MIN 4 VWS", "code_information": [{"code": "70260", "type": "CPT"}, {"code": "3270100021", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE 1 VIEW SPE", "code_information": [{"code": "72020", "type": "CPT"}, {"code": "3270100034", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE CERV 6 OR", "code_information": [{"code": "72052", "type": "CPT"}, {"code": "3270100037", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE CERVICL 4 O", "code_information": [{"code": "72050", "type": "CPT"}, {"code": "3270100036", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE CERVICLE 2", "code_information": [{"code": "72040", "type": "CPT"}, {"code": "3270100035", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE ENTIRE AP &", "code_information": [{"code": "72010", "type": "CPT"}, {"code": "3270100033", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 245.0, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 525.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "XR SPINE LUMB ONLY B", "code_information": [{"code": "72120", "type": "CPT"}, {"code": "3270100030", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE LUMBAR 2 OR", "code_information": [{"code": "72100", "type": "CPT"}, {"code": "3270100040", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE LUMBAR 4VWS", "code_information": [{"code": "72110", "type": "CPT"}, {"code": "3270100041", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE LUMBAR W BE", "code_information": [{"code": "72114", "type": "CPT"}, {"code": "3270100042", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE SCOLIOSIS S", "code_information": [{"code": "72081", "type": "CPT"}, {"code": "3270102285", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 61.41, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE THORACIC 2", "code_information": [{"code": "72070", "type": "CPT"}, {"code": "3270100038", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE THORACIC 3", "code_information": [{"code": "72072", "type": "CPT"}, {"code": "3270100039", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR SPINE THORACIC 4", "code_information": [{"code": "72074", "type": "CPT"}, {"code": "3270102286", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR STERNOCLVCLR JNT", "code_information": [{"code": "71130", "type": "CPT"}, {"code": "3270100032", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR STERNUM MIN 2 VWS", "code_information": [{"code": "71120", "type": "CPT"}, {"code": "3270100031", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR TIBIA/FIBULA 2 VW", "code_information": [{"code": "73590", "type": "CPT"}, {"code": "3270100078", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR TMJ BILAT", "code_information": [{"code": "70330", "type": "CPT"}, {"code": "3270102284", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 339.5, "gross_charge": 350.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 339.5, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 245.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 262.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 297.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 280.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR TOE(S) MIN 2 VWS", "code_information": [{"code": "73660", "type": "CPT"}, {"code": "3270100085", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR UPPER EXT INFANT", "code_information": [{"code": "73092", "type": "CPT"}, {"code": "3270100062", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 168.29, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 116.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 115.56, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 133.51, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 112.19, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 114.43, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR UROGRAPH RETROGRA", "code_information": [{"code": "74420", "type": "CPT"}, {"code": "3270100091", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 999.1, "gross_charge": 1030.0, "discounted_cash": 588.66, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 405.78, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 404.21, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 467.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 824.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 392.44, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 400.29, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR VOIDING CYSTOURET", "code_information": [{"code": "74455", "type": "CPT"}, {"code": "3270100093", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 198.47, "maximum": 999.1, "gross_charge": 1030.0, "discounted_cash": 375.08, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 258.55, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 999.1, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 721.0, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 257.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 772.5, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 297.56, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 875.5, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 824.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 250.05, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 255.05, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 198.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR WRIST 2 VWS", "code_information": [{"code": "73100", "type": "CPT"}, {"code": "3270100063", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 262.87, "gross_charge": 271.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 262.87, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 189.7, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 203.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 230.35, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 216.8, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XR WRIST MIN 3 VWS", "code_information": [{"code": "73110", "type": "CPT"}, {"code": "3270100064", "type": "CDM"}, {"code": "320", "type": "RC"}], "standard_charges": [{"minimum": 61.41, "maximum": 220.19, "gross_charge": 227.0, "discounted_cash": 139.1, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.88, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 220.19, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 158.9, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 95.51, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 170.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 110.35, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 192.95, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 181.6, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 92.73, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 94.58, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 61.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XRAY CONTROL CATHETER CHANGE", "code_information": [{"code": "75984", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75956", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XRAY ENDOVASC THOR AO REPR", "code_information": [{"code": "75957", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE DIST EXT THOR AO", "code_information": [{"code": "75959", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XRAY PLACE PROX EXT THOR AO", "code_information": [{"code": "75958", "type": "CPT"}], "standard_charges": [{"minimum": 217.16, "maximum": 217.16, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 217.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XRAY SPEC BOWL", "code_information": [{"code": "3100102112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 100.5, "setting": "both", "billing_class": "facility"}]}, {"description": "XWRAP 1 SQ CM", "code_information": [{"code": "Q4204", "type": "HCPCS"}], "standard_charges": [{"minimum": 1725.27, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XYLOSE TOLERANCE TEST", "code_information": [{"code": "84620", "type": "CPT"}], "standard_charges": [{"minimum": 12.91, "maximum": 40.05, "discounted_cash": 20.75, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 12.91, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 40.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "XYNTHA INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.37, "maximum": 1.37, "discounted_cash": 2.09, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Y-PLATE 1.4 6H*AR-1", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Y-PLATE 1.6 6H*AR-18", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100208427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1636.11, "maximum": 2267.18, "gross_charge": 2337.3, "discounted_cash": 3505.95, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2267.18, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1636.11, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1752.97, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1986.7, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 1869.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Y90 IBRITUMOMAB, RX", "code_information": [{"code": "A9543", "type": "HCPCS"}], "standard_charges": [{"discounted_cash": 105188.13, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "YASARGIL MICRO SCISS", "code_information": [{"code": "3100102113", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 977.0, "discounted_cash": 1465.5, "setting": "both", "billing_class": "facility"}]}, {"description": "YELLOW FEVER VACCINE SUBQ", "code_information": [{"code": "90717", "type": "CPT"}], "standard_charges": [{"minimum": 119.53, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 119.53, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "YERSINIA ANTIBODY", "code_information": [{"code": "86793", "type": "CPT"}], "standard_charges": [{"minimum": 13.19, "maximum": 30.26, "discounted_cash": 21.2, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 13.19, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "YT GNOTYP ACHE EXON 2", "code_information": [{"code": "201U", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 95.68, "discounted_cash": 297.53, "setting": "outpatient", "payers_information": [{"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ZAIRE EBOLAVIRUS VAC LIVE IM", "code_information": [{"code": "90758", "type": "CPT"}], "standard_charges": [{"minimum": 233.63, "maximum": 233.63, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 233.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ZENITH AMNIOTIC MEMBRANE PSC", "code_information": [{"code": "Q4253", "type": "HCPCS"}], "standard_charges": [{"minimum": 244.1, "maximum": 1725.27, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 244.1, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 1725.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ZERO PROFILE 7MM*RH2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100209746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZERO PROFILE 8MM*RH2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100206496", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZERO PROFILE 9MM*RH2", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100205478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3913.0, "maximum": 5422.3, "gross_charge": 5590.0, "discounted_cash": 8385.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5422.3, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3913.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4192.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4751.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4472.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZERO SCREW 16MM*04.6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100203435", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 577.5, "maximum": 800.25, "gross_charge": 825.0, "discounted_cash": 1237.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 800.25, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 577.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 618.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 701.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 660.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZEUS LLIF", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3100104153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 9100.0, "maximum": 12610.0, "gross_charge": 13000.0, "discounted_cash": 19500.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 12610.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 9100.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 9750.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 11050.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 10400.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZEUS-C 17X14X10*1001", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202274", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZEUS-C 17X14X7*10011", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100202275", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1764.0, "maximum": 2444.4, "gross_charge": 2520.0, "discounted_cash": 3780.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 2444.4, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 1764.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2142.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 2016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZEVO LEVEL 1*M100000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203237", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2639.0, "maximum": 3656.9, "gross_charge": 3770.0, "discounted_cash": 5655.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 3656.9, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 2639.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 2827.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3204.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3016.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZEVO LEVEL 2*M100000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203214", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3371.55, "maximum": 4672.0, "gross_charge": 4816.5, "discounted_cash": 7224.75, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4094.02, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 3612.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3371.55, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 4672.0, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 3371.55, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 3612.37, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4094.02, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3853.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZEVO LEVEL 3*M100000", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3100203519", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 4049.5, "maximum": 5611.45, "gross_charge": 5785.0, "discounted_cash": 8677.5, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 4917.25, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 4338.75, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 4049.5, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 5611.45, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 4049.5, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 4338.75, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4917.25, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4628.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZICONOTIDE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2278", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.04, "maximum": 9.04, "discounted_cash": 14.52, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZIDOVUDINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3485", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.51, "maximum": 1.51, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZIKA VIRUS DNA/RNA AMP PROBE", "code_information": [{"code": "87662", "type": "CPT"}], "standard_charges": [{"minimum": 41.83, "maximum": 51.31, "discounted_cash": 82.43, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 51.31, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 41.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ZIKA VIRUS IGM ANTIBODY", "code_information": [{"code": "86794", "type": "CPT"}], "standard_charges": [{"minimum": 16.85, "maximum": 30.26, "discounted_cash": 27.08, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 16.85, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 30.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ZINC", "code_information": [{"code": "84630", "type": "CPT"}, {"code": "3440101018", "type": "CDM"}, {"code": "301", "type": "RC"}], "standard_charges": [{"minimum": 11.39, "maximum": 99.91, "gross_charge": 103.0, "discounted_cash": 18.3, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Amerigroup", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.61, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 99.91, "methodology": "fee schedule"}, {"payer_name": "IA Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "fee schedule"}, {"payer_name": "Molina", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.57, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 77.25, "methodology": "fee schedule"}, {"payer_name": "NE Total Care", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "Oscar", "plan_name": "HIX", "standard_charge_dollar": 14.52, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 87.55, "methodology": "fee schedule"}, {"payer_name": "Siouxland PACE", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 82.4, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 11.39, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "VA CCN", "standard_charge_dollar": 12.2, "methodology": "fee schedule"}, {"payer_name": "Wellpoint", "plan_name": "Medicare Advantage", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 20.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ZIPRASIDONE MESYLATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3486", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.22, "maximum": 10.22, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 10.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZOLEDRONIC ACID 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3489", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.94, "maximum": 6.94, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 6.94, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ZONE NAV ANTER/CANNU", "code_information": [{"code": "3100204775", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ZONE NAV MIDPOST*AR-", "code_information": [{"code": "3100204776", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ZONE NAV MIDPOST*AR-", "code_information": [{"code": "3100204777", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 675.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ZONE NAV SYS HANDLE*", "code_information": [{"code": "3100204774", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 787.5, "discounted_cash": 1181.25, "setting": "both", "billing_class": "facility"}]}, {"description": "ZRSR2 GENE COMMON VARIANTS", "code_information": [{"code": "81360", "type": "CPT"}], "standard_charges": [{"minimum": 95.68, "maximum": 193.25, "discounted_cash": 310.46, "setting": "outpatient", "payers_information": [{"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 193.25, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 95.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "pneumococcal 23 vacc", "code_information": [{"code": "90732", "type": "CPT"}, {"code": "3400300326", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"minimum": 55.18, "maximum": 145.5, "gross_charge": 150.0, "discounted_cash": 225.0, "setting": "both", "payers_information": [{"payer_name": "Accountable HealthPlan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "Avera Health Plans", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Health Partners", "plan_name": "Commercial", "standard_charge_dollar": 145.5, "methodology": "fee schedule"}, {"payer_name": "Midlands Choice", "plan_name": "Commercial", "standard_charge_dollar": 105.0, "methodology": "fee schedule"}, {"payer_name": "Multiplan", "plan_name": "Commercial", "standard_charge_dollar": 112.5, "methodology": "fee schedule"}, {"payer_name": "Sanford Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 127.5, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 120.0, "methodology": "fee schedule"}, {"payer_name": "United Healthcare", "plan_name": "Medicaid", "standard_charge_dollar": 133.47, "methodology": "fee schedule"}, {"payer_name": "blue cross blue shield", "plan_name": "Commercial", "standard_charge_dollar": 55.18, "methodology": "case rate"}], "billing_class": "facility"}]}]}